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Peyser A, Gulersen M, Krantz D, Li X, Bornstein E, Rochelson B, Mullin C, Goldman R. The impact of fresh versus frozen-thawed embryos on maternal serum analyte levels in IVF singleton and twin pregnancies. J Assist Reprod Genet 2024; 41:473-481. [PMID: 38133878 PMCID: PMC10894779 DOI: 10.1007/s10815-023-03007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To determine whether embryo cryopreservation is associated with a difference in maternal serum analyte levels in singleton and twin pregnancies conceived via in vitro fertilization (IVF). METHODS This was a retrospective cohort study of singleton and twin pregnancies conceived via IVF from a university health system from 01/2014 to 09/2019. Patients with available first and second trimester serum analyte data were included and analyzed separately. Multiple of the median (MoM) values for free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A, alpha-fetoprotein (AFP), Inhibin A, and unconjugated estriol (uE3) were compared between two groups: pregnancies conceived after the transfer of fresh embryos versus pregnancies conceived after the transfer of frozen-thawed embryos. Multiple linear regression of log MoM values with F test was performed to adjust for potential confounders. RESULTS For singletons, fresh embryos were associated with a lower median first trimester free β-hCG (1.00 MoM vs. 1.14 MoM; parameter estimate [PE] 0.90, 95% CI 0.82-0.99, p = .03) compared to frozen-thawed embryos. Fresh embryos were also associated with a lower median second trimester uE3 (0.93 MoM vs. 1.05 MoM; PE 0.88, CI 0.83-0.95, p = .0004) and AFP (1.02 MoM vs. 1.19 MoM; PE 0.91, CI 0.84-0.99, p = .02) compared to frozen-thawed embryos in singletons. There were no significant differences between median first and second trimester serum analytes in twin pregnancies compared between the two groups. CONCLUSION Singleton pregnancies derived from fresh embryos had lower first (free β-hCG) and second (uE3 and AFP) trimester analytes compared to frozen-thawed embryos. Twin pregnancies demonstrated no difference between the groups.
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Affiliation(s)
- Alexandra Peyser
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA.
| | - Moti Gulersen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - David Krantz
- Prenatal Screening Lab, Northwell Health Laboratories, Lake Success, NY, USA
| | - Xueying Li
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Burton Rochelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Christine Mullin
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Randi Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, North Shore University Hospital - Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA
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Asoglu MR, Bahceci M. Does endometrial thickness affect birth weight and serum levels of pregnancy-associated plasma protein-A in frozen cycles? Eur J Obstet Gynecol Reprod Biol 2023; 284:24-29. [PMID: 36924659 DOI: 10.1016/j.ejogrb.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/14/2023] [Accepted: 03/09/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE To investigate whether endometrial thickness (EMT) affects birth weight and maternal serum pregnancy-associated plasma protein-A (PAPP-A) level in singleton pregnancies following frozen-thawed blastocyst transfer (FET). METHODS This retrospective study included women who underwent first-trimester combined screening for aneuploidy after FET, and subsequently delivered a singleton live birth after 24 weeks of gestation at a private in-vitro fertilization centre. The subjects were stratified into three groups based on EMT percentiles: <7.7 mm (<10th percentile), 7.7-12 mm (10-90th percentile), and > 12 mm (>90th percentile). Multi-variable linear regression analysis was undertaken to identify the association between birth weight and EMT after adjusting for variables with p < 0.1 on univariate analysis. RESULTS In total, 560 women met the inclusion criteria. Mean (±standard deviation) birth weight was 3127 ± 783 g in those with EMT < 7.7 mm, 3225 ± 644 g in those with EMT 7.7-12 mm, and 3256 ± 599 g in those with EMT > 12 mm (p = 0.577). Mean PAPP-A and PAPP-A < 0.5 rates were similar in the three groups. On multi-variate analysis, maternal serum PAPP-A was found to be a significant predictor of birth weight (p = 0.013), but EMT was not found to be predictive of birth weight on univariate or multi-variate analysis. CONCLUSION This study provided a new angle to evaluate the association between EMT and neonatal birth weight by analysing this association along with maternal serum PAPP-A as a marker for placental function, suggesting that EMT is not an independent factor for neonatal birth weight.
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Affiliation(s)
| | - Mustafa Bahceci
- Bahceci Fulya Assisted Reproduction Centre, Istanbul, Turkey
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Kayacık Günday Ö, Aldemir O, Özelçi R, Dilbaz S, Başer E, Moraloğlu Tekin Ö. Supraphysiological hCG day estradiol levels can predict pregnancy-associated plasma protein A levels in maternal serum in the first trimester. Gynecol Endocrinol 2022; 38:455-460. [PMID: 35384772 DOI: 10.1080/09513590.2022.2057946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To investigate the effect of hCG day estradiol (hCG-E2) used in Down Syndrome screening on maternal serum levels of PAPP-A in fresh in vitro fertilization (IVF) cycles. METHODS This study was a retrospective analysis of a cohort that resulted in a single pregnancy after a total of 92 fresh IVF cycles. The primary outcome of this study was to determine the effect of fresh IVF cycle parameters on the PAPP-A level and the cutoff value for hCG-E2 predicting a low PAPP-A level, while the secondary outcome was to determine whether the effect of IVF parameters on the PAPP-A level was significant. RESULTS There was a negative correlation between PAPP-A levels and the number of hCG-E2 and grade 1 embryos (respectively, p = .049; .047), while a positive correlation was observed between baby weight at birth and the PAPP-A (p < .05). At a PAPP-A value of 0.82, the difference between the two groups, in terms of hCG-E2, the number of grade 1 embryos, and pregnancy-related complications was significant (p = .050; .029; .033, respectively). The threshold value of hCG-E2 affecting PAPP-A levels was statistically significant (AUC = 0.618; p = .050; hCG-E2 = 4869.5 pg/ml). In the model, an increase in the number of grade 1 embryos resulted in higher PAPP-A levels (OR = 2.26; p = .044). CONCLUSION The fact that the hCG-E2 cutoff value, which lowers PAPP-A, reflects excessive ovarian stimulation argues for the correction of the dual screening test in a subset of patients with high response to the first-trimester screening test.
