Early Serum hCG in IVF: Are We Trending in the Right Direction?
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REVIEW
Early Serum hCG in IVF: Are We Trending in the Right Direction? Jessica Ryniec 1 & Navid Esfandiari 1 Received: 26 May 2020 / Accepted: 5 October 2020 # Society for Reproductive Investigation 2020
Abstract Human chorionic gonadotropin (hCG) measurements may be the earliest indicator of fertility cycle success, available several weeks before an ultrasound would be diagnostic for pregnancy. Outcomes of these cycles are high stakes for a couple, and the earliest reassurance of a normal pregnancy would be beneficial for their well-being. Additionally, earlier diagnosis can allow for more rapid management by providers in the case of abnormal pregnancies. Therefore, establishing normal values for initial hCG level and early hCG kinetics is of great interest. There are many factors involved in assisted reproductive techniques that may lead to alterations in hCG kinetics when compared with spontaneous pregnancies. We aim to characterize normal hCG values for in vitro fertilization (IVF) pregnancies and review how different aspects of the IVF process may alter these trends in order to establish how best to counsel patients during the waiting period. Keywords In vitro fertilization . Embryo transfer . Early pregnancy . hCG value . Patient counseling
Introduction Early diagnosis of pregnancy following assisted reproductive technology cycles is critical both for the emotional well-being of the couple as well as for management guidance for their health care providers. While transvaginal ultrasound is a useful tool in diagnosis of early pregnancies, it is typically nondiagnostic before 5–6-week gestation. Serial human chorionic gonadotropin (hCG) measurements in early pregnancy can allow for diagnosis, monitoring, and potential early differentiation of normal versus abnormal pregnancies. Ideally, this would lead to reduced stress surrounding uncertainty of treatment success and to swift management to avoid delaying further attempts at conception if desired. Fertility clinics may follow different protocols, but initial serum hCG measurement typically occurs around 11 days following transfer of cleavage stage embryos or 9 days following transfer of blastocysts, a time that correlates with the 14th day following oocyte retrieval. Serum hCG can then be followed prior to scheduling an ultrasound. In spontaneously conceived normal pregnancies, the rate of hCG rise has been reported to be at least
* Navid Esfandiari [email protected] 1
Department of Obstetrics and Gynecology and Reproductive Sciences, University of Vermont Medical Center, Larner College of Medicine, 111 Colchester Ave, Burlington, VT 05401, USA
53% in 2 days, with a median increase of 50% in 1 day and 124% in 2 days [1]. In order to characterize the rate of hCG rise for pregnancies conceived through IVF, a retrospective cohort study in 2005 demonstrated that the average rate of rise in pregnancies that resulted in live birth was 50% in 1 day and 124% in 2 days, similar to spontaneous pregnancies [2]. There was, however, an earlier plateau in I
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