Predictive Value of Decreased Serum Estradiol Levels Following Human Chorionic Gonadotropin Trigger For Unexpected Ovulation During In Vitro Fertilization Cycle of Patients With Poor Ovarian Response

Abstract Background Unexpected spontaneous ovulation typically occurs in patients with poor ovarian response (POR); however, reliable predictors are lacking. We analyzed explore the predictive value of decreased serum estradiol (E2) levels on the day after human chorionic gonadotropin (hCG) trigger during in vitro fertilization (IVF) cycles. Methods We retrospectively analyzed clinical data (n = 978) in IVF cycles between 2017 and 2020. According to decreased ratios of E2 levels (△E2%) between day 1 and day 0 of hCG trigger, patients were divided into: ≤10% (group A), 10–20% (group B), and ≥ 20% (group C). Basic characteristics and laboratory data were compared using analysis of variance or Mann–Whitney U-test. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the relationship between △E2% and spontaneous unexpected ovulation. Fresh embryo transfer cycles in groups A, B, and C were subgrouped as A1, B1, and C1, respectively; clinical outcomes were compared. Results Mean E2 and luteinizing hormone (LH) levels, ratio of premature LH peak and high progesterone levels, time interval between hCG trigger and oocyte retrieval, number of follicles ≥ 11 mm in diameter, and dose regimen of gonadotropin among the three groups showed significant differences (P < 0.05). After adjusting for relevant confounders, likelihood ratios of unexpected ovulation in groups B and C were 2.96 (95 % confidence interval [CI]: 0.64–13.70), and 11.74 (95 % CI: 3.09–44.62), respectively, compared with that in group A. The test for trend was significant before and after correction (P for trend < 0.05). On combining premature LH peak (> 10 mIU/mL) or high progesterone level (> 1.0 ng/mL) on the day of hCG, area under ROC curve (AUC) was 0.849 (95 % CI, 0.764–0.934, P < 0.05). However, when we only considered △E2%, AUC was 0.738 (95 % CI. 0.562–0.914, P < 0.05). Rates of embryo implantation, clinical pregnancy, live birth in fresh embryo transfer cycle, and early abortion among the three subgroups did not differ significantly (P > 0.05). Conclusions E2 levels on the day after hCG trigger are valuable for predicting unexpected ovulation. However, their decreased levels do not directly affect clinical pregnancy outcomes.

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Predicting Ectopic Pregnancy Using Human Chorionic Gonadotropin (hCG) Levels and Main Cause of Infertility in Women Undergoing Assisted Reproductive Treatment: Retrospective Observational Cohort Study

JMIR Medical Informatics ◽

10.2196/17366 ◽

2020 ◽

Vol 8 (4) ◽

pp. e17366 ◽

Cited By ~ 1

Author(s):

Huiyu Xu ◽

Guoshuang Feng ◽

Yuan Wei ◽

Ying Feng ◽

Rui Yang ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Embryo Transfer ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Multinomial Logistic Regression ◽

Low Risk ◽

Receiver Operating Curve ◽

Fresh Embryo Transfer ◽

Intrauterine Pregnancy

Background Ectopic pregnancy (EP) is a serious complication of assisted reproductive technology (ART). However, there is no acknowledged mathematical model for predicting EP in the ART population. Objective The goal of the research was to establish a model to tailor treatment for women with a higher risk of EP. Methods From December 2015 to July 2016, we retrospectively included 1703 women whose serum human chorionic gonadotropin (hCG) levels were positive on day 21 (hCG21) after fresh embryo transfer. Multivariable multinomial logistic regression was used to predict EP, intrauterine pregnancy (IUP), and biochemical pregnancy (BCP). Results The variables included in the final predicting model were (hCG21, ratio of hCG21/hCG14, and main cause of infertility). During evaluation of the model, the areas under the receiver operating curve for IUP, EP, and BCP were 0.978, 0.962, and 0.999, respectively, in the training set, and 0.963, 0.942, and 0.996, respectively, in the validation set. The misclassification rates were 0.038 and 0.045, respectively, in the training and validation sets. Our model classified the whole in vitro fertilization/intracytoplasmic sperm injection–embryo transfer population into four groups: first, the low-risk EP group, with incidence of EP of 0.52% (0.23%-1.03%); second, a predicted BCP group, with incidence of EP of 5.79% (1.21%-15.95%); third, a predicted undetermined group, with incidence of EP of 28.32% (21.10%-35.53%), and fourth, a predicted high-risk EP group, with incidence of EP of 64.11% (47.22%-78.81%). Conclusions We have established a model to sort the women undergoing ART into four groups according to their incidence of EP in order to reduce the medical resources spent on women with low-risk EP and provide targeted tailor-made treatment for women with a higher risk of EP.

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Superovulation with human chorionic gonadotropin (hCG) trigger and gonadotropin releasing hormone agonist (GnRHa) trigger differentially alter essential angiogenic factors in the endometrium in a mouse ART model†

Biology of Reproduction ◽

10.1093/biolre/ioaa014 ◽

2020 ◽

Vol 102 (5) ◽

pp. 1122-1133

Author(s):

Thalia R Segal ◽

Peyvand Amini ◽

Junye Wang ◽

Gregory Peters ◽

Yelenna Skomorovska-Prokvolit ◽

...

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Maternal Serum ◽

Gonadotropin Releasing Hormone ◽

Angiogenic Factors ◽

Critical Periods ◽

Placental Development ◽

Releasing Hormone ◽

Hcg Trigger

Abstract Gonadotropin-releasing hormone agonists (GnRHa) are used as an alternative to human chorionic gonadotropin (hCG) to trigger ovulation and decrease the risk of ovarian hyperstimulation syndrome. GnRHa is less potent at inducing ovarian vascular endothelial growth factor (VEGF), but may also affect endometrial angiogenesis and early placental development. In this study, we explore the effect of superovulation on endometrial angiogenesis during critical periods of gestation in a mouse model. We assigned female mice to three groups: natural mating or mating following injection with equine chorionic gonadotropin and trigger with GnRHa or hCG trigger. Females were killed prior to implantation (E3.5), post-implantation (E7.5), and at midgestation (E10.5), and maternal serum, uterus, and ovaries were collected. During peri-implantation, endometrial Vegfr1 and Vegfr2 mRNA were significantly increased in the GnRHa trigger group (P < 0.02) relative to the hCG group. Vegfr1 is highly expressed in the endometrial lining and secretory glands immediately prior to implantation. At E7.5, the ectoplacental cone expression of Vegfa and its receptor, Vegfr2, was significantly higher in the hCG trigger group compared to the GnRHa group (P < 0.05). Soluble VEGFR1 and free VEGFA were much higher in the serum of mice exposed to the hCG trigger compared to GnRHa group. At midgestation, there was significantly more local Vegfa expression in the placenta of mice triggered with hCG. GnRHa and hCG triggers differentially disrupt the endometrial expression of key angiogenic factors during critical periods of mouse gestation. These results may have significant implications for placental development and neonatal outcomes following human in vitro fertilization.

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