Mediating role of serum β-hCG levels in the relationship between blastocyst quality and pregnancy outcomes in frozen-thawed single blastocyst transfer
10.3760/cma.j.cn101441-20250213-00063
- VernacularTitle:冻融周期单囊胚移植中血清β-hCG水平对囊胚质量与妊娠结局关系的中介作用研究
- Author:
Peixin LI
1
;
Ruowen ZU
1
;
Bingnan REN
1
;
Jingyi HAN
1
;
Wei ZHENG
1
;
Chen YANG
1
;
Yichun GUAN
1
Author Information
1. 郑州大学第三附属医院生殖健康医院，郑州 450052
- Publication Type:Journal Article
- Keywords:
Pregnancy outcome;
Mediation analysis;
β-human chorionic gonadotropin;
Single blastocyst transfer;
Frozen-thawed cycle
- From:
Chinese Journal of Reproduction and Contraception
2025;45(6):582-590
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the mediating role of serum β-human chorionic gonadotropin (hCG) levels on the relationship between embryo quality and pregnancy outcomes following single frozen-thawed blastocyst transfer 14 d post-transfer.Methods:This retrospective cohort study collected data from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between August 2017 and June 2021. Patients were grouped according to embryo quality into good-quality blastocyst group ( n=3 191) and available blastocyst group ( n=2 027). Differences in serum β-hCG levels and pregnancy outcomes at 14 d post-transfer were compared between the two groups. Mediation analysis and receiver operating characteristic (ROC) analysis were used to explore the mediating effect of β-hCG levels on the relationship between embryo quality and pregnancy outcomes and to evaluate the differences in the incidence of placental-related diseases between the two groups. Results:The good-quality blastocyst group had significantly higher serum β-hCG levels [1 177.0 (1.8, 2 278.5) U/L], clinical pregnancy rate [65.62% (2 094/3 191)], and live birth rate [52.55% (1 667/3 191)] compared with the available blastocyst group [54.4 (0.1, 1 453.5) U/L, P<0.001; 46.13% (935/2 027), P<0.001; 34.19% (693/2 027), P<0.001]. The early miscarriage rate in the good-quality group [13.47% (282/2 094)] was lower than that in the available blastocyst group [19.14% (179/935), P<0.001]. Serum β-hCG levels at 14 d post-transfer showed significant mediating effects on clinical pregnancy rate ( r=-0.126), live birth rate ( r=-0.122), and early miscarriage rate ( r=0.028) in both groups (all P<0.001). The cut-off values for β-hCG to predict live birth in the available and good-quality blastocyst groups were 366.9 U/L and 485.5 U/L, with positive predictive values of 76.28% (672/881) and 82.84% (1 628/1 965), respectively, and negative predictive values of 98.15% (1 114/1 135) and 96.14% (1 170/1 217). The cut-off values for predicting clinical pregnancy were 118.8 U/L and 226.5 U/L, with positive predictive values of 95.43% (919/963) and 98.45% (2 037/2 069), and negative predictive values of 99.72% (1 050/1 053) and 94.89% (1 059/1 116). The cut-off values for predicting early miscarriage were 1 337.0 U/L and 1 162.6 U/L, with positive predictive values of 32.75% (130/397) and 30.18% (150/497), and negative predictive values of 90.89% (489/538) and 91.73% (1 465/1 597). No differences were found in the incidence of placental-related diseases between the two groups (all P>0.05). Conclusion:This study indicates that both embryo quality and serum β-hCG levels at 14 d post-transfer significantly affect pregnancy outcomes. β-hCG levels play an important mediating role between embryo quality and pregnancy outcomes. ROC analysis demonstrates the good predictive efficacy of serum β-hCG levels for pregnancy outcomes, providing scientific evidence for optimizing embryo selection.
