Urine hCG (human chorionic gonadotropin) level test: positiv | Figure 1
%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)
Deleted account
Urine hCG level test: positive pregnancy
Why you should join Figure 1
- Share your knowledge with our global community of healthcare professionals
- Get help from experts in your field
- Learn from our library of real-world cases and quizzes
Monitoring of stimulated cycles in fertility treatment involving in vitro fertilisation (IVF) and intra‐cytoplasmic sperm injection (ICSI)
Review question: can ultrasound alone be used safely without adding estradiol blood test measurements to monitor women undergoing controlled ovarian hyperstimulation during IVF and ICSI? We reviewed the evidence on monitoring women undergoing controlled ovarian hyperstimulation as part of IVF or ICSI by transvaginal ultrasound (TVUS) only versus traditional combined monitoring (TVUS) and blood hormone (estradiol) levels.
Background: Assisted reproduction techniques such as IVF and ICSI involve a process called controlled ovarian stimulation. The ovaries are artificially stimulated to produce follicles and then ovulation (release of a mature ovum or egg) is induced so that eggs can be retrieved for use in either IVF or ICSI to produce embryos in the laboratory. Traditionally women undergoing controlled ovarian hyperstimulation prior to ovulation induction have been monitored by TVUS and measurement of the hormone estradiol level in their blood. The aim of monitoring is to detect the optimum time to induce ovulation (by the administration of human chorionic gonadotrophin or luteinising hormone) and to determine an adequate response to ovarian hyperstimulation to allow egg retrieval, but importantly also to identify women at risk of the potentially serious rare condition of ovarian hyperstimulation syndrome (OHSS). It has been suggested that a simplified protocol of monitoring by TVUS alone may reduce unnecessary anxiety and operational costs during IVF and ICSI.
Study characteristics: we included six randomised controlled trials conducted in the UK, France, Spain, Israel and the US, including 781 women. They compared monitoring with TVUS only versus TVUS plus serum estradiol concentration in women undergoing ovarian hyperstimulation for IVF and ICSI treatment. The evidence was current to March 2020.
Key results: none of the six studies reported our primary outcome of live birth rate. Only four of the six studies reported pregnancy rate per woman; we are uncertain of the effect of monitoring with TVUS only versus TVUS plus estradiol measurement on clinical pregnancy rate per woman. Our findings suggest that in women with a 36% chance of clinical pregnancy using monitoring with TVUS plus serum estradiol, the clinical pregnancy rate using TVUS only would be between 31% and 46%.
We are uncertain of any effect in the mean number of oocytes retrieved per woman.
We are uncertain whether monitoring with TVUS only versus TVUS plus estradiol measurement affected the incidence of OHSS. The evidence suggested that in women with a 4% chance of OHSS using monitoring with TVUS plus serum estradiol, the OHSS rate monitored by TVUS only would be between 2% and 8%. The cycle cancellation rate was similar in both arms of two studies reporting this outcome.
Quality of the evidence: the evidence was of low quality. Limitations included imprecision and potential bias due to unclear description of randomisation methods, allocation concealment and blinding, as well as differences in the treatment protocols. Quality assessment was hampered by a lack of methodological descriptions in several studies. Two studies reported funding by pharmaceutical companies, whereas the remaining four studies did not report their sources of funding.