Serum human chorionic gonadotropin levels on the day before oocyte retrieval do not correlate with oocyte maturity

Capsule:
Serum hCG levels on the day before oocyte retrieval do not correlate with oocyte maturity.

Authors:
Gary Levy, M.D., Micah J. Hill, D.O., Christina Ramirez, M.D., Torrie Plowden, M.D., M.P.H., Justin Pilgrim, D.O., Robin S. Howard, M.A., James H. Segars, M.D., John Csokmay, M.D.

Volume 99, Issue 6, Pages 1610-1614, May 2013

Abstract:

Objective:
To evaluate the correlation of preretrieval quantitative serum human chorionic gonadotropin (hCG) level with oocyte maturity.

Design:
Retrospective Cohort Study.

Settings:
Military ART program.

Patients:
Fresh autologous ART cycles.

Interventions:
Serum hCG level the day before oocyte retrieval.

Materials and Methods:
Linear regression was used to correlate serum hCG and oocyte maturity rates. Normal oocyte maturity was defined as 75% and the Wilcoxon rank sum test was used to compare serum hCG in patients with normal and low oocyte maturity. Threshold analysis was performed to determine hCG levels that could predict oocyte maturity.

Results:
A total of 468 ART cycles were analyzed. Serum hCG level was not correlated with hCG dose; however, it was negatively correlated with body mass index (BMI). Serum hCG levels did not differ between patients with oocyte maturity of <75% and ≥75%. Serum hCG levels did not correlate with oocyte maturity rates. Receiver operator characteristic and less than efficiency curves failed to demonstrate thresholds at which hCG could predict oocyte maturity.

Conclusions:
Serum hCG levels were not correlated with oocyte maturity. While a positive hCG was reassuring that mature oocytes would be retrieved for most patients, the specific value was not helpful.

  • Fernando Bronet, PhD

    This study is very interesting. Is the first paper that I have read trying to correlate serum
    hCG levels with Oocyte maturity. I thought that it was possible to establish that
    correlation, but surprisingly there is no correlation, but it is an important
    result to keep in mind.

    • Micah Hill

      Thank you for your comments Dr Bronet. I was also surprised that the data did not demonstrate a correlation with serum hCG and oocyte maturity. It is possible that a much larger sample size might demonstrate some smaller correlations, but we did not identify any trends to suggest that might be the case.

  • Micah Hill

    Recently we added quantitative hCG testing to our lab panel on the day after hCG triggering for ART. This allows us to identify hCG medication error 24 hours earlier and avoid potential failed retrieval from the first ovary. We occasionally see relatively low values of hCG (25-50), but were unsure what clinical significance this had. In this study, we determined that any positive hCG value was associated with a normal rate of oocyte maturity. Therefore low values were not of clinical concern. Potential future directions could include evaluating qualitative hCG measures and cost analyses. We appreciate any comments.

    • for patients unable or unwilling to come in for the “post hcg level” we have simply had them do a home urine pregnancy test and call if its negative or positive. Should pick up a level corresponding to >25— I appreciated your paper because we do always worry when the level on serum testing is low. besides errors in administration or body weight I am always amazed at the enormous variability in levels we see on the serum testing!

      • Micah Hill

        Thanks for the reply Steven. I wasn’t sure if people were using urine testing and its nice to hear its used in some situations!

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