Predictive value of early serum beta-hCG levels after single blastocyst transfer

Acta Obstet Gynecol Scand. 2009;88(12):1382-8. doi: 10.3109/00016340903322743.

Abstract

Objective: Analysis of serum beta-human chorionic gonadotropin (beta-hCG) levels on standardized days after oocyte retrieval (OR) following single blastocyst transfer to predict pregnancy outcome after assisted reproductive technology.

Design: Retrospective study.

Setting: Private fertility center.

Population: A total of 230 women with an intact intrauterine pregnancy 21 days after OR and a vital term delivery (n = 191) or a miscarriage (< 10+0 gestational weeks) (n = 39) in the course of the pregnancy following single blastocyst transfer between 1999 and 2008.

Methods: Blood was sampled 11, 14 and partly 21 days after OR. The serum concentration of total beta-hCG was measured by an automated quantitative immunoassay. Receiver operating characteristic curves were generated to calculate sensitivity and specificity.

Main outcome measures: A total of 509 beta-hCG measurements.

Results: The mean beta-hCG concentrations on days 11, 14 and 21 after OR were significantly lower in the group of patients with a miscarriage compared to the group with a term delivery (p = 0.02, < 0.001 and < 0.001 respectively). With the cut-off values of 15 mIU/mL, 80 mIU/mL and 1500 mIU/mL on days 11, 14 and 21, the positive predictive value was 89%, 93% and 92%. The negative predictive value was 28%, 40% and 54%.

Conclusions: The predictive value of a single beta-hCG measurement for pregnancy outcome after single blastocyst transfer increases between days 11 and 21 after OR. A single beta-hCG measurement on day 14 may balance the accuracy of prediction and the necessity of an early reassuring test.

MeSH terms

  • Adult
  • Chorionic Gonadotropin, beta Subunit, Human / blood*
  • Embryo Transfer*
  • Female
  • Humans
  • Oocyte Retrieval*
  • Predictive Value of Tests
  • Pregnancy
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity
  • Time Factors

Substances

  • Chorionic Gonadotropin, beta Subunit, Human