Fourth World Conference on Early Pregnancy CONTINUUM BETWEEN IMPLANTATION AND PERINATAL EVENTS

Role Of Serum hCG Measurements In Predicting Pregnancy Outcome And Multiple Gestation After In Vitro Fertilization

Hauzman E., Fedorcsák P., Halmos A., Vass Z., Dévényi N., Papp Z. and Urbancsek J

First Department of Obstetrics and Gynecology, Semmelweis University Medical School, Budapest, Hungary

Women undergoing IVF treatment are at an increased risk of early pregnancy loss. Our aim was to predict pregnancy outcome and multiple gestation using a common parameter by which hCG values become comparable independently of the specific day of blood sampling.

We studied early hCG values of 129 IVF pregnancies conceived during the period of May 1994 to August 1999. The cause of infertility was tubal factor (48%), endometriosis (5%), male factor (39%), or it had an unexplained etiology (8%). The median age of the patients was 31 years (range 23-44 years). None of them received hCG for luteal phase support. Two blood samples for serum hCG assay were collected from each patient 8 to 16 days after ET. Preclinical and first trimester abortions, as well as ectopic pregnancies were grouped as early pregnancy loss. Ongoing pregnancies were defined as singleton and multiple deliveries, and second trimester abortions. Since serum samples were obtained on different days. we calculated the day 11 hCG levels, based on the exponential increase in hCG values in early pregnancy. Using receiver-operating characteristic (ROC) analysis we determined sensitivities and specificities for possible cut- off values discriminating early pregnancy losses and ongoing pregnancies, as well as for cut-off points for multiple gestations.

The geometric means and 95% confidence intervals of serum hCG levels in the group defined as early pregnancy loss (n = 32) were significantly lower [24.3 (16.8-35.3) IU/I] than in ongoing pregnancies [n = 97 103.5 (85.6-125.2) IU/1; P < 0.001]. ROC analysis revealed that a cut-off level of SO IU/I predicts pregnancy outcome with a sensitivity of 81.3% and a specificity of 81.4%, while an hCG value >100 IU/I predicts a multiple ongoing pregnancy with a sensitivity of 85.7% and a specificity of 81.3%.

Early hCG measurements in IVF pregnancies may predict pregnancy outcome and multiple gestation with relatively high precision. For this purpose, we defined cut-off values for day 1 l hCG levels derived from two measurements independent of the day of serum sample collection.

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