Progesterone production in early pregnancy

Before and after elective abortion, progesterone (P) and human chorionic gonadotropin (hCG) levels were determined to describe the origin of P and to investigate the relationship between levels of hCG and luteal steroidogenesis. After abortion, P levels initially fell rapidly, followed by a slower decline. The initial fall in P levels and the remaining level of P 3 hours after abortion were taken to represent the removal of P that originated from the trophoblast and the continuing P contribution by the corpus luteum (CL), respectively. Using this analysis, we conclude: (1) P production by the CL is sustained well into the second trimester of pregnancy and (2) increasing trophoblastic production of P allows the pregnancy progressive independence from the CL.     

Beta-human chorionic gonadotropin as a monitor of pregnancy outcome in in vitro fertilization-embryo transfer patients

Serum human chorionic gonadotropin (hCG) was studied to test its predictability of pregnancy outcome in in vitro fertilization (IVF) patients. The mean +/- standard deviation of serum hCG concentration related to the day complete clearance of exogenous hCG was derived from 47 single term pregnancies as a normal range. This range can be used to predict spontaneous abortion (77%), multiple pregnancy (60%), and abortion in multiple-sac pregnancies terminating in the birth of fewer infants than the initial number of sacs (80%). The results also showed that our stimulation protocol did not affect the clearance rate and doubling time of endogenous hCG or implantation time as suggested by the time of endogenous hCG detection and that spontaneous abortion may be due to late implantation.     

不同黄体支持方法对体外受精-胚胎移植结果的影响

目的:探讨三种黄体支持方法对体外受精-胚胎移植(IVF-ET)结果的影响。方法:回顾性分析195个IVF-ET周期的结果,根据注射hCG当天的血E2水平、B超示直径≥14 mm卵泡数目及所用的黄体支持方法分组。A组:112例,E2<2 000 pg/mL,直径≥14 mm的卵泡数<10个,hCG进行黄体支持;对E2≥2 000 pg/mL,卵泡数目≥10个者,随机分为两组,B组,46例,单用黄体酮进行黄体支持;C组,37例,黄体酮加雌激素进行黄体支持。结果: 三组间妊娠率、种植率、流产率、OHSS发生率差异均无显著性,P>0.05。结论:hCG用于IVF黄体支持并不优于黄体酮,但在一定程度上可避免某些患者由于注射黄体酮产生的痛苦。黄体酮+雌激素进行黄体支持应该是黄体支持较合理的方案,还需进一步研究。     

Variations in peripheral blood levels of immunoreactive tumor necrosis factor alpha (TNFalpha) throughout the menstrual cycle and secretion of TNFalpha from the human corpus luteum.

OBJECTIVE: Several cytokines have been implicated as important mediators in the cyclic processes occurring in the reproductive organs. In the present study the peripheral blood concentrations of the cytokines interleukin(IL)-2, IL-6, and tumor necrosis factor (TNF) alpha, as well as the secretion of TNFalpha from the human corpus luteum were investigated. STUDY DESIGN: The study was undertaken at infertility clinics at large teaching hospitals. Eight women with unexplained infertility undergoing investigations with measurements of endocrine profiles throughout a cycle prior to IVF treatment were included in the study of blood concentrations of cytokines. Blood plasma were taken daily or every second day from a time 3-4 days before expected LH peak until menstruation. The levels of immunoreactive IL-2, IL-6 and TNFalpha were measured by ELISA technique and evaluated (repeated measures ANOVA and Scheffes test) in relation to levels on the day of the LH surge. To investigate a possible ovarian source of TNFalpha, corpus luteum (CL) tissue and cells obtained during the luteal phase from another group of women during abdominal surgery for benign uterine diseases, were cultured for 24 h to assess (ANOVA and Bonferroni test) the release of TNFalpha. RESULTS: There were no significant fluctuations in the levels of IL-2 and IL-6 throughout the menstrual cycle. The concentration of TNFalpha showed significant fluctuations over the menstrual cycle. Compared to the values on the day of the LH surge, the concentrations were significantly increased during the late follicular phase and during the mid luteal phase. In the early luteal phase the levels were significantly decreased. Measurable levels of TNFalpha were found in the conditioned media from one out of three CL obtained from the early luteal phase, and in all media from CL obtained from mid- and late-luteal phases. Luteal cells in culture secreted TNFalpha, and the levels in the media were not influenced by the presence of hCG (100 IU/L). The conditioned media of luteal cells from late luteal phase contained higher levels than media of cells from early luteal phase, with the levels being higher in media of a mixture of all luteal cells, and large luteal cells as compared to small luteal cells. CONCLUSION: This study demonstrates that there are marked fluctuations of blood levels of TNFalpha during the menstrual cycle and that the human CL secretes TNFalpha, with indications of higher secretion during late luteal phase as compared to early luteal phase.     

