Comparison of Pregnancy Outcomes of Progesterone or Progesterone + Estradiol for Luteal Phase Support in ICSI-ET Cycles

Abstract Background Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer. Methods A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5–299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results 312 patients had serum β-hCG levels < 300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 h, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%. Conclusions Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG > 58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

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Possibility of Live Birth in Patients with Low Serum β-hCG 14 Days After Blastocyst Transfer

10.21203/rs.3.rs-30101/v2 ◽

2020 ◽

Author(s):

Yixuan Wu ◽

Haiying Liu

Keyword(s):

Live Birth ◽

Roc Curve ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Clinical Pregnancy ◽

Blastocyst Transfer ◽

Luteal Phase Support ◽

Live Births ◽

Β Hcg ◽

Low Serum

Abstract Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. Live birth rates were higher in the <38 years of age group as compared those > 38 years (19.0% vs.16.6%; P=0.045). ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

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Possibility of Live Birth in Patients with Low Serum β -hCG 14 Days After Blastocyst Transfer

10.21203/rs.3.rs-30101/v3 ◽

2020 ◽

Author(s):

Yixuan Wu ◽

Haiying Liu

Keyword(s):

Live Birth ◽

Roc Curve ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Clinical Pregnancy ◽

Blastocyst Transfer ◽

Luteal Phase Support ◽

Live Births ◽

Β Hcg ◽

Low Serum

Abstract Background: Although prior work has attempted to predict pregnancy outcomes by assaying serum β-hCG levels after blastocyst transfer, no study has focused on pregnancy outcomes in those with initially low serum β-hCG levels. This study sought to investigate pregnancy outcomes of patients with low serum β-hCG levels 14 days after blastocyst transfer.Methods: A retrospective study was conducted at the Third Affiliated Hospital of Guangzhou Medical University to study patients whose serum β-hCG levels were at 5-299 mIU/ml 14 days after frozen blastocyst transfer. Rates of live birth, early miscarriage, biochemical pregnancy loss and ectopic pregnancy were analyzed according to the female patients’ age by Chi-squared analysis. Receiver operating characteristic (ROC) curves were plotted to explore the threshold of predicting clinical pregnancy and live births. Results: 312 patients had serum β-hCG levels <300 mIU/ml at 14 days after frozen blastocyst transfer, among which, 18.6% were live births, 47.4% were early miscarriages, 22.8% were biochemical pregnancies and 9.6% were ectopic pregnancies. ROC curve analysis showed that a predicted value of β-hCG for clinical pregnancy was 58.8 mIU/ml with an area under the ROC curve (AUC) of 0.752, a sensitivity of 95.0% and specificity of 53.5%. The threshold for live births was 108.6 mIU/ml with an AUC of 0.649, a sensitivity of 93.1% and a specificity of 37.0%. For the β-hCG fold increase over 48 hours, the cut-off for clinical pregnancy was 1.4 with an AUC of 0.899, a sensitivity of 90.3% and a specificity of 77.8%. The threshold for live birth was 1.9 with an AUC of 0.808, a sensitivity of 88.5% and specificity of 64.5%.Conclusions: Initially low serum β-hCG levels 14 days after frozen blastocyst transfer indicated minimal chances of live birth. For patients having an initial β-hCG >58.8 mIU/ml, luteal phase support should continue. Another serum β-hCG test and ultrasound should be performed one week later. When an initial serum β-hCG is < 58.8 mIU/ml, luteal phase support should be discontinued and serum β-hCG measured with ultrasound one week later.

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Does luteal phase support by human chorionic gonadotropin improve pregnancy outcomes in frozen-thawed embryo transfer cycles?

Middle East Fertility Society Journal ◽

10.1016/j.mefs.2018.03.003 ◽

2018 ◽

Vol 23 (4) ◽

pp. 300-302

Author(s):

Maryam Eftekhar ◽

Saeideh Dashti ◽

Marjan Omidi ◽

Afsar Alsadat Tabatabaei

Keyword(s):

Embryo Transfer ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Luteal Phase Support ◽

Frozen Thawed Embryo Transfer ◽

Thawed Embryo Transfer

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The effects of low-dose human chorionic gonadotropin for luteal phase support on pregnancy outcomes in poor ovarian responders: a randomized clinical trial

10.21203/rs.3.rs-328212/v1 ◽

2021 ◽

Author(s):

Tahereh Madani ◽

Arezoo Arabipoor ◽

Fariba Ramezanali ◽

Shabnam Khodabakhshi ◽

Zahra Zolfaghari

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Live Birth ◽

Pregnancy Outcomes ◽

Luteal Phase ◽

Clinical Pregnancy ◽

Birth Rates ◽

Luteal Phase Support ◽

Live Birth Rates ◽

Significant Difference

Abstract Purpose: The question that remains is, does changing the type of luteal phase support (LPS) improve the pregnancy outcomes in patients with poor ovarian response (POR) diagnosis?. Therefore, this study was designed to investigate and compare the efficiency of different methods of luteal phase support (progesterone alone or hCG alone and the combination of progesterone with hCG) in these patients.Methods: This randomized clinical trial evaluated three hundred seventy five patients who were diagnosed as POR on the basis of Bologna criteria undergoing intracytoplasmic sperm injection- embryo transfer (ICSI-ET) cycles at Royan institute from November 2015 to June 2019. The patients were allocated randomly into three different LPS groups on the day of oocyte pickup. In first group, 1500 IU of hCG IM on the ET day, as well as 4 days after that were administrated. In the second group, the patients received 1500 IU of hCG IM on the ET day, as well as 3 and 6 days after the ET along with vaginal suppositories 400 mg twice daily. For the third group, only vaginal suppositories twice daily was administrated from the day of oocyte pick up until the pregnancy test day.The clinical pregnancy, miscarriage and live birth rates were the main outcomes. Results: The data analysis showed that the three groups were comparable. In the following, there is no significant difference in terms of implantation, clinical pregnancy, and miscarriage and live birth rates among groups. The twin pregnancy rate in the hCG-only group was higher than those of in the other two groups, although this difference was not statistically significant (P=0.06).Conclusion: The type of LPS does not improve the pregnancy and live birth rates in POR patients. A multi-center clinical trial is warranted to confirm or refute these findings.Trial registration: The study was registered in the clinicaltrial.gov site on 14 June 2015. (NCT02798653 at www. clinicaltrials.gov, registered prospectively).

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