Occult abnormal pregnancies after first post embryo transfer serum β hCG levels of 1 0 5 0 mIU mL

A first post–embryo transfer serum beta-human chorionic gonadotropin level of 1.0–5.0 mIU/mL may not exclude pregnancy and is associated with poor outcomes compared with a level <1.0 mIU/mL. Serial testing may be warranted.

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Authors

Bat-Sheva L. Maslow, M.D., Alison Bartolucci, M.S., Carolina Sueldo, M.D., Lawrence Engmann, M.D., Claudio Benadiva, M.D., John C. Nulsen III, M.D.

Volume 105, Issue 4, Pages 938-945

Abstract

Objective:

To assess the occult pregnancy rate after “negative” first post−embryo transfer (ET) serum β-hCG results.

Design:

Two-part retrospective cohort study and nested case series.

Setting:

University-based fertility center.

Patient(s):

A total of 1,571 negative first post-ET serum β-hCG results were included in the study; 1,326 results (primary cohort, June 2009–December 2013) were initially reported as <5 mIU/mL and 245 results (secondary cohort, January 2014–March 2015) were reported as discrete values from 1.0 to 5.0 mIU/mL. Intervention(s):

None.

Main Outcome Measure(s):

Rates of occult pregnancy, ectopic pregnancy, and complications after negative first post-ET serum β-hCG results.

Result(s):

A total of 88.8% (1,178/1,326) of the negative first post-ET results reported as <5 were <1.0 mIU/mL. Occult pregnancy was incidentally identified in 1.2% (12/1,041) of subjects with follow-up. Six had ectopic pregnancies, and seven experienced serious complications; 11 (91.7%) of the 12 occult pregnancies had a first post-ET serum β-hCG level of 1.0–5.0 mIU/mL and 1 (8.3%) <1.0 mIU/mL. All pregnancies with serious complications had initial β-hCG levels of 1.0–5.0 mIU/mL. Of the 245 results from after the policy change, occult pregnancies were diagnosed in 5.5% (9/163) of subjects with follow-up. One had an ectopic pregnancy, which was treated with methotrexate. There were no serious complications in the secondary cohort. Conclusion(s):

The majority of negative first post-ET serum β-hCG levels are <1.0 mIU/mL. Results from 1.0 to 5.0 mIU/mL may fail to exclude abnormal pregnancy and are associated with poor outcomes compared with β-hCG levels <1.0 mIU/mL. Serial serum β-hCG may be warranted in this population.

Read the full text at: http://www.fertstert.org/article/S0015-0282(15)02133-0/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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