Memorial Sisli Hospital, IVF and Reproductive Genetics Centre, Istanbul, Turkey.
Medicine (Baltimore). 2023 Oct 20;102(42):e35605. doi: 10.1097/MD.0000000000035605.
To investigate whether the initial beta-human chorionic gonadotropin (β-hCG) levels and their rate of increase differ after single fresh and frozen blastocyst transfers, and whether these values effectively predict pregnancy outcomes. This retrospective cohort study was conducted at the Sisli Memorial Hospital, assisted reproductive technology, and Reproductive Genetics Center in Istanbul, Turkey, between January 2016 and January 2022. Three thousand two hundred thirty-eight single blastocyst transfers with positive pregnancy test results were evaluated. Of these, 738 were fresh transfer cycles and 2500 were frozen-thawed embryo transfer (FET) cycles. β-hCG test results from 9 days after fresh and FET cycles were compared between the groups with biochemical pregnancy, early pregnancy loss, and live birth outcomes. The threshold values were determined for each pregnancy outcome. The rate of increase between the first and second β-hCG tests performed 2 days apart was determined for each pregnancy outcome. Finally, the listed values were compared between the FET and fresh cycle. Mean baseline β-hCG levels were significantly higher in FET cycles than in fresh cycles, regardless of pregnancy outcomes (P < .005). Baseline β-hCG levels were higher in fresh cycles with live births (171.76 ± 109.64 IU/L) compared to biochemical and clinical pregnancy losses (50.37 ± 24.31 and 114.86 ± 72.42, respectively) (P < .001). Live births in FET cycles resulted in higher baseline β-hCG levels (193.57 ± 100.38 IU/L) compared to biochemical and clinical pregnancy loss groups (68.41 ± 51.85 and 149.29 ± 96.99 IU/L, respectively) (P < .001). The β-hCG threshold for live birth for fresh cycles was 116.5 IU/L (sensitivity 80%, specificity 70%, positive predictive value 90%, negative predictive value 54%) and 131.5 IU/L for FET cycles (sensitivity 71%, specificity 68%, positive predictive value 87%, negative predictive value 50%). The percentage of the area under the curve for single fresh blastocyst transfers was 0.81 and 0.76 for frozen transfers. The rate of increase in β-hCG was similar in fresh and FET cycles. Initial β-hCG levels and 2-day increases are effective parameters for diagnosing pregnancy in fresh and FET cycles. The initial β-hCG level was significantly higher in the FET cycles than in the fresh cycles. Predicting outcomes earlier helps clinicians to manage and follow high-risk pregnancies.
为了研究在单个新鲜和冷冻囊胚移植后，初始β-人绒毛膜促性腺激素（β-hCG）水平及其增长率是否存在差异，以及这些值是否能有效预测妊娠结局。这项回顾性队列研究在土耳其伊斯坦布尔的 Sisli Memorial 医院、辅助生殖技术和生殖遗传学中心进行，时间为 2016 年 1 月至 2022 年 1 月。评估了 3238 例有阳性妊娠试验结果的单个囊胚移植。其中，738 例为新鲜移植周期，2500 例为冷冻胚胎移植（FET）周期。比较了生化妊娠、早期妊娠丢失和活产结局组中新鲜和 FET 周期 9 天后β-hCG 检测结果。确定了每个妊娠结局的阈值。确定了每个妊娠结局两次相隔 2 天的β-hCG 检测之间的增长率。最后，比较了 FET 和新鲜周期的列出值。FET 周期的基础β-hCG 水平明显高于新鲜周期，无论妊娠结局如何（P<0.005）。与生化妊娠和临床妊娠丢失相比，新鲜周期活产的基础β-hCG 水平更高（分别为 171.76±109.64IU/L 和 50.37±24.31IU/L 和 114.86±72.42IU/L）（P<0.001）。FET 周期的活产导致基础β-hCG 水平升高（分别为 193.57±100.38IU/L 和 68.41±51.85IU/L 和 149.29±96.99IU/L）（P<0.001）。新鲜周期活产的β-hCG 阈值为 116.5IU/L（灵敏度 80%，特异性 70%，阳性预测值 90%，阴性预测值 54%），FET 周期为 131.5IU/L（灵敏度 71%，特异性 68%，阳性预测值 87%，阴性预测值 50%）。单个新鲜囊胚转移的曲线下面积百分比为 0.81，冷冻转移为 0.76。新鲜和 FET 周期的β-hCG 增长率相似。初始β-hCG 水平和 2 天的增加是新鲜和 FET 周期妊娠诊断的有效参数。FET 周期的初始β-hCG 水平明显高于新鲜周期。更早地预测结局有助于临床医生管理和随访高危妊娠。
