整倍体单细胞冷冻移植后HCG的升高模式！

Objective

目 的

Initial serum HCG levels are measured less than two weeks after FET, and interpretation of HCG levels is crucial in early diagnosis of viability of pregnancies. Prior studies have described a quadratic curve with an earlier plateau in viable pregnancies conceived with in vitro fertilization compared to unassisted pregnancies. In pregnancies achieved by single euploid FET, more studies are needed to understand thresholds and expected trends to differentiate viability from ectopic pregnancy and pregnancy loss. In this study we aimed to evaluate HCG trends following single euploid FET in cases resulting in live birth, ectopic pregnancy,and spontaneous loss.

冷冻胚胎移植术（FET）后两周内能够测出血清人绒毛膜促性腺激素（HCG）水平，而HCG水平的解读在早期诊断妊娠的持续能力至关重要。既往研究表明，体外受精妊娠与自然妊娠相比，妊娠抛物线图达平台期更快。然而，对于整倍体单胚胎FET妊娠周期，仍需要更多的研究了解阈值和预期趋势来区分存活能力、异位妊娠和妊娠丢失。在本研究中，我们旨在评估整倍体单胚胚胎FET后活产、异位妊娠和妊娠丢失情况下的HCG趋势。

MATERIALS AND METHODS:

材料与方法

This is a retrospective cohort study including patients who underwent single euploid FET at a university-affiliated fertility center between January 2017 to August 2022. Serum HCG level measurements on day 9 and 11 after FET were studied. Patients with a decline between days 9 and 11 were excluded. The primary outcome was the rise in HCG between days 9 and 11 in patients with live birth. Secondary outcomes included rise in HCG between days 9 and 11 in patients with ectopic pregnancy and spontaneous loss. Logarithmic curves were also fit to the distribution of HCG trend in live birth, as well as ectopic pregnancy and spontaneous loss.

本研究为回顾性队列研究，纳入2017年01月至2022年08月在一所大学附属的生殖中心进行整倍体单胚胎FET的患者，研究FET后第9天和第11天的血清HCG水平，排除第9天至11天HCG下降的患者。主要结果为活产患者在第9天至第11天内HCG水平的上升趋势。次要结果包括异位妊娠和妊娠丢失患者在第9天至第11天内HCG水平的上升趋势。对数曲线也符合血清HCG水平在活产、异位妊娠、妊娠丢失的分布趋势。

RESULTS

结 果

A total of 3,543 subjects met inclusion criteria. Results were analyzed in three groups of pregnancy outcomes: live birth, ectopic pregnancy and spontaneous loss. All HCG values were formed to the natural log scale to create a normal distribution in each group. The mean HCG value on day 9 after FET in the live birth group was 195.3mIU/mL, which was increased compared to both ectopic and spontaneous loss groups (33.1mIU/mL and 122.0mIU/mL, respectively).The mean % rise between day 9 and day 11 in the live birth group was 168.7%, compared to 142.8% in the spontaneous loss group. In the live birth group, 99% of patients had a rise of at least 54.4%.

共有3543名受试者符合纳入标准。分析了活产、异位妊娠和妊娠丢失三组妊娠结局的结果。所有HCG值均按自然对数比例形成，在每一组中形成正态分布。活产组FET后第9天的平均HCG值为195.3mIU/mL，较异位妊娠组和妊娠丢失组均有增加（分别为33.1mIU/mL和122.0mIU/mL）。活产组第9天至第11天之间的平均百分比上升为168.7%，而妊娠丢失组为142.8%。在活产组中，99%的患者上升了至少54.4%。

CONCLUSIONS

结 论

Early serum HCG values and % rise measured after single, euploid FET are higher in pregnancies resulting in live birth compared to those resulting in ectopic pregnancy and spontaneous loss. In cases where an increase is appreciated 48 hours apart, the trend is significantly decreased in pregnancies later diagnosed as ectopic or nonviable compared to those resulting in live birth, reflecting a similar trend in unassisted pregnancies. This data helps to define the rise appreciated in highly desired pregnancies that ultimately result in live birth, and suggest observation rather than intervention in early stages after FET.

单个整倍体胚胎FET后活产患者早期血清HCG值及其后上升的百分比相较妊娠结局为异位妊娠及妊娠丢失的患者更高。在间隔48小时HCG上升的患者中，与活产组相比，异位妊娠或妊娠丢失组升高的趋势显著下降，趋势类似自然妊娠的趋势。这一数据有助于定义辅助生殖助孕后活产的HCG期望上升值，并建议在FET后的早期阶段进行观察而不是干预。

IMPACT STATEMENT

影响陈述

HCG values and rise in the setting of single,euploid, FET are higher in pregnancies resulting in live birth compared to those resulting in ectopic pregnancy and spontaneous loss. Understanding HCG trends enables improved management of patient expectations in early pregnancies achieved through single, euploid FET.

整倍体单胚胎FET活产患者的HCG水平上升比例较异位妊娠和妊娠丢失高。了解HCG趋势有助于管理整倍体单胚胎FET后早期妊娠患者的期望值。

文章来源：

CHARACTERIZING SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) RISE PARADIGM IN THE SETTING OF SINGLE, EUPLOID, FROZEN EMBRYO TRANSFER (FET): FINDINGS FROM 3,543 PREGNANCIESWillson, Stephanie et al.Fertility and Sterility, Volume 120, Issue 4, e28 - e29