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Affiliation(s)
- Özlem Kayacık Günday
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Oya Aldemir
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Runa Özelçi
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Serdar Dilbaz
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Emre Başer
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
| | - Özlem Moraloğlu Tekin
- Department of Assisted Reproductive Technology, Ankara Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Kavoussi SK, Chen SH, Wininger JD, Lal A, Roudebush WE, Lanford HC, Esqueda AS, Barsky M, Lebovic DI, Kavoussi PK, Gilkey MS, Chen J, Machen GL, Chosed RJ. The expression of pregnancy-associated plasma protein-A (PAPP-A) in human blastocoel fluid-conditioned media: a proof of concept study. J Assist Reprod Genet 2022; 39:389-394. [PMID: 35013837 PMCID: PMC8956765 DOI: 10.1007/s10815-022-02393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/04/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to determine if pregnancy-associated plasma protein-A (PAPP-A), typically measured in maternal serum and a potential predictor of adverse maternal and fetal outcomes such as spontaneous miscarriage, pre-eclampsia, and stillbirth, is expressed in blastocoel fluid–conditioned media (BFCM) at the embryonic blastocyst stage. Design This is an in vitro study. Methods BFCM samples from trophectoderm-tested euploid blastocysts (n = 80) from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients were analyzed for PAPP-A mRNA. BFCM was obtained from blastocyst stage embryos in 20 uL drops. Blastocysts underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy prior to blastocyst vitrification and BFCM collection for snap freezing. cfDNA was synthesized using BFCM collected from 80 individual euploid blastocysts. Next, real-time qPCR was performed to detect expression of PAPP-A with GAPDH for normalization of expression in each sample. Results PAPP-A mRNA was detected in 45 of 80 BFCM samples (56.3%), with varying levels of expression across samples. Conclusion Our study demonstrates the expression of PAPP-A in BFCM. To our knowledge, this is the first study to report detection of PAPP-A mRNA in BFCM. Further studies are required and underway to investigate a greater number of BFCM samples as well as the possible correlation of PAPP-A expression with pregnancy outcomes of transferred euploid blastocysts. If found to predict IVF and obstetric outcomes, PAPP-A may provide additional information along with embryonic euploidy for the selection of the optimal blastocyst for embryo transfer.
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Affiliation(s)
- Shahryar K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA.
| | - Shu-Hung Chen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - John David Wininger
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Arnav Lal
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - William E Roudebush
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - Hayes C Lanford
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
| | - Amy S Esqueda
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Maya Barsky
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Dan I Lebovic
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Parviz K Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Melissa S Gilkey
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Justin Chen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Graham L Machen
- Austin Fertility & Reproductive Medicine/Westlake IVF, 300 Beardsley Lane, Bldg B, Suite 200, Austin, TX, 78746, USA
| | - Renee J Chosed
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC, 29605, USA
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Pérennec A, Reignier A, Goronflot T, Gourraud PA, Masson D, Barrière P, Fréour T, Lefebvre T. Association between blastocyst morphology and maternal first trimester serum markers in ongoing pregnancies obtained after single fresh blastocyst transfer. Eur J Obstet Gynecol Reprod Biol 2020; 258:63-69. [PMID: 33421812 DOI: 10.1016/j.ejogrb.2020.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Is there an association between blastocyst morphology and maternal first trimester serum markers in In Vitro Fertilization (IVF) pregnancies obtained after fresh single blastocyst transfer? STUDY DESIGN This bi-centric retrospective study was conducted between January 2012 and August 2018. We included 122 women aged from 18 to 43 years-old, whose pregnancy progressed at least beyond 13 weeks after a single blastocyst transfer and who participated in the first trimester combined screening test. Day 5 and day 6 blastocysts were evaluated according to Gardner and Schoolcraft classification. Patients were classified into three groups according to blastocysts morphological quality: excellent (≥ 3AA), good (3-6AB, 3-6BA, B2), and medium to poor (3-6BB, 3-6AC, 3-6CA, B1, 3-6CB, 3-6BC). First trimester serum markers were measured in maternal blood between 9 and 11 + 6 gestational weeks. Univariate and multivariate analyses were performed. RESULTS Female body mass index, smoking status, type of infertility, geographical origin, anti-mullerian hormone level, ovarian stimulation characteristics, pregnancy outcomes and obstetrical complications were comparable between the three groups. Patient's age was not distributed evenly across groups, with women in group "Medium to Poor" appearing to be slightly younger than in other groups. There were no significant differences in mean first trimester serum markers between the three groups (PAPP-A: excellent: 1.23 ± 0.59 MoM; good: 1.45 ± 0.71 MoM; medium to poor: 1.22 ± 0.52 MoM; p = 0,20; free beta-HCG: excellent: 1.66 ± 1.38 MoM; good: 1.19 ± 0.76 MoM; medium to poor: 1.81 ± 1.34 MoM; p = 0,12). No significant difference was found either between mean first trimester serum markers and inner cell mass morphology (PAPP-A: grade A: 1.23 ± 0.58 MoM; grade B: 1.26 ± 0.60 MoM; medium to poor: 1.64 ± 0.87 MoM; p = 0,67 ; free beta-HCG: grade A: 1.66 ± 1.36 MoM; grade B: 1.52 ± 1.10 MoM; medium to poor: 1.57 ± 0.39 MoM p = 0,60), trophectoderm cells morphology (PAPP-A: grade A: 1.25 ± 0.63 MoM; grade B: 1.26 ± 0.51 MoM; medium to poor: not comparable; p = 0,66; free beta-HCG: grade A: 1.60 ± 1.34 MoM; grade B: 1.69 ± 1.14 MoM; medium to poor: not comparable; p = 0,25), or blastocoel expansion (PAPP-A: B1: 1.08 ± 0.51MoM; B2: 1.57 ± 0.70 MoM; B3: 1.26 ± 0.61 MoM; B4: 1.28 ± 0.62 MoM; B5: 1.04 ± 0.38 MoM; p = 0,22; free beta-HCG: B1: 2.01 ± 1.88 MoM; B2: 1.07 ± 0.49 MoM; B3: 1.43 ± 0.87 MoM; B4: 1.68 ± 1.28 MoM ; B5: 1.82 ± 2.03 MoM; p = 0,48). After adjustment on potential confounding factors (female age, type of gonadotropin, parity, number of oocytes retrieved and occurrence of ovarian hyperstimulation syndrome), we did not observe any association between PAPP-A or free beta-HCG levels and blastocyst morphology. CONCLUSION Our study concluded that first trimester serum markers were not associated with blastocyst morphological characteristics. Although this needs further confirmation, this suggests that blastocyst morphology would not have an impact on placentation. Therefore, these findings are reassuring for couples undergoing IVF and blastocyst transfer.