Unsuspected subclinical pregnancies in patients with luteal phase defects.

Patients with different types of luteal phase defects were studied with the use of the radioimmunoassay for the beta subunit of human chorionic gonadotropin (hCG) to determine if unsuspected subclinical pregnancies were more common in a particular type of defect. A type I luteal phase defect is always characterized by a chronologic lag in endometrial development when repeatedly studied with timed endometrial biopsies. A type II luteal phase defect is always characterized by an in phase endometrium when repeatedly studied by timed endometrial biopsies but always has less than a 14 day luteal span. All blood samples were drawn at least 7 days after ovulation/conception. In 22 cycles in which patients had a type I luteal phase defect, no subclinical pregnancies were detected. In 18 cycles in which a type II luteal phase defect was present, 12 instances of unsuspected subclinical pregnancy were detected and all ended in spontaneous abortion. This study shows that unsuspected subclinical pregnancies ending in abortion do occur and are quite commonly associated with the type II luteal phase defect.     

不同剂量黄体酮在体外受精-胚胎移植中黄体支持的效果

目的:探讨不同剂量黄体支持对IVF-ET周期黄体期雌、孕激素水平及临床结局的影响。方法:回顾分析长方案超促排卵IVF-ET305周期,根据hCG日雌激素水平采取4种不同黄体支持方案;对照组53例,hCG日血清E2值≤8000pmol/L,胚胎移植日开始肌注黄体酮60mg/d到验孕日。实验组:A组43例,hCG日血清E2值≤4000pmol/L,在取卵第2天开始肌注黄体酮20mg/d联合2000IU hCG q3d×4次到验孕日;B组115例,hCG日E24000pmol/L～8000pmol/L,取卵后第2天开始肌注40mg/d黄体酮到验孕日;C组94例,hCG日血清E2值≥8000pmol/L,取卵后第2天开始肌注60mg/d黄体酮到验孕日。结果:4组患者年龄、不孕年限、不孕因素、Gn用药天数、用药量、移植胚胎数均无明显差异(P0.05);4组hCG日雌激素水平、获卵数、ET日和种植窗期雌激素水平均有显著差异(P0.05),但4组ET日及种植窗期的E2/P值无显著差异;4组的种植率和妊娠率分别为27.68%、32.18%、32.54%、29.33%和41.51%、46.51%、50.43%、42.55%,无统计学差异。结论:不同剂量黄体支持有助于维持黄体期雌、孕激素平衡,有利于减少黄体酮剂量而不影响妊娠结局。     

Luteal-phase support in stimulated cycles in an in vitro fertilization/embryo transfer program: Progesterone versus human chorionic gonadotropin

A study was undertaken to compare the hormonal parameters [serum concentrations of estradiol (E₂), and progesterone (P) and P/E₂ ratios] of patients undergoing in vitro fertilization/embryo transfer to whom either progesterone in oil or human chorionic gonadotropin (hCG) was administered as luteal support. Seventeen patients were studied in 20 cycles. In 10 randomly assigned cycles 25 mg of intramuscular progesterone in oil was administered daily from the day of embryo transfer (day +4) until day +18. In the other 10 cycles, 1500 IU of hCG was given intramuscularly on days +4, +7, +10, and +13. Even when accounting for the differences in recruitment in the two groups, the hCG-treated group had significantly higher concentrations of serum P (P<0.01) and E₂ (P<0.05) during the luteal phase. The luteal P/E₂ ratios were higher in the progesterone-treated group because of the lower E₂ levels in that group, although the difference was not statistically significant. The ratio of the mean luteal P to the preovulatory serum E₂ was significantly higher in the hCG-treated group (P<0.01). There were three clinical pregnancies in the hCG-treated group. We conclude that (1) higher P concentrations are achieved with hCG treatment than with progesterone treatment during the luteal phase; (2) high luteal P/E₂ ratios per se may not be an important determinant of implantation; (3) progesterone production by the corpus luteum is not maximal in progesterone-treated cycles; and (4) the usefulness of hCG as a luteal support agent should be further evaluated.     

