Fetal cardiac activity at 4 weeks after in vitro fertilization predicts successful completion of the first trimester of pregnancy

Objective: To determine the predictive value of fetal cardiac activity (FCA), measured at 6 weeks' gestation, on first-trimester pregnancy success after IVF. Design: Retrospective cohort study. Setting: University-based reproductive endocrinology and infertility practice. Patient(s): One hundred thirty-nine women, without a history of recurrent miscarriage, who were undergoing fresh IVF cycles from August 1, 2004 to February 28, 2005. Intervention(s): Transvaginal ultrasound. Main Outcome Measure(s): First-trimester pregnancy success. Result(s): Ninety-three percent (51/53) of gestational sacs with FCA completed the first trimester (positive predictive value of 93%). Eighty-seven percent (13/15) of sacs without FCA failed in the first trimester (negative predictive value of 87%). In singletons, the positive and negative predictive value of FCA on first-trimester success was 100%. All twin pregnancies (n = 11) successfully completed the first trimester. Conclusion(s): This analysis, which was performed strictly in an IVF population with no history of recurrent pregnancy loss, demonstrates that positive FCA at 6 weeks' gestation is an excellent predictor of first-trimester pregnancy outcome.