Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지
DOI QR코드

DOI QR Code

Development of a novel nomogram for predicting ongoing pregnancy after in vitro fertilization and embryo transfer

  • Kim, Seul Ki (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital) ;
  • Kim, Hyein (Department of Obstetrics and Gynecology, Seoul National University Hospital) ;
  • Oh, Soohyun (Department of Obstetrics and Gynecology, Seoul National University Hospital) ;
  • Lee, Jung Ryeol (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital) ;
  • Jee, Byung Chul (Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital) ;
  • Kim, Seok Hyun (Department of Obstetrics and Gynecology, Seoul National University College of Medicine)
  • Received : 2017.12.09
  • Accepted : 2018.05.01
  • Published : 2018.11.15
⟨ Previous Next ⟩

Abstract

Objective This study aimed to develop a nomogram that predicts ongoing pregnancy after in vitro fertilization and embryo transfer (IVF-ET) using patient age and serum hormonal markers. Methods A total of 284 IVF-ET cycles were retrospectively analyzed. At 14 days post-oocyte pick-up (OPU), the serum human chorionic gonadotropin (HCG) and progesterone levels were measured. The main predicted outcome was ongoing pregnancy. Results Patient age and serum of HCG and progesterone levels at 14 days post-OPU were good predictors of ongoing pregnancy. The cut-off value and area under the curve (AUC) (95% confidence interval) were 36.5 years and 0.666 (0.599-0.733), respectively, for patient age; 67.8 mIU/mL and 0.969 (0.951-0.987), respectively, for serum HCG level; and 29.8 ng/mL and 0.883 (0.840-0.925), respectively, for serum progesterone level. When the prediction model was constructed using these three parameters, the addition of serum progesterone level to the prediction model did not increase its overall predictability. Furthermore, a high linear co-relationship was found between serum HCG and progesterone levels. Therefore, we developed a new nomogram using patient age and HCG serum level only. The AUC of the newly developed nomogram for predicting ongoing pregnancy after IVF-ET cycles using patient age and serum HCG level was as high as 0.975. Conclusion We showed that ongoing pregnancy may be predicted using only patient age and HCG serum level. Our nomogram could help clinicians and patients predict ongoing pregnancy after IVF-ET if the serum JCG level was ${\geq}5IU/L$ at 14 days post-OPU.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

References

  1. Turner K, Reynolds-May MF, Zitek EM, Tisdale RL, Carlisle AB, Westphal LM. Stress and anxiety scores in first and repeat IVF cycles: a pilot study. PLoS One 2013;8:e63743. https://doi.org/10.1371/journal.pone.0063743
  2. Kim JH, Shin MS, Yi G, Jee BC, Lee JR, Suh CS, et al. Serum biomarkers for predicting pregnancy outcome in women undergoing IVF: human chorionic gonadotropin, progesterone, and inhibin A level at 11 days post-ET. Clin Exp Reprod Med 2012;39:28-32. https://doi.org/10.5653/cerm.2012.39.1.28
  3. Wang Q, Zhang R, Jia M, Luo L, Ding C, Li TC, et al. Serum human chorionic gonadotropin measured 7 days following day 3 embryo transfer might predict pregnancy outcome in IVF. Gynecol Endocrinol 2017;33:62-6. https://doi.org/10.1080/09513590.2016.1203894
  4. Urbancsek J, Hauzman E, Fedorcsak P, Halmos A, Devenyi N, Papp Z. Serum human chorionic gonadotropin measurements may predict pregnancy outcome and multiple gestation after in vitro fertilization. Fertil Steril 2002;78:540-2. https://doi.org/10.1016/S0015-0282(02)03278-8
  5. van Mello NM, Mol F, Opmeer BC, Ankum WM, Barnhart K, Coomarasamy A, et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update 2012;18:603-17. https://doi.org/10.1093/humupd/dms035
  6. Eastham JA, Kattan MW, Scardino PT. Nomograms as predictive models. Semin Urol Oncol 2002;20:108-15. https://doi.org/10.1053/suro.2002.32936
  7. Kim JH, Jee BC, Suh CS, Kim SH. Nomogram to predict ongoing pregnancy using age of women and serum biomarkers after in vitro fertilization cycles. Eur J Obstet Gynecol Reprod Biol 2014;172:65-9. https://doi.org/10.1016/j.ejogrb.2013.10.015
  8. Tulchinsky D, Hobel CJ. Plasma human chorionic gonadotropin, estrone, estradiol, estriol, progesterone, and 17 $\alpha$-hydroxyprogesterone in human pregnancy. 3. Early normal pregnancy. Am J Obstet Gynecol 1973;117:884-93. https://doi.org/10.1016/0002-9378(73)90057-4
  9. van Kooij RJ, Looman CW, Habbema JD, Dorland M, te Velde ER. Age-dependent decrease in embryo implantation rate after in vitro fertilization. Fertil Steril 1996;66:769-75. https://doi.org/10.1016/S0015-0282(16)58634-8
  10. Arck P, Hansen PJ, Mulac Jericevic B, Piccinni MP, Szekeres-Bartho J. Progesterone during pregnancy: endocrine-immune cross talk in mammalian species and the role of stress. Am J Reprod Immunol 2007;58:268-79. https://doi.org/10.1111/j.1600-0897.2007.00512.x

Cited by

  1. Predictive value of serum β-human chorionic gonadotropin for early pregnancy outcomes vol.301, pp.1, 2018, https://doi.org/10.1007/s00404-019-05388-2