正常妊娠与自然流产、早早孕丢失周期生殖激素水平的比较

目的:了解异常妊娠周期的生殖内分泌激素的特征。方法:以某纺织厂符合研究条件的轮班作业女工为研究对象,收集每日晨尿直到临床怀孕或满一年,所有尿样用放射免疫法(IRMA)测定绒毛膜促性腺激素(hCG)判断怀孕周期,并结合卵泡刺激素(FSH),雌激素代谢产物E1C与孕激素代谢产物PdG等的测定确定是否排卵及排卵日,从而判断EFL。对已确定排卵日的周期用酶免疫(EIA)法测定排卵日前后各8d尿中PdG、E1C。结果:正常妊娠周期(从排卵到受精卵着床这一段时间)组尿中E1C浓度在卵泡晚期及黄体中期显著低于临床自然流产(SAB)组(P<0.05),与早早孕丢失(EFL)组相比在黄体中期也明显偏低(P<0.05),但在卵泡晚期二者差异无显著性(P>0.05);PdG/E1C在黄体期d4-8的平均值正常组高于SAB组(P<0.05);FSH在排卵日当天正常组大于EFL和SAB组,但无显著性(P>0.05)。结论:临床可见SAB可能与在妊娠周期黄体中期及卵泡晚期PdG/E1C降低、黄体中期E1C升高有关。妊娠周期尿样E1C、PdG测定可用于预测不良的生殖结局。     

Early pregnancy wastage: the role of repetitive human chorionic gonadotropin supplementation during the first 8 weeks of gestation.

OBJECTIVE: To determine if repetitive administration of hCG causes decreased pregnancy wastage rates in patients who are at a high risk of luteal inadequacy. DESIGN: Ovulation induction using human menopausal gonadotropin (hMG)/human chorionic gonadotropin (hCG) or clomiphene citrate (CC) is associated with luteal phase defects that may cause increased pregnancy wastage. An increased risk of abortion exists also in pregnancies in patients with previous repeated miscarriage, women older than 37 years, and various causes of infertility such as hyperprolactinemia. Because the presumed common denominator to the increased rate of pregnancy wastage in all these cases is luteal dysfunction, repetitive hCG administration, 2,500 U two times weekly, was carried out between the 4th and 8th week of gestation in 249 cases of ovulation induction and/or previous abortions, whereas 198 gestations served as controls (no hCG administration). RESULTS: In the hCG treatment group, 43 ended in miscarriage (17.3%) versus 97 abortions in the control group (49%, P less than 0.01). In 160 cases of hMG/hCG generated gestations, 94 received hCG and 66 did not. The pregnancy wastage rates were 21.3% and 42.4%, respectively (P less than 0.05). In 144 cases of CC/hCG-induced pregnancies, 95 received hCG and 49 served as controls. The respective abortion rates were 15.8% and 44.8% (P less than 0.01). The remaining 143 spontaneous conceptions occurred in infertile patients with previous repeated abortions. In 60 of these conceptions, hCG was administered during the first 4 weeks of gestation and 83 cases served as control. The pregnancy wastage rates were 13.3% versus 56.6%, respectively (P less than 0.001). CONCLUSION: Repetitive administration of hCG during the early gestation in cases that are at high risk of luteal inadequacy may significantly decrease the pregnancy wastage rate.     

Luteal phase hormonal profile in prediction of pregnancy outcome after assisted reproduction

The clinical efficacy of luteal phase hormones including estradiol and progesterone in the prediction of pregnancy and its outcome in ICSI-ET cycles was evaluated. In 121 ICSI-ET cycles, serial estradiol and progesterone levels were measured in the luteal phase. The day of ovum pick-up was designated as day 0. All the patients had luteal support with vaginal progesterone suppositories after embryo transfer (ET). Serial estradiol measurements were performed on days 8, 11 and 13 and progesterone level on day 11. A single dose of hCG was given for corpus luteum rescue 5000 IU, if day 8 estradiol level <200pg/ml; 2000IU, if estradiol between 200 and 800pg/ml; no hCG if estradiol level >800pg/ml). On day 15, beta-hCG level was measured to detect pregnancy and if positive, injected on day 17. Fifty-seven pregnancies were achieved in 121 cases after ET (47%). Clinical pregnancy rate and ongoing pregnancy rate per ET were 37.1 and 30%, respectively. While there was no difference between progesterone levels measured on day 11, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. In 40 patients taking only progesterone and in 81 cases taking hCG plus progesterone, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. Progesterone levels on day 11, in progesterone treated groups, did not differ between pregnant and non-pregnant patients. Estradiol and progesterone levels on day 11 and estradiol levels on day 13 showed a big overlap between pregnant and non-pregnant patients. The efficacy of serial testing was evaluated. An increase in estradiol level from day 11 to 13 was associated with 71% pregnancy rate (72% ongoing). In the case of a decrease in estradiol level, the pregnancy rate was 18% of which 80% had to implant. Rising estradiol in the late luteal phase is associated with higher pregnancy rate and more successful pregnancy outcome.     

