Human Reproduction, Vol. 10, No. 12, pp. 3293-3296, 1995
© 1995 European Society of Human Reproduction and Embryology
research-article |
Association of early 
-human chorionic gonadotrophin values with pregnancy wastage and multiple implantation in a donor oocyte programme*
1Department of Obstetrics and Gynecology, Pennsylvania State University M.S.Hershey Medical Center, Hershey, PA 17033 2Department of Obstetrics and Gynecology, University of Southern California/Women's Hospital Los Angeles, CA 90033 3Department of Obstetrics and Gynecology, Columbia University of Physicians and Surgeons 622 West 168th Street, PH-16, New York, NY 10032, USA
Correspondence: 4To whom correspondence should be addressed
An early marker predictive of a viable pregnancy would ease the anxiety associated with positive pregnancy tests after the use of donor oocytes. We examined the predictive value of an early serum quantitative human chorionic gonadotrophin (Q-HCG) concentration on pregnancy outcome following oocyte donation. Embryo transfers after oocyte donation resulting in a positive serum 
-HCG were examined beginning 9 days after embryo transfer from those samples assayed in our laboratory (n = 77). Q-HCG concentrations were measured in our laboratory by an immunoradiometric assay utilizing the first International Reference Preparation. Implantations were defined as the number of gestational sacs visualized by transvaginal ultrasound 21 days after embryo transfer. Biochemical pregnancies were those with transient elevations in -HCG concentration but without implantation sites. Spontaneous abortions were characterized by an implantation site with the eventual arrest of development. Ongoing/delivered pregnancies developed appropriately and proceeded beyond the first trimester. Day 9 Q-HCG concentrations did not differentiate between biochemical pregnancies/spontaneous abortions and ongoing/delivered pregnancies, although mean ± SD concentrations for biochemical pregnancies were significantly lower than those for the other groups (P < 0.0001): biochemical pregnancies, n = 18, 5.8 ± 8.9 mlU/ml, range 0–35; spontaneous abortions, n = 2, 46.0 ± 10.0 mlU/ml, range 39–53; ongoing/delivered pregnancies, n = 57, 41.5 ± 35.4 mlU/ml, range 0–214. In addition, day 9 Q-HCG concentrations did not differentiate between multiple implantations, although the implantation of four sacs had a significantly higher mean Q-HCG concentration compared with the implantation of fewer sacs (P > 0.0001): one sac, n = 22, 32.2 ± 21.5 mlU/ml, range 3–78; two sacs, n = 25, 35.8 ± 21.3, range 0–81; three sacs, n = 7, 47.1 ± 37.1 mlU/ml, range 22–126; four sacs, n = 4, 122.3 ± 62.4 mlU/ml, range 76–214. The positive predictive value of a Q-HCG >10 mlU/ml was 0.91 (sensitivity 91%, specificity 75%). These initial data suggest that early day 9 serum Q-HCG determinations do not accurately identify viable pregnancies or multiple implantations. Even an early negative pregnancy test should be repeated because it can be associated with a normal pregnancy.
Key words: ART pregnancies/donor oocytes/HCG/predictive value
*This paper was presented at the 50th Annual Meeting of the American Fertility Society, San Antonio, TX, USA, November 5–10, 1994.
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