Abstract
Purpose
To evaluate the association, if any, between the grade of the trophectoderm (TE) and the rate at which β-human-chorionic gonadotropin (β-HCG) rises in early pregnancy.
Methods
This is a retrospective cohort study including 1116 singleton clinical pregnancies resulting from in vitro fertilization with single day 5 blastocyst transfer at an academic fertility center. TE quality was assessed by trained embryologists employing standard criteria. Three groups were formed based on the TE grade: grade A (n = 358), grade B (n = 628), and grade C (n = 130). Main outcome measure was the rise (%) in serum levels of β-HCG (days 12 to 14 post embryo transfer), using the following formula [(β-HCG D14 − β-HCG D12) * 100/β-HCG D12].
Results
Fresh embryo transfers accounted for 64.1% of the population. Overall, in adjusted models there were no significant differences in the β-HCG% rise when comparing the TE grade C group to TE grade A [adjβ (95%CI): 10.09 (− 0.05, 20.22)] or when comparing TE grade Β group to TE grade A [4.46 (− 2.97, 11.88)]. When the analysis was restricted to fresh embryo transfers, significant differences were observed in the % rise of β-HCG when comparing the TE grade C group to TE grade A [adjβ (95%CI): 21.71 (5.67, 37.74)], but not when comparing the TE grade B group to TE grade A [2.68 (− 5.59, 10.95)]. In frozen transfers, there were no significant differences.
Conclusion
TE grade appears to impact early pregnancy serum β-HCG levels in the setting of a fresh day 5 embryo transfer, even after adjusting for potential confounders.
Similar content being viewed by others
References
Marikawa Y, Alarcon VB. Creation of trophectoderm, the first epithelium, in mouse preimplantation development. Results Probl Cell Differ. 2012;55:165–84. https://doi.org/10.1007/978-3-642-30406-4_9.
Betz D, Fane K. 2023 Human chorionic gonadotropin. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Kathleen Fane declares no relevant financial relationships with ineligible companies
Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004;104(1):50–5. https://doi.org/10.1097/01.AOG.0000128174.48843.12.
Kadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol. 1981;58(2):162–6.
Rauchfuss LK, Ainsworth AJ, Shenoy CC. Abnormal rate of human chorionic gonadotropin rise: a case series of patients with viable intrauterine pregnancies after embryo transfer. F S Rep. 2021;2(1):129–32. https://doi.org/10.1016/j.xfre.2020.11.006.
Barnhart KT, Guo W, Cary MS, Morse CB, Chung K, Takacs P, et al. Differences in serum human chorionic gonadotropin rise in early pregnancy by race and value at presentation. Obstet Gynecol. 2016;128(3):504–11. https://doi.org/10.1097/AOG.0000000000001568.
Chung K, Sammel MD, Coutifaris C, Chalian R, Lin K, Castelbaum AJ, et al. Defining the rise of serum HCG in viable pregnancies achieved through use of IVF. Hum Reprod. 2006;21(3):823–8. https://doi.org/10.1093/humrep/dei389.
Morse CB, Barnhart KT, Senapati S, Sammel MD, Prochaska EC, Dokras A, et al. Association of the very early rise of human chorionic gonadotropin with adverse outcomes in singleton pregnancies after in vitro fertilization. Fertil Steril. 2016;105(5):1208–14. https://doi.org/10.1016/j.fertnstert.2015.12.141.
Shamonki MI, Frattarelli JL, Bergh PA, Scott RT. Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: an analysis of 6021 pregnancies. Fertil Steril. 2009;91(5):1760–4. https://doi.org/10.1016/j.fertnstert.2008.02.171.
Hughes LM, Schuler A, Sharmuk M, Schauer JM, Pavone ME, Bernardi LA. Early beta-hCG levels predict live birth after single embryo transfer. J Assist Reprod Genet. 2022;39(10):2355–64. https://doi.org/10.1007/s10815-022-02606-w.
Mejia RB, Cox TW, Nguyen EB, Summers KM, Eyck PT, Sparks AE, et al. Effect of body weight on early hormone levels in singleton pregnancies resulting in delivery after in vitro fertilization. Fertil Steril. 2018;110(7):1311–7. https://doi.org/10.1016/j.fertnstert.2018.08.047.