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Affiliation(s)
- Audrey Pérennec
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France
| | - Arnaud Reignier
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France
| | - Thomas Goronflot
- University Hospital of Nantes, INSERM, CIC 1413, PHU 11: Santé Publique, Clinique des données, 44000, Nantes, France
| | - Pierre-Antoine Gourraud
- Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France; University Hospital of Nantes, INSERM, CIC 1413, PHU 11: Santé Publique, Clinique des données, 44000, Nantes, France
| | - Damien Masson
- Department of Biochemistry, University Hospital of Nantes, 44000, Nantes, France
| | - Paul Barrière
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France
| | - Thomas Fréour
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France.
| | - Tiphaine Lefebvre
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France
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Güzel Y, Türkgeldi E, Yağmur H, Salar Z, Balaban B, Urman B, Öktem Ö. Spontaneous and in vitro fertilization pregnancies have comparable first trimester screening profiles for Down syndrome. J Turk Ger Gynecol Assoc 2019; 20:97-105. [PMID: 30206047 PMCID: PMC6558359 DOI: 10.4274/jtgga.galenos.2018.2017.0133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective We aimed to compare the first trimester screening profiles of spontaneous (n=972) and in in vitro fertilization (IVF) pregnancies (n=339) in a population of patients who had uncomplicated singleton pregnancies comparable for maternal age, gestation, body mass index, and ethnicity. Material and Methods A non-interventional analysis of retrospective cohort data and review of the literature. Results All IVF pregnancies were achieved via intracytoplasmic sperm injection using the same ovarian stimulation protocol with recombinant follicle-stimulating hormone and a gonadotropin-releasing hormone antagonist, cetrorelix acetate. The means of the multiple of median (MoM) of pregnancy-associated plasma protein-A (PAPP-A) were slightly lower in the fresh (1.19±0.6 vs 1.33±0.7, respectively; p=0.056) and frozen embryo transfer (1.03±0.5 vs 1.33±0.7, respectively; p=0.036) IVF pregnancies compared with natural conceptions. However, when the medians of the MoMs of PAPP-A and beta-human chorionic gonadotrophin (β-hCG), and their distributions were compared across the mode of conception, there were no differences between IVF pregnancies spontaneous pregnancies. Furthermore, the scatterplot diagram and curve fitting regression analyses revealed no difference in the temporal relations of β-hCG and PAPP-A with each other and gestational age between spontaneous and IVF pregnancies. Conclusion These results support the notion that uncomplicated singleton IVF pregnancies have similar first trimester screening profiles to spontaneous conceptions.
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Affiliation(s)
- Yılmaz Güzel
- Assisted Reproduction Unit, American Hospital, Women’s Health Center, İstanbul, Turkey
| | - Engin Türkgeldi
- Department of Obstetrics and Gynecology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Hande Yağmur
- Department of Obstetrics and Gynecology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Zeki Salar
- Assisted Reproduction Unit, American Hospital, Women’s Health Center, İstanbul, Turkey
| | - Başak Balaban
- Assisted Reproduction Unit, American Hospital, Women’s Health Center, İstanbul, Turkey
| | - Bülent Urman
- Assisted Reproduction Unit, American Hospital, Women’s Health Center, İstanbul, Turkey,Department of Obstetrics and Gynecology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Özgür Öktem
- Assisted Reproduction Unit, American Hospital, Women’s Health Center, İstanbul, Turkey,Department of Obstetrics and Gynecology, Koç University Faculty of Medicine, İstanbul, Turkey
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Reljič M, Porović A. Maternal serum levels of angiogenic markers and markers of placentation in pregnancies conceived with fresh and vitrified-warmed blastocyst transfer. J Assist Reprod Genet 2019; 36:1489-1495. [PMID: 31104293 DOI: 10.1007/s10815-019-01484-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The aim of the study was to compare the levels of angiogenic markers and markers of placentation between pregnancies conceived with fresh (ET) and vitrified-warmed blastocyst transfer (FET). METHODS Women with singleton pregnancies resulting from fresh ET or FET during the period between 2013 and 2017 were included in this prospective observational study. Fresh ET was performed in a stimulated and FET in natural cycle. At 6-7 weeks of gestation, after ultrasound confirmation of a single gestational sac with a viable embryo, serum levels of free β-hCG, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PIGF) and fms-like tyrosine kinase (sFlt-1) were measured. Data on the patients' characteristics, pregnancy complications and outcomes were collected from a questionnaire and National Perinatal Information System of Slovenia. RESULTS Among 211 pregnancies, 126 were achieved with fresh ET and 85 with FET. There were no significant differences in perinatal outcome, pregnancy complication and PIGF level between the fresh ET and FET group. Women achieving pregnancy with FET had significant higher levels of free β-hCG (40.20 ± 30.62 IU/L vs. 28.74 ± 23.52, p = 0.002), PAPP-A (0.09 ± 0.06 vs. 0.06 ± 0.05 IU/L, p = 0.004) and sFlt-1 (596.19 ± 283.06 vs. 436.53 ± 248.23 pg/L, p < 0.0001) compared to women having conceived with fresh ET. There were no significant differences in the levels of evaluated biomarkers between patients with different pregnancy outcomes and complications. CONCLUSION Levels of angiogenic markers and markers of placentation differ between pregnancies achieved with fresh ET and FET which may reflect altered implantation and early placentation with some forms of assisted reproductive technologies.
