The Predictive Value of Serum ß-HCG Levels in The Detection of Ectopic Pregnancy Sixteen Days after Embryo Transfer: A Cross-Sectional Study.

IF 2.3 Q2 OBSTETRICS & GYNECOLOGY International Journal of Fertility & Sterility Pub Date : 2023-04-01 DOI:10.22074/ijfs.2022.546087.1247
Seyedehhoura Hashemi, Arezoo Arabipoor, Solmaz Kohestani, Zahra Zolfaghary, Samira Vesali, Firouzeh Ghaffari
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Abstract

Background: To detect the predictive value of beta human chorionic gonadotropin (β-hCG) levels 16 days post embryo transfer (ET) regarding detection of an ectopic pregnancy (EP) in assisted reproductive technology (ART) cycles.

Materials and methods: In this cross-sectional study, we reviewed the database of Royan Institute from January 2011 to December 2014 and from January 2017 to December 2019 retrospectively. All cases with positive β-hCG levels sixteen days after ET were screened (n=4149). The pregnancies with oocyte or embryo donation and the multiple pregnancies based on the first ultrasound were excluded. All eligible singleton pregnancies with documented serum β-hCG levels at Royan institute laboratory (n=765) were included and then classified according to the type of pregnancy: EP (n=189) or non-EP (n=576). The data of the treatment cycle was extracted from the patients' files. A receiver operating characteristic (ROC) curve was used to detect the predictive power of the first measurement of β-hCG level in distinguishing EP from ongoing pregnancy in the ART and intrauterine insemination (IUI) cycles separately. Sensitivity, specificity, area under the ROC curve and 95% confidence intervals (CI) were calculated for each of the estimates.

Results: The mean levels of β-hCG 16 days after ET were remarkably higher in the ongoing pregnancy group than the EP group (1592.35 ± 87 IU/L vs. 369.69 ± 50.61 IU/L, P<0.001). The β-hCG thresholds predictive of ongoing pregnancy were 278 IU/L as the most suitable cut-off to predict viable pregnancy with a sensitivity of 72.8%, a specificity of 67.5%, a positive predictive value of 77.8%, standard error of 0.02, and a confidence interval of 73.8- 81.7%. However, this relationship was not found in IUI cycles.

Conclusion: Based on these findings, if β-hCG levels 16 days after ET are below 278 IU/l, close follow-up is recommended, until either the diagnosis of EP or miscarriage is established.

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血清ß-HCG水平在胚胎移植16天后检测异位妊娠中的预测价值:一项横断面研究。
背景:检测胚胎移植(ET)后16天β-人绒毛膜促性腺激素(β-hCG)水平对辅助生殖技术(ART)周期中异位妊娠(EP)检测的预测价值。材料与方法:在本横断面研究中,我们回顾性回顾了2011年1月至2014年12月和2017年1月至2019年12月的Royan研究所数据库。所有ET后16天β-hCG水平呈阳性的病例均进行筛查(n=4149)。排除有卵母细胞或胚胎捐赠的妊娠和基于首次超声的多胎妊娠。纳入Royan研究所实验室记录的血清β-hCG水平的所有符合条件的单胎妊娠(n=765),然后根据妊娠类型进行分类:EP (n=189)或非EP (n=576)。从患者档案中提取治疗周期的数据。采用受试者工作特征(ROC)曲线分别检测首次测定β-hCG水平在ART和宫内人工授精(IUI)周期中区分EP与妊娠的预测能力。计算每个估计值的敏感性、特异性、ROC曲线下面积和95%置信区间(CI)。结果:持续妊娠组ET后16天β-hCG水平明显高于EP组(1592.35±87 IU/L vs 369.69±50.61 IU/L)。结论:ET后16天β-hCG水平低于278 IU/L,建议密切随访,直至确诊EP或流产。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
68
审稿时长
>12 weeks
期刊介绍: International Journal of Fertility & Sterility is a quarterly English publication of Royan Institute . The aim of the journal is to disseminate information through publishing the most recent scientific research studies on Fertility and Sterility and other related topics. Int J Fertil Steril has been certified by Ministry of Culture and Islamic Guidance in 2007 and was accredited as a scientific and research journal by HBI (Health and Biomedical Information) Journal Accreditation Commission in 2008. Int J Fertil Steril is an Open Access journal.
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