Grin L, Indurski A, Leytes S, Rabinovich M, Friedler S. Trends in primeval beta-hCG level increment after fresh and frozen-thawed IVF embryo transfer cycles. Gynecol Endocrinol. 2019;35(3):261–6. https://doi.org/10.1080/09513590.2018.1519789.
Lu MM, Wen YX, Liu YL, Ding CH, Zhou CQ, Xu YW. Trophectoderm biopsy reduces the level of serum beta-human chorionic gonadotropin in early pregnancy. Fertil Steril. 2020;114(4):801–8. https://doi.org/10.1016/j.fertnstert.2020.05.015.
Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155–8. https://doi.org/10.1016/s0015-0282(00)00518-5.
Men CJ, Bormann CL, Walsh BW, Racowsky C. Is the presence of an uncleaved embryo on day 3 a useful predictor of outcomes following day 5 transfer? J Assist Reprod Genet. 2015;32(9):1379–84. https://doi.org/10.1007/s10815-015-0532-0.
Wu Y, Ying Y, Cao M, Liu J, Liu H. Trophectoderm biopsy of blastocysts for a preimplantation genetic test does not affect serum beta-hCG levels in early pregnancy: a study using propensity score matching. J Ovarian Res. 2021;14(1):78. https://doi.org/10.1186/s13048-021-00824-x.
Li Y, Wen Q, Liao J, Ma S, Zhang S, Gu Y, et al. Trophectoderm biopsy differentially influences the level of serum beta-human chorionic gonadotropin with different embryonic trophectoderm scores in early pregnancy from 7847 single-blastocyst transfer cycles. Front Endocrinol (Lausanne). 2022;13:794720. https://doi.org/10.3389/fendo.2022.794720.
Zhang X, Barnes R, Confino E, Milad M, Puscheck E, Kazer RR. Delay of embryo transfer to day 5 results in decreased initial serum beta-human chorionic gonadotropin levels. Fertil Steril. 2003;80(6):1359–63. https://doi.org/10.1016/s0015-0282(03)02201-5.
Committee on Practice B-G. ACOG Practice Bulletin No 191: tubal ectopic pregnancy. Obstet Gynecol. 2018;131(2):e65–77. https://doi.org/10.1097/AOG.0000000000002464.
Knofler M, Haider S, Saleh L, Pollheimer J, Gamage T, James J. Human placenta and trophoblast development: key molecular mechanisms and model systems. Cell Mol Life Sci. 2019;76(18):3479–96. https://doi.org/10.1007/s00018-019-03104-6.
Chen X, Zhang J, Wu X, Cao S, Zhou L, Wang Y, et al. Trophectoderm morphology predicts outcomes of pregnancy in vitrified-warmed single-blastocyst transfer cycle in a Chinese population. J Assist Reprod Genet. 2014;31(11):1475–81. https://doi.org/10.1007/s10815-014-0317-x.
Thompson SM, Onwubalili N, Brown K, Jindal SK, McGovern PG. Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer (eSET): a national study. J Assist Reprod Genet. 2013;30(12):1577–81. https://doi.org/10.1007/s10815-013-0100-4.
Ai J, Jin L, Zheng Y, Yang P, Huang B, Dong X. The morphology of inner cell mass is the strongest predictor of live birth after a frozen-thawed single embryo transfer. Front Endocrinol (Lausanne). 2021;12:621221. https://doi.org/10.3389/fendo.2021.621221.
Steiner N, Al Mamari N, Rotshenker-Olshinka K, Khayat S, Alzawawi N, Son WY, et al. Blastocyst morphology has no relationship with serum beta-hCG levels and live birth rates once pregnant. Eur J Obstet Gynecol Reprod Biol. 2021;258:98–102. https://doi.org/10.1016/j.ejogrb.2020.12.047.
Dokras A, Sargent IL, Barlow DH. Human blastocyst grading: an indicator of developmental potential? Hum Reprod. 1993;8(12):2119–27. https://doi.org/10.1093/oxfordjournals.humrep.a137993.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Vagios, S., Cherouveim, P., Fitz, V.W. et al. Trophectoderm grade as a predictor of beta human-chorionic gonadotropin rise in early pregnancy. J Assist Reprod Genet 41, 2311–2318 (2024). https://doi.org/10.1007/s10815-024-03166-x
Received:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1007/s10815-024-03166-x