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Affiliation(s)
- Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Division of Gynaecology and Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Admir Porović
- Department of Gynaecology and Perinatology, Academic HELIOS Hospital Köthen, University Martin-Luther Halle-Wittenberg, Hallesche Str. 29, 06366, Köthen (Anhalt), Germany
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Choux C, Ginod P, Barberet J, Rousseau T, Bruno C, Sagot P, Astruc K, Fauque P. Placental volume and other first-trimester outcomes: are there differences between fresh embryo transfer, frozen-thawed embryo transfer and natural conception? Reprod Biomed Online 2018; 38:538-548. [PMID: 30850320 DOI: 10.1016/j.rbmo.2018.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
RESEARCH QUESTION Does mode of conception influence placental volume and other first-trimester outcomes? DESIGN This retrospective single-centre case-control study led in Dijon University Hospital included 252 singleton pregnancies (84 IVF with either fresh embryo transfer or frozen-thawed embryo transfer [FET] and 168 natural conceptions). First-trimester placental volume, uterine artery pulsatility index and maternal serum PAPP-A and beta-HCG were measured. Statistical analyses were adjusted for gestational age, the newborn's gender, maternal age, parity, body mass index and smoking status. RESULTS Placental volume was significantly greater in the FET group than in the control group (P = 0.043) and fresh embryo transfer (P = 0.023) groups. At birth, fresh embryo transfer newborns were significantly smaller than controls (P = 0.01) and FET newborns (P = 0.008). Postpartum haemorrhage was far more frequent in FET than in controls and fresh embryo transfer group (38.1%, 2.6% and 1.9%, respectively; P < 0.0001). Placental volume positively correlated with PAPP-A, beta-HCG and the newborn's birth weight, and negatively correlated with uterine artery pulsatility index. CONCLUSIONS Placental volume and other first-trimester parameters are modified by IVF with fresh embryo transfer and FET compared with natural conception, but with opposite trends. Given the different protocols used for these techniques, hormonal treatment per se may have a major effect on pregnancy outcomes through the modification of placental invasiveness.
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Affiliation(s)
- Cécile Choux
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France.
| | - Perrine Ginod
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Julie Barberet
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Thierry Rousseau
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Céline Bruno
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Paul Sagot
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Karine Astruc
- Dijon University Hospital, Epidemiology Unit, Dijon F-21000, France
| | - Patricia Fauque
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
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Szymusik I, Kosinski P, Kosinska-Kaczynska K, Warzecha D, Karwacka A, Kaczynski B, Wielgos M. The first trimester aneuploidy biochemical markers in IVF/ICSI patients have no additional benefit compared to spontaneous conceptions in the prediction of pregnancy complications. J Perinat Med 2018; 46:953-959. [PMID: 29216009 DOI: 10.1515/jpm-2017-0199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of this study was to determine if the levels of biochemical aneuploidy markers in in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) pregnancies differ from those in spontaneous pregnancies and to verify if biochemical markers could predict pregnancy outcome in IVF/ICSI gestations. METHODS This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM). RESULTS The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%). CONCLUSIONS The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.
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Affiliation(s)
- Iwona Szymusik
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Przemyslaw Kosinski
- First Department Of Obstetrics and Gynecology, Medical University of Warsaw, Starynkiewicza Square 1/3;02-015 Warsaw, Poland, Tel.: +48 22 5830300, Fax: +48 22 5830302
| | | | - Damian Warzecha
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Bartosz Kaczynski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Lanes A, Dougan S, Fell DB, Huang T, Sprague A, Johnson M, Leader A, Potter B, Okun N, Walker M. Comparing Maternal Serum Screening Markers Among IVF and Spontaneous Conceptions in Ontario Through Registry Data. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1608-1617. [PMID: 30539731 DOI: 10.1016/j.jogc.2018.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objectives of this study were as follows: (1) to investigate the accuracy of IVF identification on the prenatal screening record from prenatal screening laboratories; (2) to compare the screening markers in IVF and non-IVF pregnancies in the population of Ontario; and (3) to propose more appropriate IVF adjustment factors for the Ontario population. METHODS Two years of IVF treatment, data from all fertility clinics in Ontario were merged with the corresponding prenatal screening data from all five prenatal screening labs. New adjustment factors for IVF were developed for each maternal serum screening marker and nuchal translucency measurement. Means and SDs and linear regression models were reported for all prenatal screening records, as well as for records that had IVF identified through the prenatal screening requisition and records that were identified through the Canadian Assisted Reproductive Technologies Register (CARTR) Plus database. RESULTS Significant differences between IVF and non-IVF groups on the basis of the prenatal screening requisition information and CARTR Plus information were found among the ethnicity-adjusted mean multiple of the medians for alpha fetoprotein, first trimester pregnancy-associated plasma protein A, second trimester unconjugated estradiol, first trimester human chorionic gonadotropin, total human chorionic gonadotropin, and dimeric inhibin A. CONCLUSION This study proposed alternate IVF adjustment factors that will produce more accurate screening results within the population of Ontario.
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Affiliation(s)
- Andrea Lanes
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON; BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; OMNI Research Group, Ottawa, ON.
