早期β-hCG 水平可预测单胚胎移植后的活产。
Early β-hCG levels predict live birth after single embryo transfer.
机构信息
Division of Reproductive Endocrinology and Infertility, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair Street, Suite 2310, Chicago, IL, 60611, USA.
Biostatistics Collaboration Center, Northwestern University, Chicago, IL, USA.
出版信息
J Assist Reprod Genet. 2022 Oct;39(10):2355-2364. doi: 10.1007/s10815-022-02606-w. Epub 2022 Sep 8.
PURPOSE
Specific serum beta human chorionic gonadotropin (β-hCG) parameters that can predict live birth after an embryo transfer have yet to be defined.
METHODS
We performed a retrospective cohort study of 1,028 patients with a detectable β-hCG who underwent a single embryo transfer between 2002 and 2019 at a large academic center. Two β-hCG parameters were examined in relation to live birth: 1) "doubling" defined as β-hCG doubling over 48 h and 2) "reaching 100" defined as a β-hCG ≥ 100 mIU/mL by 15 days after oocyte retrieval (AOR).
RESULTS
One thousand three hundred forty cycles involving a single embryo were analyzed. Two thirds were frozen embryos and 86% were blastocyst transfers. Preimplantation genetic testing was performed in almost 30% of cycles. When β-hCG levels "doubled," a live birth occurred in 80.7% of cycles and when β-hCG levels "reached 100" by 15 days AOR, live birth occurred in 81.6% of cycles. When β-hCG levels both doubled and reached 100 by 15 days, AOR 85.4% cycles resulted in live birth. A multiple logistic regression model to control for patient and cycle level factors revealed a live birth odds ratio (OR) of 8.0 (95% CI 5.7-11.1) when β-hCG "doubled" and an OR of 21.2 (95% CI 14.3-31.5) when β-hCG "reached 100." When both these latter parameters were met, the OR was 12.5 (95% CI 8.9-17.8).
CONCLUSION
β-hCG parameters of "doubling" and "reaching 100" by 15 days AOR are robust predictors of live birth and can aid in patient counseling regarding pregnancy outcomes soon after single embryo transfer.
目的
特定的血清β人绒毛膜促性腺激素（β-hCG）参数可以预测胚胎移植后的活产，但尚未确定。
方法
我们对 2002 年至 2019 年期间在一家大型学术中心接受单次胚胎移植的 1028 例可检测β-hCG 的患者进行了回顾性队列研究。检查了与活产相关的两个β-hCG 参数：1）“翻倍”定义为 48 小时内β-hCG 翻倍，2）“达到 100”定义为取卵后 15 天β-hCG≥100 mIU/mL（AOR）。
结果
分析了 1340 个涉及单个胚胎的周期。三分之二为冷冻胚胎，86%为囊胚移植。近 30%的周期进行了植入前遗传学检测。当β-hCG 水平“翻倍”时，80.7%的周期发生活产，当β-hCG 水平在 AOR 15 天达到 100 时，81.6%的周期发生活产。当β-hCG 水平在 AOR 15 天内同时翻倍且达到 100 时，85.4%的周期发生活产。控制患者和周期水平因素的多变量逻辑回归模型显示，β-hCG“翻倍”时活产的优势比（OR）为 8.0（95%置信区间 5.7-11.1），β-hCG“达到 100”时 OR 为 21.2（95%置信区间 14.3-31.5）。当满足这两个参数时，OR 为 12.5（95%置信区间 8.9-17.8）。
结论
β-hCG 的“翻倍”和“在 AOR 15 天达到 100”参数是活产的可靠预测指标，可以帮助患者在接受单胚胎移植后不久就妊娠结局进行咨询。
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