Comparative studies on steroidogenesis and prostaglandins production by luteal cells in newly formed corpora lutea and early pregnancy

The present study was undertaken to assess the ability of cultured luteal cells from human corpora lutea (CL) in the mid luteal phase and the early pregnancy to secrete steroids and prostaglandins (PGs). Luteal cells responded to hCG with a significant increase (2- to 4-fold) in progesterone (P) production. The addition of hCG to the culture media did not stimulate estradiol (E2) production. In contrast, both P and E2 secretion by luteal cells in early pregnancy were significantly lower than those found in the mid luteal phase. Exposure to hCG did not affect P production by luteal cells in early pregnancy. Arachidonic acid (AA) significantly stimulated PGE2 synthesis by luteal cells in the mid luteal phase in a dose-dependent manner. Both basal PGE2 production and the responsiveness to AA were maintained for the duration of the culture. However, hCG did not affect AA-stimulated PGE2 production. Both PGF2 alpha and 6-keto-PGF1 alpha production abruptly declined as the culture proceeded. PG synthesis by cultured luteal cells in early pregnancy was significantly lower than in the mid luteal phase. The ultrastructural characteristics of luteal cells in early pregnancy, which contained lipid droplets, granular and agranular endoplasmic reticulum and large spherical mitochondria, were maintained after 10 days in culture. The present results demonstrate that P and PGE2 production by cultured luteal cells predominate during the mid luteal phase. These data suggest that PGE2, but not PGF2 alpha, may be involved in the regulation of CL function in the menstrual cycle.     

Human chorionic gonadotropin, estradiol, and progesterone profiles in conception and nonconception cycles in an in vitro fertilization program

In 22 consecutive in vitro fertilization cycles stimulated with purified follicle-stimulating hormone, human chorionic gonadotropin (hCG), estradiol (E2), and progesterone (P) were measured every 3 days during the luteal phase. All serum measurements were normalized to the day of hCG administration (day 0). There was a total of nine pregnancies; two were biochemical pregnancies, whereas 7 of the 22 women had clinical pregnancies (31.8%). Of these, two miscarried and five had term pregnancies (three singleton, two twin). Conception cycles could be differentiated from nonconception cycles by serum E2 levels on day 8 (P = 0.035), by hCG levels on day 11 (P = 0.03), and by P levels on day 14 (P = 0.001). From days 8 to 11, hCG levels plateaued in conception cycles and decreased in nonconception cycles. However, during that period, E2 and P fell in both groups of women. This decline in sex steroids, which was observed in both conception and nonconception cycles, may well negatively influence endometrial development during the peri-implantation period and compromise conception, resulting in failure to conceive, biochemical pregnancy, and early miscarriage.     

Gonadotropin receptors of human corpus luteum during menstrual cycle and pregnancy.

Specific high-affinity low-capacity binding of human chorionic gonadotropin (hCG) and lutropin (hLH) was demonstrated in the plasma membrane fractions of human corpora lutea. The number of binding sites for both hormones increased from early to late luteal phase, whereas regressing corpus luteum from proliferative phase did not bind either hormone. On the basis of apparent dissociation constants the affinity of the receptor for hLH is highest during early luteal phase and decreases toward the end of the cycle, which may reflect an increasing insensitivity of the corpus luteum to circulating hLH. By contrast, the affinity of the receptor for hCG is highest in the midluteal phase. There are gonadotropin binding sites in the human corpus luteum also during pregnancy, but they are saturated by endogenous hCG. Evidence for this was obtained by elution of hCG with 0.15M sodium chloride at pH 2.3 from washed plasma membrane fractions of luteal tissue from six to 16 week's gestation. After acid treatment and neutralization these preparations showed specific binding for 125I-labeled hCG, but not for 125I-labeled hLH. Our results demonstrate a shift in the balance of affinity of the gonadotropin receptor from hLH to hCG during the course of luteal phase, and during pregnancy the binding sites appear to be available for hCG only.     