| | - Shelley Dougan
- BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON; CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON; CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON
| | - Tianhua Huang
- BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON
| | - Ann Sprague
- BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON; CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON
| | - Moya Johnson
- BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON
| | - Arthur Leader
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Ottawa Fertility Centre, Ottawa, ON
| | - Beth Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Nanette Okun
- Department of Obsetrics and Gynaecology, Mt. Sinai Hospital, Toronto, ON
| | - Mark Walker
- BORN (Better Outcomes Registry and Network) Ontario, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; OMNI Research Group, Ottawa, ON; CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
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Dunne C, Cho K, Shan A, Hutcheon J, Durland US, Seethram K, Havelock JC. Peak Serum Estradiol Level During Controlled Ovarian Stimulation Is not Associated with Lower Levels of Pregnancy-Associated Plasma Protein-A or Small for Gestational Age Infants: A Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:870-879. [DOI: 10.1016/j.jogc.2017.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
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Hunt LP, McInerney-Leo AM, Sinnott S, Sutton B, Cincotta R, Duncombe G, Chua J, Peterson M. Low first-trimester PAPP-A in IVF (fresh and frozen-thawed) pregnancies, likely due to a biological cause. J Assist Reprod Genet 2017; 34:1367-1375. [PMID: 28718082 DOI: 10.1007/s10815-017-0996-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The purpose of this study is to confirm a difference in the first-trimester screen maternal biochemistry and false-positive rates (FPR) between pregnancies conceived spontaneously and those conceived via assisted reproductive technologies (ART). METHODS Retrospective analysis of the complete population of women (17,889 pregnancies) who had undergone first-trimester screening between January 2004 and September 2009 at three private ultrasound clinics in Queensland, Australia was used in the study. The age, gestation, method of conception, ultrasound markers, biochemistry markers (PAPP-A, fβ-hCG), and type of biochemical analyzer platform (Brahms Kryptor, Immulite 2000) data was collated. Univariate analysis of variance (ANOVA), Spearman's rank nonparametric correlation analysis, and Binary Logistic Regression analysis were used to analyze data. Spontaneous pregnancies were used as controls. Results were considered significant when the p value was less than 0.05. RESULTS After exclusions, 16,363 singleton pregnancies, including 1543 conceived via ART, were analyzed. Results from the two biochemistry platforms, Brahms Kryptor and Immulite 2000 were significantly different (p < 0.001); thus, the data was divided for analysis purposes. PAPP-A was universally significantly lower in IVF pregnancies compared to spontaneously conceived pregnancies (p < 0.001). Using the Brahms Kryptor platform, ICSI was associated with significantly decreased PAPP-A (p < 0.046), and a significantly increased FPR (p = 0.012). CONCLUSIONS Consistent with previous studies IVF pregnancies had significantly lower PAPP-A levels supporting the need to appropriately adjust the combined first-trimester screening (cFTS) risk algorithm for IVF conceptions. The Brahms Kryptor and Immulite 2000 platforms are significantly different; however, the universally lower PAPP-A findings support the hypothesis that the lower PAPP-A is due to a biological cause.
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Affiliation(s)
- Lauren P Hunt
- Genetic Health Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia. .,School of Natural Sciences, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia. .,Department of Nursing and Midwifery, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - A M McInerney-Leo
- University of Queensland Diamantina Institute, University of Queensland, Level 7, 37 Kent Street, Translational Research Institute, Woolloongabba, QLD, 4102, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - S Sinnott
- Specialised Obstetric & Gynaecological Imaging (so+gi), 4A/15 Tribune Street, South Bank, QLD, 4101, Australia
| | - B Sutton
- Specialised Obstetric & Gynaecological Imaging (so+gi), 4A/15 Tribune Street, South Bank, QLD, 4101, Australia
| | - R Cincotta
- Queensland Ultrasound for Women, 1/55 Little Edward Street, Spring Hill, QLD, 4000, Australia.,Department of Obstetrics and Gynaecology, University of Queensland, St Lucia, QLD, 4072, Australia
| | - G Duncombe
- Queensland Ultrasound for Women, 1/55 Little Edward Street, Spring Hill, QLD, 4000, Australia.,Department of Obstetrics and Gynaecology, University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Clinical Research, University of Queensland, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - J Chua
- Queensland Ultrasound for Women, 1/55 Little Edward Street, Spring Hill, QLD, 4000, Australia
| | - M Peterson
- School of Natural Sciences, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia.,Specialised Obstetric & Gynaecological Imaging (so+gi), 4A/15 Tribune Street, South Bank, QLD, 4101, Australia
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Cavoretto P, Giorgione V, Cipriani S, Viganò P, Candiani M, Inversetti A, Ricci E, Parazzini F. Nuchal translucency measurement, free β-hCG and PAPP-A concentrations in IVF/ICSI pregnancies: systematic review and meta-analysis. Prenat Diagn 2017; 37:540-555. [PMID: 28419502 DOI: 10.1002/pd.5052] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/09/2017] [Indexed: 01/05/2023]
Abstract
So far, data on the effect of assisted reproductive technologies (ART) on the components of first trimester combined screening for Down syndrome are still controversial. A systematic search of the literature was performed in order to identify the effect of ART, particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with fresh embryo transfer, on the nuchal translucency, free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein-A measurements. Moreover, a meta-analysis and a descriptive graphical representation of the ratios between ART and spontaneous pregnancies (controls) values of median of the multiple of median (m0 MoM) were performed. Free beta-human chorionic gonadotrophin test showed slightly higher values in the ICSI group than controls (RR = 1.09, 95%CI: 1.03-1.16) but not in the IVF group (RR = 1.03, 95%CI: 0.94-1.12). Pregnancy-associated plasma protein-A values for IVF/ICSI, IVF and ICSI showed lower values in comparison with controls (RR, 95%CI 0.85, 0.80-0.90; 0.82, 0.74-0.89 and 0.83, 0.79-0.86, respectively). The nuchal translucency measurement did not show any statistical differences between study groups (IVF and ICSI) and controls (RR = 1.00, 95%CI: 0.94-1.08 and RR = 1.01, 95%CI: 0.97-1.05, respectively). These results may be due to alterations in the placentation of ART pregnancies. Differentiating further subgroups of ART pregnancies may explain the differences in biomarker concentrations, in prenatal behavior and in obstetric outcomes between ART and spontaneous pregnancies. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paolo Cavoretto
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Veronica Giorgione
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Sonia Cipriani
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile Clinica Ostetrico Ginecologica, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Paola Viganò
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Annalisa Inversetti
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Elena Ricci
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile Clinica Ostetrico Ginecologica, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile Clinica Ostetrico Ginecologica, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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Lanes A, Huang T, Sprague AE, Leader A, Potter B, Walker M. Maternal serum screening markers and nuchal translucency measurements in in vitro fertilization pregnancies: a systematic review. Fertil Steril 2016; 106:1463-1469.e2. [DOI: 10.1016/j.fertnstert.2016.07.1120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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15
