Date Published: July 14, 2017
Publisher: Public Library of Science
Author(s): Yong Jin Kim, Jung Ho Shin, Jun Yong Hur, Hoon Kim, Seung-Yup Ku, Chang Suk Suh, Jae-Wook Jeong.
To evaluate the predictive value of the progesterone level at the beta-human chorionic gonadotropin (β-hCG) check day for ongoing pregnancy maintenance in in vitro fertilization (IVF) cycles in women with previous unexplained repeated miscarriages.
One hundred and forty-eight women, with visible gestational sac after IVF, were recruited in this observational study. All subjects had unexplained recurrent miscarriages in more than two previous IVF cycles. The progesterone level at the β-hCG check day (i.e. 14 days after oocyte retrieval) was assessed. The area under the curve (AUC) of the progesterone level was evaluated to predict the ongoing pregnancy or miscarriage outcomes.
The overall ongoing pregnancy rate was 60.8% (90/148). The cut-off value with β-hCG levels higher than 126.5 mIU/mL and with progesterone levels higher than 25.2 ng/mL could be the predictive factors for ongoing pregnancy maintenance (AUC = 0.788 and 0.826; sensitivity = 0.788 and 0.723; specificity = 0.689 and 0.833; P < 0.0001 and P < 0.0001, respectively). The miscarriage rates were 19.5% (15/77) in the women with β-hCG > 126.5 mIU/mL and 13.0% (10/77) in those with > 25.2 ng/mL. In the comparison of the ROC curves between both values, a similar significance was found. The subjects with β-hCG > 126.5 mIU/mL and progesterone > 25.2 ng/mL showed higher ongoing pregnancy rates [98.0% (49/50) vs. 41.8% (41/98)] than those with β-hCG ≤ 126.5 mIU/mL or progesterone ≤ 25.2 ng/mL.
The progesterone level at 14 days after oocyte retrieval can be a good predictive marker for ongoing pregnancy maintenance in women with repeated IVF failure with miscarriage, together with the β-hCG level. The combined cut-off value of progesterone > 25.2 ng/mL and β-hCG > 126.5 mIU/mL may suggest a good prognosis.
The overall miscarriage rate in pregnant women after in vitro fertilization (IVF) was reported to be ~23% [1, 2]. For couples who conceive via IVF, miscarriage after confirmation of a visible intrauterine gestational sac (G-sac) can be another “hope torture” in a different way compared to infertility. Furthermore, unexplained recurrent miscarriages after IVF can be a challenging and frustrating condition for both patients and clinicians. Numerous previous studies have suggested the predictors for miscarriage after IVF, such as endometrial thickness  and pattern , anti-Müllerian hormone level , beta-human chorionic gonadotropin (β-hCG) , even previous miscarriage history . However, these predictors may not be clinically valuable in terms of their sensitivity and specificity, especially at early pregnancy period, as the first checked serum β-hCG.
Our study showed that the progesterone level 14 days after oocyte retrieval can be a good predictive marker for ongoing pregnancy maintenance in women with repeated IVF failure, together with the β-hCG level. The combined cut-off value of progesterone > 25.2 ng/mL and β-hCG > 126.5 mIU/mL may suggest a good prognosis.