Phase-dependent influence of nonsteroidogenic cells on steroidogenesis and prostaglandin production by the human corpus luteum

OBJECTIVE: To test the hypothesis that paraluteal cells in the human corpus luteum (CL) modulate steroidogenesis and prostaglandin production by the CL. DESIGN: In vitro cell culture study using human luteal cells. SETTING AND PATIENT(S): Women (n = 7) with normal menstrual cycles who were undergoing operations for benign, nonovarian conditions during the midluteal phase (5-9 days after ovulation) or the late luteal phase (10-14 days after ovulation) at a university hospital. INTERVENTION(S): Steroidogenic and nonsteroidogenic human CL cells were isolated by mechanical and enzymatic digestion and density sedimentation. The cells were cultured (75,000 cells per well) for 24 hours either as a crude sample of all CL cells or as an enriched fraction of steroidogenic CL cells. MAIN OUTCOME MEASURE(S): Levels of progesterone, E2, prostaglandins F2alpha, E2, and I2 in conditioned medium. RESULT(S): Higher concentrations of progesterone, E2, and prostaglandins F2alpha, E2, and I2 were released into the media of the crude sample of all CL cells than into the enriched fraction of steroidogenic CL cells from the midluteal phase. No such difference was noted in CL cells from the late luteal phase. CONCLUSION(S): The paraluteal cells in the human CL stimulated progesterone and E2 synthesis. This may be mediated by an increase in prostaglandin production in the midluteal phase.     

Progesterone:estradiol ratios at implantation in ongoing pregnancies, abortions, and nonconception cycles resulting from ovulation induction

The purpose of this study was to compare progesterone (P):estradiol (E2) ratios after ovulation induction at the time of implantation in cycles resulting in ongoing pregnancies or abortions and in nonconception cycles. Material included 43 stimulated conception cycles, 29 with human menopausal gonadotropins (hMG) and human chorionic gonadotropins (hCG), 14 with clomiphene citrate (CC) with or without hCG, and 28 nonconception cycles (13 hMG and hCG, 15 CC with or without hCG). Midluteal P and E2 were measured and expressed in ng/mL. There were no differences in P:E2 ratios (mean +/- SE) for ongoing pregnancies after hMG and hCG (n = 20, 112.6 +/- 14.9), CC and hCG (n = 6, 97.0 +/- 15.9), or CC alone (n = 5, 96.2 +/- 25.5), and the data were pooled. Progesterone:estradiol ratios in 31 ongoing pregnancies and 28 nonconception cycles were 107.0 +/- 10.7 and 115.2 +/- 12.5, respectively, both significantly higher than in 12 abortions (64.5 +/- 13.2). In conclusion: (1) P:E2 ratios at the time of implantation were similar after CC with or without hCG and hMG and hCG treatment; (2) high luteal P:E2 ratio was associated with ongoing pregnancies; and (3) lower P:E2 ratio was seen in cycles leading to spontaneous abortion.     

Gonadotropin-releasing hormone agonist versus human chorionic gonadotropin for triggering follicular maturation in in vitro fertilization.

OBJECTIVE: To compare the use of gonadotropin-releasing hormone agonist (GnRH-a) with human chorionic gonadotropin (hCG) for triggering the final stage of follicular maturation for in vitro fertilization (IVF). DESIGN: In vitro fertilization outcome was determined in a randomized, prospective study. SETTING: The University of Toronto IVF program at The Toronto Hospital, Toronto General Division. PATIENTS AND INTERVENTIONS: One hundred seventy-nine women in the IVF program were given a subcutaneous injection of leuprolide acetate (500 micrograms) or an intramuscular injection of hCG (5,000 IU) 34 to 36 hours before oocyte retrieval. Vaginal progesterone (P) suppositories (50 mg) were used two times a day for luteal phase support. A subgroup of 41 women had serum estradiol (E2) and P levels determined 2 and 7 days after embryo transfer (ET). MAIN OUTCOME MEASURES: Pregnancy rates and luteal phase E2 and P were compared. RESULTS: In the GnRH-a group, there were 18 pregnancies from 84 ETs (20%). In the hCG group, there were 19 pregnancies from 95 ETs (19%). Luteal phase E2 and P levels were significantly lower in the GnRH-a group compared with the hCG group, and 18% of the former group had an apparent short luteal phase. CONCLUSIONS: Gonadotropin-releasing hormone agonist appears to be an effective alternative to hCG for inducing follicular maturation in IVF. The lower luteal phase E2 concentrations may potentially be beneficial in preventing ovarian hyperstimulation and for enhancing implantation. Better luteal phase support or a different dose of GnRH-a is needed to prevent luteal phase deficiency.     

