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This investigation examines the hormone pattern in in vitro fertilization (IVF) cycles from the time of human chorionic gonadotropin (hCG) administration through embryo transfer to ascertain whether the absolute levels or secretory patterns of the major reproductive hormones affect the IVF pregnancy rate. Thirty-one women who underwent IVF treatment were enrolled in the study. All patients received clomiphene citrate/human menopausal gonadotropin for ovulation induction. Significant elevations in serum estradiol (E2) levels in the pregnant group were found throughout the cycle interval studied. After hCG administration the serum hCG levels were not different between the groups. Significant elevations in serum progesterone (P) concentrations were found in the pregnant group from the day after laparoscopy through embryo transfer. Embryos obtained from the pregnant group appeared to be different in that the mean number of blastomeres per embryo transferred was significantly greater. Therefore for achievement of an IVF pregnancy the optimal hormone pattern employing combination ovulation induction in the ovulation to transfer interval is a relatively high E2level in ovulation followed by a high P level at transfer and into the luteal phase. These elevated hormone levels do not depend on the response to exogenous hCG.

Serial human chorionic gonadotropin (hCG) βsubunit measurements of 300 pregnancies achieved by in vitro fertilization (IVF) were obtained by 15 IVF centers worldwide. Hormonal curves were established for 164 normal singleton pregnancies, 25 normal multiple gestations, 60 chemical pregnancies, 41 first-trimester spontaneous abortions, and 10 ectopic pregnancies. In comparison to the normal singleton pregnancy curve, chemical pregnancies and spontaneous abortions showed statistically lower hCG levels. hCG levels of ectopic pregnancies, compared with normal singleton gestations, were lower from days 7 to 14. It is concluded that β-hCG determinations of in vitro fertilized pregnancies allow pregnancy diagnosis as early as 7 to 9days after embryo transfer (ET) and will permit early discrimination between normal and abnormal IVF pregnancies. A single β-hCG determination on day 9 after ET may discriminate chemical, ectopic pregnancy or impending miscarriage from a normal gestation. An hCG determination on day 17 will predict early normal development of an IVF pregnancy.

To study the effects of controlled ovarian hyperstimulation (COH) on endometrial receptivity during human in vitro fertilization (IVF), we compared embryo implantation data obtained from our nonanonymous donor oocyte program with those obtained from standard IVF. To control for embryo quality, IVF patient characteristics were matched to those of the oocyte donors with regard to age and previous gravidity. All cycles were performed in an identical manner, using standardized ovarian stimulation protocols, transvaginal follicle aspiration, fertilization and culture in vitro, and transcervical embryo transfer. A similar number of oocytes per cycle were obtained, fertilization rates were similar, and similar numbers of embryos were transferred in both groups. Transferred embryos had similar numbers of blastomeres and were morphologically judged to be of similar quality in both groups. Implantation rates per individual embryo were significantly higher in donor than in standard IVF (35% versus 10.7%) as were ongoing per embryo implantation rates (23% versus 8%). Clinical and ongoing pregnancy rates per cycle were likewise higher in the donor group than in the standard IVF group (67% versus 39%, and 61% versus 30%, respectively). We conclude that COH inhibits embryo implantation after IVF by decreasing endometrial receptivity, which is an important factor in IVF pregnancy success.

Pregnancy rates vary considerably with the type of ovarian stimulation used for in vitro fertilization and embryo transfer (IVF-ET). The window of implantation may represent one of the rate-limiting steps in IVF success. We therefore investigated estimated implantation times of 10 consecutive IVF singleton pregnancies, achieved using pituitary suppression with gonadotropin-releasing hormone agonist (GnRH-a) before and during ovarian stimulation with human menopausal gonadotropins (hMG), and compared those with 9 consecutive IVF pregnancies achieved by hMG stimulation only. Estimated implantation times were calculated by regression analysis of serial human chorionic gonadotropin (hCG) measurements between days 7 and 16 after ET. The GnRH-a/hMG pregnancies implanted between days 7 and 11, whereas hMG pregnancies implanted between days 7 and 9 after ET. The hCG regression curve for the GnRH-a/hMG pregnancies revealed a delay of 1.5days in estimated implantation time compared with the hMG only group. There were no significant differences in pretransfer in vitro embryos development between the two groups. Thus, the delay in hCG rise probably reflects a delay in embryo implantation. We therefore conclude that a GnRH-a/hMG stimulation protocol appears to widen the implantation window in comparison with a hMG only protocol. This observation may at least in part explain the improved IVF pregnancy success with GnRH-a/hMG stimulation protocols.

Two hundred twenty consecutive in vitro fertilization (IVF) conception cycles were studied prospectively in order to examine the predictive value of serum human chorionic gonadotropin β-subunit (β-hCG), estradiol (E2), and progesterone (P) in predicting pregnancy outcome between 2 and 4 weeks after oocyte collection. To examine the predictive value of each hormone in predicting clinical pregnancy outcome, each patient’s result at each week was assigned a scoring system based on the 25th percentile value of the concentration of β-hCG, E2, and P in ongoing singleton IVF pregnancies for each week of the study. All but one ectopic pregnancies had scores of 0 or 1 points between 2 and 4 weeks after oocyte collection. The scores in successful pregnancies were significantly higher than in unsuccessful pregnancies 2 weeks after oocyte collection. Ninety percent of women scoring 3 points 2 weeks after oocyte collection had ongoing IVF pregnancies. The authors conclude that determination of serum β-hCG, E2, and P concentrations between 2 and 4 weeks after oocyte collection provides clinically useful information not only in the prediction of ectopic IVF pregnancy, but also, conversely, in the identification of IVF pregnancies that are destined to be ongoing.

Since in vitro fertilization (IVF) pregnancy rates have reached a plateau in recent years, there is need for a system of assessment, which could provide a guide for improvements. The follicular characteristics, the response to stimulation, the quality of sperm used for insemination, and the embryonic human chorionic gonadotropin production of 222 women who had undergone routine IVF treatment have been analyed. Models, predictive of IVF outcome, have been developed using these parameters in various combinations. The results have shown that follicular health and maturity are critical to IVF outcome and that certain patterns of response to ovarian stimulation are associated with the more frequent occurrence of oocytes capable of normal embryonic development after fertilization.

To investigate further the association between human leukocyte antigen G (HLA-G) expression in human embryos and other factors known to influence IVF pregnancy outcome.