The Predictive Value of Serum Human ChorionicGonadotropin (β-hCG) in Detection of Ectopic PregnancyFollowing Assis ted Reproductive Technology (ART)

Ectopic pregnancy is a well-known risk of IVF. The rate ofectopic pregnancy is higher in pregnancies resulting from assisted reproduction technologies (ARTs) than in spontaneouspregnancies. Ectopic pregnancy is the mos t common reason formaternal mortality in early pregnancy and ۵ to ۱۰% of all maternaldeaths.The incidence of ectopic pregnancy after IVF generally rangesfrom ۲.۱ to ۸.۶% of all clinical pregnancies. several factorswere associated with increased risk of ectopic pregnancy afterART and include tubal factor infertility, use of assis ted hatching,and intracytoplasmic sperm injection, fresh compared withfrozen embryo transfers, day of embryo transfer, and the hormonalmilieu specific to ovarian s timulation. Delay in detectionof EP following ART has occurred in ۱۲.۹% of cases. EPrupture which occurred due to delay in its early diagnosis isresponsible for more than a third of maternal mortality in thefirs t trimes ter.Early diagnosis of ectopic pregnancy is done by β- hCG titersand Transvaginal sonography. But ultrasound is not completelyeffective before ۵-۶ weeks of pregnancy.Human chorionic gonadotrophin (HCG) is one of the prime physiologicalcandidates for embryo–endometrial signal transduction,which can be detected in maternal blood as early as ۶–۸ days afterfertilization. As a key pregnancy hormone secreted by trophoblas tcells during initial implantation and subsequent pregnancy, maternalserum HCG is widely used in pregnancy tes ts. Moreover,HCG is regarded as the earlies t reliable factor for predicting clinicaloutcomes after embryo transfer in IVF and intracytoplasmicsperm injection (ICSI) cycles. Higher initial maternal serum HCGlevels are associated with better outcomes on ongoing pregnanciesand live births, whereas lower HCG levels indicated poorprognosis such as biochemical pregnancy, miscarriage, ectopicpregnancy. Different s tudies have determined the cutoff value ofHCG that can discriminate viable from non-viable pregnancies.However and ideally, each ART center should analyze its owndata to determine HCG cutoff value based on its experience.