Fridström M, Garoff L, Sjöblom P, Hillensjö T
Department of Obstetrics and Gynaecology, Karolinska Institute, Huddinge University Hospital, Sweden.
Acta Obstet Gynecol Scand. 1995 Aug;74(7):534-8. doi: 10.3109/00016349509024385.
Assisted reproduction implies increased risks of pathological pregnancy, necessitating close follow up of early pregnancy. The use of serum hCG levels two and three weeks after embryo transfer for prediction of pregnancy outcome after in vitro fertilization-embryo transfer (IVF/ET) or gamete intrafallopian transfer (GIFT) was evaluated.
Three hundred and twenty-nine treatment cycles were included. Serum samples were obtained on days 14 and 21 after ET and hCG was determined by fluoroimmunoassay. Receiver operating characteristic (ROC) curves were analyzed to find cut-off levels of hCG giving maximal sensitivity and specificity, identifying a low risk group and a high risk group with regard to pathological pregnancy.
The group of patients carrying a viable pregnancy had significantly higher hCG levels two and three weeks after ET than the group of patients carrying a pathological pregnancy. Furthermore, the daily increase in hCG was higher. In multiple gestations, the levels of hCG were significantly higher compared to singleton pregnancies. Ninety per cent of the patients with an hCG level > or = 150 IU/L 13-15 days after ET carried a pregnancy to term (the low risk group). Conversely, 50% of the patients with hCG < 150 IU/L carried a pathological pregnancy (the high risk group).
A single determination of the hCG level two weeks after ET, combined with transvaginal ultrasound two to three weeks later, is a reliable follow-up. In cases of subnormal hCG levels (< 150 IU/L), a second hCG determination one week later followed by sonography is recommended.
辅助生殖意味着病理性妊娠风险增加，因此需要对早期妊娠进行密切随访。本研究评估了胚胎移植后两周和三周时血清人绒毛膜促性腺激素（hCG）水平用于预测体外受精-胚胎移植（IVF/ET）或配子输卵管内移植（GIFT）后妊娠结局的价值。
纳入329个治疗周期。在胚胎移植后第14天和第21天采集血清样本，采用荧光免疫分析法测定hCG。分析受试者工作特征（ROC）曲线以确定能给出最大敏感性和特异性的hCG临界值，从而识别出病理性妊娠的低风险组和高风险组。
与携带病理性妊娠的患者组相比，携带存活妊娠的患者组在胚胎移植后两周和三周时的hCG水平显著更高。此外，hCG的每日增加值也更高。与单胎妊娠相比，多胎妊娠时的hCG水平显著更高。胚胎移植后13 - 15天hCG水平≥150 IU/L的患者中有90%妊娠至足月（低风险组）。相反，hCG＜150 IU/L的患者中有50%发生病理性妊娠（高风险组）。
胚胎移植后两周单次测定hCG水平，结合两到三周后的经阴道超声检查，是一种可靠的随访方法。对于hCG水平低于正常（＜150 IU/L）的情况，建议一周后再次测定hCG，随后进行超声检查。
