Prediction of Pregnancy Outcome and Multiple Gestation by Measurement of Serum hCG after ICSI

1. Prediction of Pregnancy Outcome and
Multiple Gestation by Measurement of Serum
hCG after ICSI
A El Nashar, N Ashmawy, A Rezk, T Asar
Benha university, Egypt
ABOUBAKR ELNASHAR

2. • The anxiety and uncertainty of pregnancy
outcome following ICSI procedure is one of
main psychological stresses for couples
undergoing ART cycles
(Theocaris et al., 2001).
• In addition, closer follow-up of multiple
gestation that is started as early as possible
is beneficial
(Urbancesek et al., 2002).
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3. • For the past 20ys, investigators
have sought to define tests which
are predictive of pregnancy out
come following ART.
• Several tests:
P, E2, inhibin
But, the clinical role of these
measurements is not yet fully
established
(Lockwood et al., 1998).
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4. • Recently HCG measurements
were proposed to predict
pregnancy outcome even as early
as 11-12 days after embryo transfer
(Frishman et al., 2001).
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5. Aim of the work
To determine the role of B HCG assay
in prediction of pregnancy outcome &
multiple gestation after ICSI .
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6. PATIENTS AND METHODS
35 females were subjected to:
1- History
2- Physical Examination
3- Infertility work up:
a- Semen analysis.
b- HSG.
c- Midluteal P
d- Pelvic U/S
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7. 4- Superovulation Protocol: Mid Luteal Long
Protocol
5- Oocyte retrieval is scheduled 34-36 hours after
HCG injection.
6- ICSI procedure was done
7- Incubation of injected oocytes for 48 hour.
8- Embryo transfer: under ultrasound
guidance.
9- Luteal phase support by progesterone only
(not HCG) is commenced on the day of ET.
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8. • 10- β- subunit assay using electrochemiluminescence
immunoassay “ECLIA” technique on 2 days between day
8 & 18 post ET to calculate β- HCG of theoretical day 11
post ET through the following equations
• HCG1 is the initial HCG recording.
• HCG2 is the subsequent HCG recording.
• The doubling time is defined as the number of days
required for serum HCG concentration to double.
log2 × (time interval in days)
log ( HCG2 / HCG1 )
(11-day1) / doubling time
• Doubling time =
• HCGday11=HCG1 × 2
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9. 11- This collection of data is filed associated with patient
name, age, height, weight, duration of infertility,
indication of ICSI, and ultrasonic follow up of
pregnancy in case of successful ICSI.
13- Clinical follow up of successful ICSI and ultrasonic
evaluation at 6 weeks, 8 weeks, 12 weeks, 20 weeks
and antenatal care of these pregnant cases and
evaluation of neonatal outcome.
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10. •Statistical analysis of different cutoff values of
day 11 post ET β-HCG level was used to
determine the most accurate cutoff value
predicting clinical pregnancy, ongoing
pregnancy and multiple gestation
•We used likelihood ratio as a parameter for the
validity of the cutoff value
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11. ABOUBAKR ELNASHAR

12. Table (1) Prediction of clinical pregnancy using
different -hCG values on day 11 post ET.
Cut off
Values
50
mlU/ml
75
mlU/ml
100
mlU/ml
125
mlU/ml
150
mlU/ml
Sensitivity 93% 59% 43% 31% 25%
Specificity 66% 100% 100% 100% 100%
+ve P. V. 96% 100% 100% 100% 100%
-ve P. V. 50% 18% 14% 12% 11%
+ve LR 2.7 ∞ ∞ ∞ ∞
-ve LR 0.1 0.41 0.66 0.69 0.75
Accuracy 91% 62.8% 48% 37% 31%
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13. Table (2) Prediction of ongoing pregnancy using
different -hCG values on day 11 post ET.
Cut off
Values
50
mlU/ml
75
mlU/ml
100
mlU/ml
125
mlU/ml
150
mlU/ml
Sensitivity 92% 55% 40% 29% 22%
Specificity 25% 50% 62% 75% 75%
+ve P. V. 80% 78.9% 78% 80% 75%
-ve P. V. 50% 25% 23% 24% 22%
+ve LR 1.2 1.1 1.05 1.16 1.04
-ve LR 0.32 0.9 0.96 0.94 0.8
Accuracy 77% 54% 45% 40% 34%
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14. Table (3) Prediction of multiple pregnancy using
different -hCG values on day 11 post ET.
Cut off
Values
50
mlU/ml
100
mlU/ml
150
mlU/ml
200
mlU/ml
250
mlU/ml
Sensitivity 100% 66% 33% 11% 11%
Specificity 23% 88% 94% 100% 100%
+ve P. V. 58% 85% 87% 100% 100%
-ve P. V. 100% 71% 59% 51% 51%
+ve LR 1.29 5.5 5.3 ∞ ∞
-ve LR 0 0.38 0.65 0.89 0.89
Accuracy 62% 77% 65% 54% 54%
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15. • So results of statistical analysis of
theoretical day 11 (post ET) β-HCG level
show that:
– The most accurate cutoff value for prediction of
clinical pregnancy is 50mIU/ml with accuracy of
91%.
– The most accurate cutoff value for prediction of
ongoing pregnancy is 50mIU/ml with accuracy of
77%.
– The most accurate cutoff value for prediction of
multiple pregnancy is 100mIU/ml with accuracy of
77%.
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16. CONCLUSION
1) β-HCG measurement is an important predictor of
pregnancy outcome and multiple gestation after
ICSI.
2) Theoretical day 11 (post ET) β-HCG level showed
that the most accurate cutoff value for prediction of
clinical pregnancy and ongoing pregnancy was
50mIU/ml, and for prediction of multiple pregnancy
was 100mIU/ml.
ABOUBAKR ELNASHAR

17. RECOMMENDATION
1) The theoretical day11 (post ET)
β-HCG level should be determined in every patient
undergoing ICSI to predict the outcome of ICSI.
2) Further prospective studies including a larger number
of cases are required.
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18. ABOUBAKR ELNASHAR