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Cavoretto P, Dallagiovanna C, Viganò P, Somigliana E, Persico N, Papaleo E, Faulisi S, Candiani M. First trimester combined screening test in pregnancies derived from blastocyst transfer. Eur J Obstet Gynecol Reprod Biol 2016; 198:50-55. [DOI: 10.1016/j.ejogrb.2015.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 11/27/2015] [Accepted: 12/21/2015] [Indexed: 10/22/2022]
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16
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Bonne S, Sauleau E, Sananes N, Akaladios C, Rongières C, Pirrello O. Influence of medically assisted reproduction techniques on crown-rump length and biochemical markers of trisomy 21 in the first trimester of pregnancy. Fertil Steril 2016; 105:410-6. [DOI: 10.1016/j.fertnstert.2015.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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Sahraravand M, Laitinen P, Järvelä I, Ryynänen M. First-trimester maternal serum ADAM12-s and PAPP-A levels are altered in pregnancies conceived after assisted reproduction techniques (ART). Prenat Diagn 2016; 36:163-9. [DOI: 10.1002/pd.4764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 12/02/2015] [Accepted: 12/19/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Maarit Sahraravand
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Päivi Laitinen
- Clinical Chemistry and Haematology; HUSLAB, Helsinki University Hospital; Helsinki Finland
| | - Ilkka Järvelä
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Markku Ryynänen
- Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
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The placenta: phenotypic and epigenetic modifications induced by Assisted Reproductive Technologies throughout pregnancy. Clin Epigenetics 2015; 7:87. [PMID: 26300992 PMCID: PMC4546204 DOI: 10.1186/s13148-015-0120-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/02/2015] [Indexed: 02/07/2023] Open
Abstract
Today, there is growing interest in the potential epigenetic risk related to assisted reproductive technologies (ART). Much evidence in the literature supports the hypothesis that adverse pregnancy outcomes linked to ART are associated with abnormal trophoblastic invasion. The aim of this review is to investigate the relationship between epigenetic dysregulation caused by ART and subsequent placental response. The dialogue between the endometrium and the embryo is a crucial step to achieve successful trophoblastic invasion, thus ensuring a non-complicated pregnancy and healthy offspring. However, as described in this review, ART could impair both actors involved in this dialogue. First, ART may induce epigenetic defects in the conceptus by modifying the embryo environment. Second, as a result of hormone treatments, ART may impair endometrial receptivity. In some cases, it results in embryonic growth arrest but, when the development of the embryo continues, the placenta could bring adaptive responses throughout pregnancy. Amongst the different mechanisms, epigenetics, especially thanks to a finely tuned network of imprinted genes stimulated by foetal signals, may modify nutrient transfer, placental growth and vascularization. If these coping mechanisms are overwhelmed, improper maternal-foetal exchanges occur, potentially leading to adverse pregnancy outcomes such as abortion, preeclampsia or intra-uterine growth restriction. But in most cases, successful placental adaptation enables normal progress of the pregnancy. Nevertheless, the risks induced by these modifications during pregnancy are not fully understood. Metabolic diseases later in life could be exacerbated through the memory of epigenetic adaptation mechanisms established during pregnancy. Thus, more research is still needed to better understand abnormal interactions between the embryo and the milieu in artificial conditions. As trophectoderm cells are in direct contact with the environment, they deserve to be studied in more detail. The ultimate goal of these studies will be to render ART protocols safer. Optimization of the environment will be the key to improving the dialogue between the endometrium and embryo, so as to ensure that placentation after ART is similar to that following natural conception.
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Stemp M, Roberts P, McClements A, Chapple V, Natalwala J, Black M, Matson P. Serum concentrations of the biomarkers CA125, CA15-3, CA72-4, tPSA and PAPP-A in natural and stimulated ovarian cycles. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2014. [DOI: 10.1016/s2305-0500(14)60010-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Additive effect of factors related to assisted conception on the reduction of maternal serum pregnancy-associated plasma protein A concentrations and the increased false-positive rates in first-trimester Down syndrome screening. Fertil Steril 2013; 100:1314-20. [DOI: 10.1016/j.fertnstert.2013.06.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 11/20/2022]
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21
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Giorgetti C, Vanden Meerschaut F, De Roo C, Saunier O, Quarello E, Hairion D, Penaranda G, Chabert-Orsini V, De Sutter P. Multivariate analysis identifies the estradiol level at ovulation triggering as an independent predictor of the first trimester pregnancy-associated plasma protein-A level in IVF/ICSI pregnancies. Hum Reprod 2013; 28:2636-42. [DOI: 10.1093/humrep/det295] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Engels MA, Pajkrt E, Groot DT, Schats R, Twisk JW, van Vugt JM. Validation of Correction Factors for Serum Markers for First-Trimester Down Syndrome Screening in Singleton Pregnancies Conceived with Assisted Reproduction. Fetal Diagn Ther 2013; 34:217-24. [DOI: 10.1159/000355527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022]
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Gjerris AC, Tabor A, Loft A, Christiansen M, Pinborg A. First trimester prenatal screening among women pregnant after IVF/ICSI. Hum Reprod Update 2012; 18:350-9. [DOI: 10.1093/humupd/dms010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sánchez O, Llurba E, Marsal G, Domínguez C, Aulesa C, Sánchez-Durán MA, Goya MM, Alijotas-Reig J, Carreras E, Cabero L. First trimester serum angiogenic/anti-angiogenic status in twin pregnancies: relationship with assisted reproduction technology. Hum Reprod 2011; 27:358-65. [PMID: 22116949 DOI: 10.1093/humrep/der394] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The risk of pre-eclampsia (PE) increases in twin pregnancies, especially when assisted reproduction technologies (ART) are used. The aim of this study was to assess angiogenic/anti-angiogenic factors in maternal serum in the first trimester of twin pregnancies and establish if the mode of conception influences angiogenic status. METHODS This prospective study enrolled women with twin (n = 61) and singleton (n = 50) pregnancies. Dichorionic twin pregnancies were divided into two groups according to their mode of conception. Singleton pregnancies were used as the control group. Soluble fms-like tyrosine kinase (sFlt-1), free placental growth factor (PlGF) and soluble endoglin (sEng) concentrations were measured in the first trimester maternal serum. RESULTS In the first trimester, women with twin pregnancies had higher serum concentrations of the anti-angiogenic factor sFlt-1 than that with singleton pregnancies (3924 ± 250 versus 2426 ± 162 pg/ml, respectively; P < 0.001). Maternal serum PlGF concentrations were lower in singleton pregnancies than those in twin pregnancies (37 ± 3.7 versus 59 ± 5.6, respectively; P < 0.001). Serum concentrations of sFlt-1 were higher in twin pregnancies conceived by ART than those in spontaneous twin pregnancies (4313 ± 389 versus 3522 ± 300 pg/ml, respectively; P < 0.05). No differences between groups were observed for sEng. CONCLUSIONS In the first trimester, twin pregnancies conceived using ART showed a heightened anti-angiogenic status that could explain the increased risk of PE in these cases.
