Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization
Received 30 August 2007; received in revised form 10 March 2008; accepted 10 March 2008. published online 24 July 2008.
Objective
To determine if embryonic heart rate (EHR) is useful to predict first-trimester pregnancy outcome after in vitro fertilization (IVF).
Design
Retrospective analysis.
Setting
University-based infertility center.
Patient(s)
Six hundred fifty patients who completed IVF with singleton implantations from October 2002 to September 2006 were identified.
Intervention(s)
Transvaginal sonography at 4–6 weeks' embryonic age.
Main Outcome Measure(s)
Embryonic heart rate at 4–6 weeks' embryonic age and first-trimester pregnancy outcome.
Result(s)
Ninety-five patients (14.6%) spontaneously aborted, and 555 (85.4%) patients had clinical pregnancies beyond the first trimester. Groups were similar regarding gravidity, parity, embryos transfered, embryonic age at time of sonogram for EHR, and infertility diagnosis. Mean maternal age was significantly higher in the group that spontaneously aborted. Mean EHR was significantly lower in the group that spontaneously aborted. Multivariate logistic regression confirmed the best predictors of poor pregnancy outcome: increasing maternal age (odds ratio [OR] 1.18) and lower EHR (OR 1.07).
Conclusion(s)
Embryonic heart rate, independent of maternal age, is useful to help predict first-trimester pregnancy prognosis after IVF. Infertility patients with a low EHR (≤110 bpm) at 4–6 weeks' embryonic age should be counseled that they are at increased risk for first-trimester pregnancy loss.
aCenter for Reproductive Medicine and Infertility, Weill Medical College of Cornell University, New York, New York
bDivision of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, New York
Reprint requests: Eden R. Rauch, M.D., M.P.H., Center for Reproductive Medicine and Infertility, 1305 York Avenue, 7th Floor, New York, New York 10021 (FAX: 212-746-8208).
E.R. has nothing to disclose. G.S. has nothing to disclose. P.C. has nothing to disclose. T.C. has nothing to disclose. Z.R. has nothing to disclose.
Presented at the American Society or Reproductive Medicine, Montreal, Canada, November 2005.
ABSTRACT