Predictive value of maternal serum human chorionic gonadotropin levels in pregnancies achieved by in vitro fertilization with single cleavage and single blastocyst embryo transfers

Capsule:
Mean human chorionic gonadotropin levels resulting from a single fresh blastocyst transfer were significantly higher than those from a single cleavage transfer after adjusting for confounding variables.

Authors:
Galia Oron, M.D., Efrat Esh-Broder, M.D., Weon-Young Son, Ph.D., Hananel Holzer, M.D., Togas Tulandi, M.D., M.H.C.M.

Volume 103, Issue 6, Pages 1526-1531

Abstract:

Objective:
To compare serum hCG levels after transfer of a single fresh cleavage embryo and of a single fresh blastocyst embryo and to determine the predictive value of serum hCG levels for pregnancy outcomes.

Design:
A single center retrospective cohort study.

Setting:
Tertiary university health center.

Patient(s):
All fresh single ETs between December 2008 and December 2013.

Intervention(s):
None.

Main Outcome Measure(s):
Mean serum hCG levels on day 16 after oocyte collection, after the transfer of a fresh single cleavage embryo and a fresh single blastocyst embryo were compared. Multivariable regression analysis was performed to determine the association of potential factors on hCG value and a clinical pregnancy.

Result(s):
One thousand twenty-six fresh single ETs were analyzed, 801 (638 pregnancies) from a single blastocyst transfer and 225 (167 pregnancies) from a single cleavage ET. The mean hCG levels resulting from a single fresh blastocyst transfer (299 ± 204 IU/L) were significantly higher than those from a cleavage transfer (245 ± 204 IU/L). This difference remained after adjusting for confounding variables. The threshold value predicting a clinical pregnancy for a cleavage embryo was 100 IU/L, and for a blastocyst transfer, 133 IU/L.

Conclusion(s):
Our study suggests that initial serum hCG values are higher after the transfer of a single fresh blastocyst embryo compared with after a single fresh cleavage ET, even after adjusting for confounding variables.

  • Jason M. Franasiak

    Thank you for your comment. I would agree it would have not been likely to affect the hcg value itself. I do know that we can see different initial hcg values with biopsied vs non-biopsied embryos, but don’t think that this extends to differences in morphology as one might expect if you are transferring the best embryo in a cohort vs. the only one remaining.

  • Galia Oron

    Thank you for your comment! Unfortunately we could not differentiate easily in our database between elective SET and selective SET – this no doubt is an important aspect especially in cycle outcome (clinical pregnancy rates etc) …however I am not sure if it should have an effect on the beta-hcg VALUE itself. I would be more than glad to get your take on this. Galia

  • Jason M. Franasiak

    A nice manuscript. Was there any analysis between elective single embryo transfer vs. single embryo transfer as a result of availability?

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