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Affiliation(s)
- O Sánchez
- Biochemistry and Molecular Biology Research Center for Nanomedicine, Vall Hebron University Hospital, Barcelona, Spain
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Are first-trimester screening markers altered in assisted reproductive technologies pregnancies? Curr Opin Obstet Gynecol 2011; 23:183-9. [PMID: 21415744 DOI: 10.1097/gco.0b013e3283455972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the current literature on first-trimester screening with respect to specific issues for assisted reproductive technologies (ARTs) singleton and twin pregnancies. RECENT FINDINGS A number of different first-trimester sonographic and biochemical markers have been validated in first-trimester screening for trisomy 21. Among sonographic markers, measurement of fetal nuchal translucency is the most investigated and least affected screening method in ART pregnancies, achieving comparable results in singletons and twins compared with spontaneous conceptions. The small deviation of nuchal translucency thickness observed in ART singletons did not influence overall screening performance, including the number of false-positive results. First-trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A levels are more obviously altered in assisted conceptions and carry the risk of higher false-positive rates if not adjusted accordingly. The reason behind the alterations is currently not quite explored, but might be attributed to infertility and a higher incidence of placental disorders rather than to the use of ART. In twin pregnancies, chorionicity is an important confounding variable with evident impact on nuchal translucency measurements and maternal biochemistry, but both issues have not been sufficiently investigated in ART twins so far. SUMMARY First-trimester measurement of fetal nuchal translucency in singleton and twin gestations is associated with similar screening results when compared with spontaneous conception. Adjustments for the mode of conception are required if maternal serum biochemistry is included in the screening algorithm. Further studies on assisted conception twins are essential to permit more conclusive results on this issue.
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Parlakgumus HA, Haydardedeoglu B, Simsek E, Bulgan Kilicdag E, Bagis T. Are serum markers altered in first trimester screening in poor ovarian reserve patients? J Obstet Gynaecol Res 2011; 37:1582-7. [PMID: 21733033 DOI: 10.1111/j.1447-0756.2011.01578.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether serum biochemical markers were altered during first trimester screenings in patients who have diminished ovarian reserve. METHODS One hundred and fifty-one women who conceived after intracytoplasmic sperm injection were enrolled during the 11- to 14-week scan between June 2006 and July 2008. The normoresponders (Group 1: 125 patients) had >6 oocytes and the poor responders (Group 2: 26 patients) had ≤6 oocytes in oocyte retrieval. The means of the multiples of the median (MoM) of pregnancy-associated plasma protein A (PAPP-A), free β-human chorionic gonadotropin (β-hCG) and nuchal translucency of the poor responder and normoresponder groups were compared and a potential relationship between serum markers and poor ovarian reserve was investigated. Data were analyzed with the Student's t-test, χ2-test and Mann-Whitney two sample test (unpaired, nonparametric). P < 0.05 was considered significant. RESULTS The means of the MoMs of the poor responders and normoresponders were 1.16 ± 0.45 and 1.04 ± 0.32 (P = 0.111) for nuchal translucency, 0.92 ± 0.48 and 0.89 ± 0.61 (P = 0.399) for PAPP-A, and 1.08 ± 0.40 and 1.21 ± 0.95 (P = 0.831) for β-hCG, respectively. CONCLUSION There was no statistically significant difference between the groups in serum biochemical markers, nuchal translucency means and screen positive rates during the first trimester screening.
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Affiliation(s)
- Huriye A Parlakgumus
- Department of Obstetrics and Gynecology, Başkent University School of Medicine, Ankara, Turkey.
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Matilainen M, Peuhkurinen S, Laitinen P, Jarvela I, Morin-Papunen L, Ryynanen M. In combined first-trimester Down syndrome screening, the false-positive rate is not higher in pregnancies conceived after assisted reproduction compared with spontaneous pregnancies. Fertil Steril 2011; 95:378-81. [DOI: 10.1016/j.fertnstert.2010.07.1048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/04/2010] [Accepted: 07/09/2010] [Indexed: 11/16/2022]
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The impact of temporal variability of biochemical markers PAPP-A and free beta-hCG on the specificity of the first-trimester Down syndrome screening: a Croatian retrospective study. BMC Res Notes 2010; 3:194. [PMID: 20630069 PMCID: PMC2919561 DOI: 10.1186/1756-0500-3-194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 07/14/2010] [Indexed: 11/10/2022] Open
Abstract
Background The variability of maternal serum biochemical markers for Down syndrome, free β-hCG and PAPP-A can have a different impact on false-positive rates between the 10+0 and 13+6 week of gestation. The study population comprised 2883 unaffected, singleton, spontaneously conceived pregnancies in Croatian women, who delivered apparently healthy child at term. Women were separated in 4 groups, dependently on the gestational week when the analyses of biochemical markers were performed. The concentrations of free β-hCG and PAPP-A in maternal serum were determined by solid-phase, enzyme-labeled chemiluminiscent immunometric assay (Siemens Immulite). Concentrations were converted to MoMs, according to centre-specific weighted regression median curves for both markers in unaffected pregnancies. The individual risks for trisomies 21, 18 and 13 were computed by Prisca 4.0 software. Findings There were no significant differences between the sub-groups, regarding maternal age, maternal weight and the proportion of smokers. The difference in log10 MoM free β-hCG values, between the 11th and 12th gestational week, was significant (p = 0.002). The difference in log10 MoM PAPP-A values between the 11th and 12th, and between 12th and 13th week of gestation was significant (p = 0.006 and p = 0.003, respectively). False-positive rates of biochemical risk for trisomies were 16.1% before the 11th week, 12.8% in week 12th, 11.9% in week 13th and 9.9% after week 13th. The differences were not statistically significant. Conclusions Biochemical markers (log10 MoMs) showed gestation related variations in the first-trimester unaffected pregnancies, although the variations could not be attributed either to the inaccuracy of analytical procedures or to the inappropriately settled curves of median values for the first-trimester biochemical markers.
