Whispers of Life: Unveiling the Impact of Low β-HCG in IVF Pregnancies

Embarking on a journey through a historic cohort spanning from 2009 to 2017 at a distinguished university medical center, this groundbreaking study delves into the repercussions of initial low serum β-human chorionic gonadotropin (HCG) levels following in vitro fertilization (IVF). As we navigate the landscape of IVF outcomes, this comprehensive analysis focuses on live singleton deliveries post-IVF, meticulously excluding oocyte recipients.

Join us in decoding the whispers of early pregnancy, where the first hints of low β-HCG levels unfold a tale of potential preterm challenges. Placental examinations, perinatal outcomes, and a nuanced understanding of pregnancies with lower 10th percentile β-HCG levels provide profound insights, urging a call for heightened vigilance in the management of IVF pregnancies that begin with this initial whisper. Stay with us as we unravel the complexity of this pioneering study, offering a nuanced approach to IVF pregnancies and redefining our understanding of low β-HCG's impact on preterm risks.

Navigating the Landscape of IVF Outcomes

This comprehensive analysis includes live singleton deliveries post-IVF, meticulously excluding oocyte recipients. Patients with low day 16 embryo age β-HCG levels (defined as the lower 10th percentile) constitute the low β-HCG group, confronting outcomes against a control group with initial β-HCG levels above this threshold. Placental examination, irrespective of complication status, offers profound insights categorized according to the Amsterdam Placental Workshop Group Consensus.

Unraveling the Tale of Low β-HCG

The lower 10th percentile of β-HCG corresponds to 149 mUI/mL. With 103 cases in the low β-HCG group and 928 in the control group, maternal demographics stand comparable, but blastocyst transfer is notably more common in the control group. The low β-HCG cohort witnesses a starkly increased rate of preterm births (15.5% vs. 8.1%, p=0.01), maintaining significance after adjusting for blastocyst transfer. Placentas in the low β-HCG group reveal a higher incidence of velamentous cord insertion (19.4% vs. 7.7%, p<0.001) and single umbilical artery (3.8% vs. 0.6%, p=0.01).

Echoes of a Whisper in the Womb

Live births arising from IVF with an initial low β-HCG level carry a two-fold increase in preterm births, accompanied by notable placental gross and histological changes. These findings advocate for a nuanced approach in managing pregnancies with an initial low β-HCG, potentially considering them under the umbrella of high-risk pregnancies.

Navigating the Uncertainty – A Call for Vigilance

While the link between initial low β-HCG and pregnancy viability is well-established, this study pioneers insights into outcomes within viable pregnancies. The discernible elevation in the risk of preterm birth and placental pathology emphasizes the need for heightened vigilance and potential high-risk pregnancy management in IVF cases with an initial low β-HCG level.

Reference: https://doi.org/10.1016/j.fertnstert.2022.08.772