Grin Leonti, Indurski Atara, Leytes Sophia, Rabinovich Mark, Friedler Shevach
a Faculty of Health Sciences, Department of OBGYN and Infertility , Barzilai University Medical Center, Ben-Gurion University of the Negev , Ashkelon , Israel.
b Sackler Faculty of Medicine, Department of Obstetrics and Gynecology , the Edith Wolfson Medical Center, Tel Aviv University , Holon , Israel.
Gynecol Endocrinol. 2019 Mar;35(3):261-266. doi: 10.1080/09513590.2018.1519789. Epub 2018 Oct 9.
Mid-trimester beta-human chorionic gonadotropin (BHCG) levels are considerably higher in pregnancies resulting from frozen embryo transfer (FET) compared with fresh (FRET), leading to a higher false positive rate in aneuploidy screening tests. We aimed to investigate the dynamics of BHCG increment and its predictive value for cycle outcome. A retrospective analysis of FRET and FET cycles. BHCG values on days 14 and 16 post embryo transfer were compared and stratified according to the number of sacs demonstrated on US scan at six weeks gestation, and pregnancy outcome (biochemical pregnancy, ectopic pregnancy, spontaneous abortion, and a singleton or twin birth). A prediction model for live birth was built. A total of 430 treatment cycles were analyzed. The average BHCG levels were significantly higher in FET compared with FRET group in nonviable pregnancies on day 14, 450 vs. 183 IU/L, p < .05 and day 16, 348 vs. 735 IU/L, p < .05, respectively. The increment of BHCG was significantly steeper in the FET compared with FRET group in biochemical pregnancies (F = 6.485, p = .012*). Optimal cutoff level for live birth prediction in the FRET group was 211 IU/L (sensitivity 84%, specificity 76.2%) for day 14 and 440 IU/L (sensitivity 86.0% and specificity 72.5%) for day 16. The increment in BHCG differed significantly between the FRET and FET cycles in nonviable pregnancies. Nevertheless, the difference in BHCG levels observed in the second trimester in pregnancies conceived after FRET and FET cycle may begin as early as the fourth week of pregnancy.
与新鲜胚胎移植（FRET）相比，冷冻胚胎移植（FET）后的妊娠中期β-人绒毛膜促性腺激素（BHCG）水平显著更高，导致非整倍体筛查试验中的假阳性率更高。我们旨在研究BHCG增加的动态变化及其对周期结局的预测价值。对FRET和FET周期进行回顾性分析。比较胚胎移植后第14天和第16天的BHCG值，并根据妊娠6周时超声扫描显示的孕囊数量以及妊娠结局（生化妊娠、异位妊娠、自然流产和单胎或双胎分娩）进行分层。建立了活产预测模型。共分析了430个治疗周期。在第14天，FET组在非存活妊娠中的平均BHCG水平显著高于FRET组，分别为450 vs. 183 IU/L，p <.05；在第16天，分别为348 vs. 735 IU/L，p <.05。在生化妊娠中，FET组的BHCG增加明显比FRET组更陡峭（F = 6.485，p =.012*）。FRET组第14天活产预测的最佳截断水平为211 IU/L（敏感性84%，特异性76.2%），第16天为440 IU/L（敏感性86.0%，特异性72.5%）。在非存活妊娠中，FRET和FET周期之间的BHCG增加差异显著。然而，FRET和FET周期受孕后的妊娠中期观察到的BHCG水平差异可能早在妊娠第4周就开始了。