Hormonal monitoring of early pregnancy by a direct radioimmunoassay of steroid glucuronides in first morning urine

The usefulness of the direct 4-hour radioimmunoassay of estriol-16-glucuronide (E3G) and pregnanediol-3-glucuronide (P2G) in first morning urine (FMU) for establishing a prognosis of the early pregnancy outcome was evaluated in 106 patients that became pregnant. Microaliquots of FMU were serially assayed from day 3 of the conception cycle until day 80 of pregnancy. The E3G and P2G profiles of 19 pregnancies which terminated in spontaneous abortion with either a diagnosis of the blighted ovum syndrome (n = 11) or presumption of a corpus luteum/trophoblast failure (n = 8) have been compared with those of clinically normal pregnancies (n = 87). Normal pregnancies displayed typical patterns of E3G and P2G development, while variations were observed in abortive events that reflected changes of the fetoplacental unit.     

Lower levels of inhibin A and pro-alphaC during the luteal phase after triggering oocyte maturation with a gonadotropin-releasing hormone agonist versus human chorionic gonadotropin

OBJECTIVE: To investigate the effect of triggering oocyte maturation with GnRH agonist on corpus luteum function by measuring luteal phase levels of inhibin A and pro-alphaC. DESIGN: Prospective randomized trial. SETTING: In vitro fertilization (IVF) program at a university hospital. PATIENT(S): Infertile women undergoing IVF-ET treatment. INTERVENTION(S): Controlled ovarian hyperstimulation with FSH and GnRH antagonist, triggering of final oocyte maturation with either hCG (n = 8) or GnRH agonist (n = 8), IVF-ET, and collection of blood samples every 2-3 days during the luteal phase. MEASUREMENTS AND MAIN RESULTS: Luteal phase serum levels of inhibin A and pro-alphaC, P, and E(2). RESULT(S): Levels of inhibin A, pro-alphaC, estrogen, and P were significantly lower from day 4 to day 14 after triggering final oocyte maturation by GnRH agonist compared with hCG. Maximal luteal serum inhibin A and pro-alphaC levels were 91.5 +/- 23.6 and 184.1 +/- 23.5 pg/mL in the GnRH agonist-treated women compared with 464.7 +/- 209.1 and 7,351.6 +/- 934.3 pg/mL in women treated with hCG. CONCLUSION(S): Triggering final oocyte maturation with GnRH agonist instead of hCG in IVF cycles dramatically decreases luteal levels of inhibins, reflecting significant inhibition of the corpus luteum function. This effect may explain, at least in part, the mechanism of ovarian hyperstimulation syndrome prevention by the use of GnRH agonist.     

Use of serum inhibin A and human chorionic gonadotropin measurements to predict the outcome of in vitro fertilization pregnancies

OBJECTIVE: To assess the clinical value of maternal serum inhibin A measurements in early pregnancy in the prediction of outcome of IVF pregnancies and to compare the predictive accuracy of inhibin A concentrations with serum hCG concentrations. DESIGN: Retrospective study.University-based IVF program. PATIENT(S): One hundred fifty IVF pregnancies of 150 couples were studied during a 4-year period. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The association between pregnancy outcome and age, number of collected oocytes, number of transferred embryos, and serum hCG and inhibin A concentrations in early pregnancy was studied with logistic regression. Predictive accuracy of inhibin A and hCG concentrations was calculated by receiver-operating characteristic (ROC) analysis. RESULT(S): Lower serum concentrations of inhibin A and hCG were associated with increased odds for preclinical abortion and early pregnancy loss, whereas higher inhibin A and hCG concentrations were observed in multiple ongoing pregnancies. Inhibin A measurements were superior to hCG in the prediction of preclinical abortions; no significant difference was observed between the predictive value of hCG, inhibin A, or their combination in differentiating between ongoing pregnancies and early pregnancy losses. The discriminative potential of inhibin A for prognosticating multiple ongoing pregnancies was lower than that of hCG. CONCLUSION(S): Although serum inhibin A concentrations are more accurate than hCG levels for predicting preclinical abortion after IVF, they had no advantage in forecasting ongoing or multiple ongoing pregnancies, suggesting that routine assessment of serum inhibin A concentrations during follow-up of IVF pregnancies is unjustified.