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

• 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).

ABOUBAKR ELNASHAR

• 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).

ABOUBAKR ELNASHAR

• Recently HCG measurements were proposed to predict pregnancy outcome even as early as 11-12 days after embryo transfer

(Frishman et al., 2001).

ABOUBAKR ELNASHAR

Aim of the work

To determine the role of B HCG assay

in prediction of pregnancy outcome &

multiple gestation after ICSI .

ABOUBAKR ELNASHAR

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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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.

ABOUBAKR ELNASHAR

• 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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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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•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

ABOUBAKR ELNASHAR

ABOUBAKR ELNASHAR

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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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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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%

ABOUBAKR ELNASHAR

• 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%.

ABOUBAKR ELNASHAR

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

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.

ABOUBAKR ELNASHAR

ABOUBAKR ELNASHAR