Initial values of human chorionic gonadotropin as a prognostic variable of pregnancy evolution in assisted reproduction

In assisted reproduction programs, once a pregnancy has been achieved, the power of predicting its evolution is important for the medical team as well as for the patient. The determination of pregnanediol or of placental protein 14 levels has been postulated as a predictive factor, however, the determination of hCG is, seemingly, the most adequate parameter for the detection of early developmental alterations during pregnancy. To determine those predictive values of hCG which establish a prognosis concerning the evolution of pregnancy through the analysis of the values of this hormone on post-transference days 14 and 16, as well as to determine hCG values for multiple pregnancies. Data from 88 patients participating in the in vitro fertilization program, in whom pregnancy was achieved, were retrospectively analyzed, and hCG levels were determined on post-transference days 14 and 16. Results were analyzed by the ANOVA test in order to compare mean values, & ROC were used to determine sensitivity and specificity. The patients were divided in three groups: 1) pregnant for more than 26 weeks; 2) pregnant for less than 26 weeks; and 3) chemical pregnancy. Significant differences in hCG levels on post-transference days were observed among these groups of patients. The levels of hCG, on post-transference day 14, 113 IU/L, and on day 16, 403 IU/L, presented, respectively, an 80% and 79% specificity, while the greater than 200.33 IU/L hCG increase offers a sensitivity and specificity of 80% and 83%, respectively, for a pregnancy of more than 26 weeks. In order to consider hCG levels as predictive for a high fetal order pregnancy, it was observed that hCC levels of 270.42 UI/L on day 14 present a sensitivity of 91% with a specificity of 64%, and levels higher than 837.14 IU/L on day 16 offer a sensitivity and specificity of 91% and 62%, respectively. The determination of hCG levels greater than 113 IU/L on day 14 and greater than 403 IU/L on day 16 offer adequate sensitivity and specificity as predictive factors for pregnancy evolution beyond the 26 GW, while hCG levels of 270.42 and 837.14, respectively, on days 14 and 16 offer a very high sensitivity (91%) for multiple pregnancy.