Presenting Author:

Lia Bernardi, M.D.

Principal Investigator:

Randall Barnes, M.D.

Department:

Obstetrics and Gynecology

Keywords:

hCG levels, IVF

Location:

Ryan Family Atrium, Robert H. Lurie Medical Research Center

C63 - Clinical Women's Health Research

hCG Levels and Prediction of Live Birth in IVF Pregnancies

Introduction: First trimester ultrasound (US) findings are commonly used to counsel individuals on expected pregnancy outcomes after IVF. Serum hCG levels, which are performed earlier in gestation, also provide valuable predictive information regarding likelihood of live birth (LB). Therefore, the objectives of this study are to evaluate whether specific hCG rises in early IVF pregnancies are associated with LB and to determine whether these hCG parameters are as predictive of LB as the presence of fetal cardiac activity (FCA) on early US. Methods: This retrospective cohort study utilized data collected from 2002-2013 in an academic REI practice. Cycles where women underwent IVF with subsequent autologous fresh or frozen embryo transfer (ET), had a serum hCG >5 mIU/mL 8 or 10 days after ET, and had an US performed between 5 0/7 and 6 6/7 weeks that did not demonstrate a viable multiple gestation were analyzed. Multiple logistic regression was used to investigate the relationship between LB and these hCG variables: doubling from the first to second hCG in early pregnancy (“doubled”), reaching an hCG of 100 mIU/mL by 10 days after blastocyst or 12 days after cleavage stage ET (“reached 100”) or the combination of doubling and reaching an hCG of 100 mIU/mL (“doubled and reached 100”). The model adjusted for age, year of ET, fresh or frozen ET, and the number of embryos transferred. Positive predictive values (PPV) of the hCG variables and the PPV of presence of FCA on early US on LB were examined. Results: 484 cycles (96.3% fresh, 3.7% frozen) were included. The mean age of the women was 35.6 ±3.9 years. The mean number of embryos transferred was 2.4 ±0.8 (8.9% blastocyst and 91.1% cleavage stage) and the LB rate was 70.9%. Both “doubled” (OR 3.6, 95% CI 2.2-5.8) and “doubled and reached 100” (OR 5.1, 95% CI 3.3-7.8) were significantly associated with odds of LB. However, the odds of LB were highest when hCG “reached 100” (OR 5.5, 95% CI 3.5-8.6). The PPV of LB was 76.5% for “doubled”, 80.4% for “reached 100”, and 82.8% for “doubled and reached 100”. The PPV of presence of FCA on LB was 74.1%. Conclusions: There was an association between hCG levels in early pregnancy and LB, with the odds of LB highest when hCG reached 100 mIU/mL by 10 to 12 days after ET. Given that the PPV of each hCG variable was higher than the PPV of FCA on early US, serum hCG levels in IVF pregnancies may allow for earlier and more accurate prediction of LB than US before 7 weeks.