Human chorionic gonadotropin levels after blastocyst transfer are highly predictive of pregnancy outcome.

OBJECTIVE: To determine the predictive value(s) of beta-hCG serum levels for pregnancy outcome following blastocyst transfer. DESIGN: Retrospective review. SETTING: University-based assisted reproductive technology (ART) program. PATIENTS: All ART patients enrolled from January 1998 to December 1999. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Beta-hCG serum levels and pregnancy outcomes. RESULT(S): Of the 836 ART cycles initiated, 608 embryo transfers met study criteria and were assigned to one of two groups: 248 day 5 blastocyst transfers or 360 day 3 embryo transfers. In the day 5 blastocyst group, 147 pregnancies occurred (59.2%), and day 3 transfers resulted in 165 pregnancies (45.8%). For day 3 and day 5 transfers, mean values of beta-hCG on day 16 post-retrieval of spontaneous abortions were lower than ongoing pregnancies (P< .05). A beta-hCG value on day 16 of >300 mIU/mL predicted an ongoing pregnancy for day 5 transfer group in 97% of pregnancies compared with 92% for day 3 embryo transfers. A multiple gestation was observed in 70% of pregnancies with a beta-hCG level >400 mIU/mL in the day 5 group compared with 63% for the day 3 group. The incidence of higher-order multiple gestations was significantly lower in the day 5 blastocyst group (P< .05). CONCLUSION(S): Beta-hCG serum levels on day 16 post-retrieval were highly predictive of pregnancy outcome after a blastocyst transfer.

Metabolic parameters that predict response to clomiphene citrate in obese oligo-ovulatory women.

OBJECTIVE: To determine whether the presence of insulin resistance in obese subjects would adversely affect the rate of ovulation induction by clomiphene citrate. RESULTS: Fasting hyperinsulinemia was associated with the failure to ovulate in response to clomiphene. In addition, other parameters found to correlate with insulin resistance and clomiphene citrate non-response were elevations of total and free testosterone and lower serum sex hormone-binding globulin. CONCLUSIONS: The existence of the presence of endocrine abnormalities associated with hyperinsulinemia and insulin resistance may serve as clinical indicators to help predict which obese patients are likely to respond to clomiphene citrate therapy.