Possibility of live birth in patients with low serum β

Assisted reproductive technology (ART) techniques and treatment protocols

Vitrification and thawing kits (Kitazato Biophama Co. Ltd. Shizuoka, Japan) were applied for blastocyst cryopreservation and thawing. The blastocysts were equilibrated for two minutes in an equilibration solution before being transferred to a vitrification solution, where they would stay for 45–60 seconds at 37 °C. The blastocysts were after that put into a Cryotop and dropped right into liquid nitrogen. Blastocysts were thawed by submerging the top of the cryotop containing the embryos in a thawing solution for one minute at 37 °C. Then, embryos were successively transferred to a Diluent Solution, a Washing Solution 1, and finally a Washing Solution 2, where they remained for 3 minutes in each successive step at room temperature.

The natural cycle, the artificial cycle, and the ovarian stimulation cycle were the three protocols that were available for endometrial preparation. The natural cycle was the first option for patients who had a regular menstrual cycle, and blastocysts were transferred five days after ovulation. For patients without follicular development, an artificial cycle was given. At 2-4 days into the cycle, oral estrogen (Estradiol Valerate, Bayer, Germany) was started and continued for at least 7 days. Blastocysts were transferred on day 6 after vaginal progesterone (Crinone, Merck Serono, Germany) was administered at 90 mg once daily for 5 days when endometrial thickness was less than 7 mm. For the stimulation cycle, 37. Human menopausal gonadotropin (HMG) was given for 2-4 days of the cycle at a dose of 5-75 IU. To induce ovulation, 8000–10,000 IU of human chorionic gonadotropin (HCG) were administered when the dominant follicle was less than 18 mm. Blastocyst transfer was done 5 days post-ovulation. For luteal phase support during synthetic cycles, vaginal progesterone (Crinone, Merck Serono, Germany, 90 mg qd) was administered. Vaginal progesterone gels (Utrogestan, Besins Healthcare, France, 200 mg bid) were used to support the luteal phase for both natural and stimulatory cycles. Serum β-hCG assays were done 14 days after embryo transfer. When -hCG tests were positive in week 10, luteal phase support was maintained.

-hCG was measured using an immunochemiluminometric assay (Architech i2000SR; Abbott Laboratories, Inc. , Chicago, IL, USA). The detection range lied between 1. 2 and 225,000 mIU/ml. The sensitivity of the assay was 1. 2 mIU/ml, with an intra-assay coefficient of variation of 7%. The External Quality Assessment of a Clinical Laboratory Center (Ministry of Health of the People’s Republic of China, Beijing, China) evaluates our laboratory each year to determine its suitability. The following equation was used to calculate fold increases in -hCG concentrations over a 48-hour period: Fold increase = (left(fracmathrmHCG1mathrmHCG0right)raisebox1ex$2$!left/!raisebox-1ex$mathrmdays$right } ). The term “days” denoted the time period between the two hCG tests. HCG0 was defined as serum hCG concentrations measured 14 days after embryo transfer. HCG1 was defined as serum hCG levels in the second test.

An intrauterine or extrauterine gestational sac that was found by ultrasound and had levels of -hCG in the blood that were considered to be clinically pregnant. A serum concentration of -HCG was used to define biochemical pregnancy loss. Fetal growth arrest or the absence of cardiac activity in the gestational sac during the first 12 weeks of pregnancy were considered early miscarriages. Live birth denoted a pregnancy that went on past the 28-week mark and showed signs of a live fetus.

Statistical analysis was performed with SPSS version 22. 0 software (IBM, Armonk, NY, USA). The means of quantitative variables with homogenous variance were expressed as X SD, and the Student’s t-test was used to compare them. The Mann-Whitney U test was used to compare the medians of quantitative variables with a heterogeneous variance, which were expressed as the median (1st and 3rd quartiles). A Chi-squared test was used to compare rates. When the anticipated count was less than, Fisher’s exact test was used. Logistic regression analysis was used to investigate the impact of serum -hCG on pregnancy outcomes. By plotting Receiver Operating Characteristic (ROC) curves, serum hCG levels and fold changes over 48 hours were used to predict clinical pregnancy as well as live births. An alpha value of P < 0. 05 was considered statistically significant.

Pregnancy outcomes of patients with low serum β-hCG

312 patients in total had serum levels of -hCG. 6% were live births, 47. 4% were early miscarriages, 22. 8% were biochemical pregnancies and 9. 6% were ectopic pregnancies. Rates of live birth, ectopic pregnancy, early and late miscarriages, and biochemical pregnancy loss were comparable between the Among the 241 clinical pregnancies, 225 (93. 4%) were singletons and 16 (6. 6%) were twins (i. e. , 9 monozygotic twins and 7 dizygotic twins). The rate of live birth was 24. 9% (56/225) in singletons and 12. 5% (2/16) in twins. The lower limits of serum-borne β-hCG levels were 64. 9 mIU/ml for singleton live births, 145. 1 mIU/ml for twin live births, 15. 3 mIU/ml for early miscarriage, and 5. 3 mIU/ml for ectopic pregnancies.

164 patients in total underwent a second serum hCG test between days 2 and 24 (mean: 6). 75 days) following the initial measurement, of which 31 had lower values and 133 had higher levels of -hCG. For patients with decreased β-hCG levels, 96. 8% (30/31) were biochemical pregnancy loss. The only patient, despite having decreased hCG levels from 133, 4 to 64. 5 mIU/ml, eventually developed into an ectopic pregnancy.

Characteristics of live birth vs. non-live birth

Age, number of prior pregnancies, number of previous transfers, anti-müllerian hormone (AMH), and body mass index (BMI) were baseline traits that were similar for both sexes. Regarding the number of embryos transferred, endometrial preparation procedures, days of embryo transfer, and endometrial thickness, there were no statistically significant differences between the groups. However, patients with live births had significantly higher serum levels of hCG (median: 196 mIU/ml vs. median: 140 mIU/ml, P = 0) than patients with non-live births. 0001; Table 3).

Low HCG Results at 5 Weeks Pregnant After 2 Miscarriages!

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