Day 28 serum Beta-hCG levels and early pregnancy outcome

Abstract

Objective: To determine whether day 28 serum beta-hCG (hCG) levels can serve as a predictor for early pregnancy outcome.Design: Retrospective analysis of day 28 serum hCG levels and early pregnancy transvaginal ultrasound findings for 683 IVF patients at a large university-based IVF program during 2000–2001.Materials and Methods: All IVF cycles with day 28 serum hCG levels obtained 14 days after oocyte retrieval were reviewed as stipulated by an IRB approved protocol. We excluded pregnancies if serum hCG levels were not drawn on day 28, or if the assay was not performed in our laboratory; monochorionic twin, ectopic and heterotopic pregnancies were also excluded. Early pregnancy monitoring by transvaginal ultrasound is routinely performed at our program at varying intervals from day 42 until approximately cycle day 60. Early pregnancy outcomes included number of gestational sacs (0–3) with and without the presence of fetal heartbeat (FH). Data was analyzed by one-way ANOVA or Student’s t-test.Results: Day 28 hCG levels (mean + SEM) are listed in Table 1 by number of sacs with or without the presence of fetal heartbeat. Biochemical pregnancies (BC) were characterized by an elevated hCG with negative findings of a sac on ultrasound. Beta-hCG levels progressively increased as number of sacs on ultrasound increased regardless of presence of FH (p<0.05, ANOVA). The lowest hCG levels were associated with a poor outcome (single sac without FH or BC). For multiple gestations, there was no difference in mean hCG levels whether or not each sac presented with a fetal heartbeat. However, there was a significant difference (p<0.001, Student’s t-test) between the presence of a single sac/+FH (mean: 106 + 4) and a single sac/-FH (mean = 54 + 5). Tabled 1Conclusion: Our data suggest that day 28 serum hCG levels may be useful in counseling patients about possible pregnancy outcomes at a time in the treatment cycle when much about the pregnancy is unknown. To the extent that sonographic features of early pregnancy correlate with outcome, further analyses are being conducted to determine if day 28 serum hCG levels are useful in predicting overall pregnancy outcome (e.g., spontaneous abortion, live birth). Objective: To determine whether day 28 serum beta-hCG (hCG) levels can serve as a predictor for early pregnancy outcome. Design: Retrospective analysis of day 28 serum hCG levels and early pregnancy transvaginal ultrasound findings for 683 IVF patients at a large university-based IVF program during 2000–2001. Materials and Methods: All IVF cycles with day 28 serum hCG levels obtained 14 days after oocyte retrieval were reviewed as stipulated by an IRB approved protocol. We excluded pregnancies if serum hCG levels were not drawn on day 28, or if the assay was not performed in our laboratory; monochorionic twin, ectopic and heterotopic pregnancies were also excluded. Early pregnancy monitoring by transvaginal ultrasound is routinely performed at our program at varying intervals from day 42 until approximately cycle day 60. Early pregnancy outcomes included number of gestational sacs (0–3) with and without the presence of fetal heartbeat (FH). Data was analyzed by one-way ANOVA or Student’s t-test. Results: Day 28 hCG levels (mean + SEM) are listed in Table 1 by number of sacs with or without the presence of fetal heartbeat. Biochemical pregnancies (BC) were characterized by an elevated hCG with negative findings of a sac on ultrasound. Beta-hCG levels progressively increased as number of sacs on ultrasound increased regardless of presence of FH (p<0.05, ANOVA). The lowest hCG levels were associated with a poor outcome (single sac without FH or BC). For multiple gestations, there was no difference in mean hCG levels whether or not each sac presented with a fetal heartbeat. However, there was a significant difference (p<0.001, Student’s t-test) between the presence of a single sac/+FH (mean: 106 + 4) and a single sac/-FH (mean = 54 + 5). Tabled 1 Conclusion: Our data suggest that day 28 serum hCG levels may be useful in counseling patients about possible pregnancy outcomes at a time in the treatment cycle when much about the pregnancy is unknown. To the extent that sonographic features of early pregnancy correlate with outcome, further analyses are being conducted to determine if day 28 serum hCG levels are useful in predicting overall pregnancy outcome (e.g., spontaneous abortion, live birth).