Photo Credit: Anusorn Nakdee

The following is a summary of “Predicting the Pregnancy Outcome: Uncovering the Link between β-hCG, patient factors and Live Birth in IVF,” published in the July 2024 issue of Obstetrics and Gynecology by Cirillo et al.

This study aimed to correlate live birth rates with initial β-hCG levels in patients undergoing embryo transfer and to develop a predictive model of live birth based on patient characteristics and assisted reproductive technology (ART) variables. Conducted as a single-center retrospective cohort study, it included 7,587 positive first serum β-hCG measurements from women who underwent fresh and frozen embryo transfers between January 2011 and December 2020. Women aged 18 to 45 years with a positive β-hCG (>20 IU/L) were included, while cycles involving gamete donation, preimplantation genetic testing (PGT), and transfers of more than three embryos were excluded.

About 21 variables related to patient characteristics and treatment modalities were analyzed through stepwise univariate analysis followed by multivariate analysis. The results showed that among the positive serum β-hCG measurements, 5,085 (67.0%) resulted in live births. The β-hCG levels were significantly higher in the live birth group (691 IU/L) compared to the failed pregnancies group (304 IU/L), with a threshold of >500 IU/mL providing a positive predictive value for live birth of 85.3% (95% CI 84.0-86.4). Failed pregnancies were more prevalent among older maternal and paternal ages, and previous abortions were more common in the failed pregnancies group (25.0%) compared to the live birth group (19.4%). Male infertility was the most common indication for treatment, constituting a larger proportion in the live birth group (41.7%).

Multivariate analysis identified the following factors as independently associated with live birth: first serum β-hCG (OR 1.35, 95% CI 1.32-1.37), maternal age (OR 0.93, 95% CI 0.91-0.95), and previous abortions (OR 0.77, 95% CI 0.68-0.88). The number of embryos transferred also showed a positive correlation with live birth rates, particularly in women under 39 years of age (<35 years old OR 1.60, 95% CI 1.32-1.94; <39 years old OR 1.27, 95% CI 1.09-1.47). The predictive model incorporating these four variables demonstrated sensitivity and specificity with an area under the ROC curve of 0.798.

In conclusion, this study confirms the critical role of the initial β-hCG value in predicting live birth outcomes. The proposed predictive model, which includes maternal age, number of embryos transferred, and obstetric history, offers valuable insights for counseling couples and enhancing patient care in ART practices.

Source: sciencedirect.com/science/article/abs/pii/S0301211524004044