Predicting the pregnancy outcome: Uncovering the link between β-hCG, patient factors and live birth in IVF.

Autor: Cirillo F; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy. Electronic address: federico.cirillo@humanitas.it., Secchi M; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy., Busnelli A; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy., Morenghi E; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Biostatistics Unit, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy., Di Segni N; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy., Baggiani A; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy., Levi-Setti PE; Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2024 Oct; Vol. 301, pp. 24-30. Date of Electronic Publication: 2024 Jul 25.
DOI: 10.1016/j.ejogrb.2024.07.049
Abstrakt: Objective: The objectives of the study were to correlate live birth rate with the initial level of β-hCG in all patients undergoing embryo transfer and develop a predictive model of live birth based on patients' and assisted reproductive technology (ART) characteristics.
Study Design: Single-center retrospective cohort study, including a total of 7587 positive first serum β-hCG from women who performed fresh and frozen embryo transfer. Twenty-one variables related to patient characteristics and treatment modalities were analyzed by step-wise univariate analysis followed by multivariate analysis. The study included women between 18 and 45 years with a positive (>20 IU/L) serum β-hCG between January 2011 and December 2020 while it excluded cycles from donation of gametes, PGT and >3 embryos transferred simultaneously.
Main Results and the Role of Chance: Among the positive serum β-hCG measurements 5085 (67.0 %) resulted in live births. β-hCG was higher in the live birth group (691 IU/L) compared to the failed pregnancies group (304 IU/L) (p500 IU/mL provided a positive predictive value for live birth of 85.3 % (95 %CI 84.0-86.4). Failed pregnancies were more common among older maternal and paternal age. Previous abortions were more common in the failed pregnancies group (25.0 %) compared to the live birth group (19.4 %). The most common indication to treatment was male infertility, accounting for a larger portion in the live birth group (41.7 %). At multivariate analysis, the factors independently associated with live birth were: first serum β-hCG (OR 1.35, 95 %CI 1.32-1.37), maternal age (OR 0.93, 95 %CI 0.91-0.95), previous abortions (OR 0.77, 95 % CI 0.68-0.88). The number of embryos transferred showed a positive correlation below a maternal age of 39 (<35 years old OR 1.60, CI 95 % 1.32-1.94; <39 years old OR 1.27 CI 95 % 1.09-1.47). The prediction model incorporating these four variables resulted in a sensitivity and specificity with an area under the ROC curve of 0.798.
Conclusion: The study confirms the importance of the first value of β-hCG and proposes a predictive model that takes into account maternal age, number of embryos transferred, and obstetric history, thereby aiding in couples' counseling and ultimately improve patients' care.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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