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Cheng PJ, Huang SY, Shaw SW, Chueh HY, Hsiao CH, Hsieh TT. Effect of Maternal Hepatitis B Carrier Status on First-Trimester Markers of Down Syndrome. Reprod Sci 2010; 17:564-567. [DOI: 10.1177/1933719110362921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Bender F, Hecken J, Reinsberg J, Berg C, van der Ven H, Gembruch U, Geipel A. Altered first-trimester screening markers after IVF/ICSI: no relationship with small-for-gestational-age and number of embryos transferred. Reprod Biomed Online 2010; 20:516-22. [DOI: 10.1016/j.rbmo.2009.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 07/22/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
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Engels MAJ, Kooij M, Schats R, Twisk JWR, Blankenstein MA, van Vugt JMG. First-trimester serum marker distribution in singleton pregnancies conceived with assisted reproduction. Prenat Diagn 2010; 30:372-7. [DOI: 10.1002/pd.2495] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Increased time-to-pregnancy and first trimester Down's syndrome screening. Hum Reprod 2009; 25:412-7. [DOI: 10.1093/humrep/dep417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Laigaard J, Gros Pedersen N, Olesen Larsen S, Hedley PL, Wøjdemann K, Gjerris AC, Shalmi AC, Sundberg K, Tabor A, Christiansen M. ADAM12 in first trimester maternal serum from pregnancies conceived by assisted reproduction techniques (ART). Prenat Diagn 2009; 29:628-9. [DOI: 10.1002/pd.2180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Amor D, Xu J, Halliday J, Francis I, Healy D, Breheny S, Baker H, Jaques A. Pregnancies conceived using assisted reproductive technologies (ART) have low levels of pregnancy-associated plasma protein-A (PAPP-A) leading to a high rate of false-positive results in first trimester screening for Down syndrome. Hum Reprod 2009; 24:1330-8. [DOI: 10.1093/humrep/dep046] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gjerris AC, Loft A, Pinborg A, Christiansen M, Tabor A. First-trimester screening markers are altered in pregnancies conceived after IVF/ICSI. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:8-17. [PMID: 19115229 DOI: 10.1002/uog.6254] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To determine the levels of first-trimester screening markers and to assess the false-positive rate for first-trimester combined screening for Down syndrome in a large national population of women pregnant after assisted reproductive technology (ART), in order to decide whether or not to correct risk calculation for mode of conception. METHODS A national prospective cohort study of 1000 pregnancies achieved after ART was compared with a control group of 2543 pregnancies conceived spontaneously. All women completed a first-trimester combined screening program. Risk calculation was performed retrospectively based on the screening parameters to avoid bias due to the use of different algorithms of risk calculation. RESULTS In chromosomally normal pregnancies conceived after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the pregnancy-associated plasma protein-A multiples of the median value was significantly decreased when compared with that of pregnancies conceived spontaneously (0.78 and 0.79 vs. 0.98), while there was no difference in the group treated by frozen embryo replacement. There was no difference in the level of free beta-human chorionic gonadotropin between groups. The median nuchal translucency thickness was smaller in the overall ART group compared with controls. The false-positive rate of first-trimester combined screening in the overall ART group, adjusted for maternal age, was significantly higher when compared with controls (9.0% vs. 6.0%). CONCLUSIONS It seems advisable to use a population of IVF/ICSI pregnancies to establish median curves for the first-trimester serum screening parameters and perhaps also for nuchal translucency thickness. However, care must be taken, as different ART treatment methods and aspects of medical history seem to alter the screening parameters in different ways.
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Affiliation(s)
- A C Gjerris
- Department of Fetal Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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Gjerris A, Loft A, Pinborg A, Christiansen M, Tabor A. The effect of a 'vanishing twin' on biochemical and ultrasound first trimester screening markers for Down's syndrome in pregnancies conceived by assisted reproductive technology. Hum Reprod 2008; 24:55-62. [DOI: 10.1093/humrep/den362] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gjerris AC, Loft A, Pinborg A, Tabor A, Christiansen M. First-trimester screening in pregnancies conceived by assisted reproductive technology: significance of gestational dating by oocyte retrieval or sonographic measurement of crown-rump length. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:612-617. [PMID: 18816495 DOI: 10.1002/uog.6128] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To evaluate, in pregnancies conceived by assisted reproductive technology, whether determination of gestational age (GA) by date of oocyte aspiration (DOA) or crown-rump length (CRL) at first-trimester screening influences the distribution of serum and sonographic markers or the performance of first-trimester screening for chromosomal abnormalities. METHODS GA was calculated using either DOA or CRL at blood sampling and nuchal translucency thickness (NT) measurement in 729 singleton pregnancies conceived by in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Weight-corrected log multiples of the median (MoM) marker distributions specific for IVF pregnancy were established using multiple log regression and compared for DOA- and CRL-based GA calculation. RESULTS GA determined by CRL was significantly larger, albeit slightly, than was GA determined by DOA, with a mean difference of 1.50 (SD, 2.4) days (P < 0.001). Log MoM distributions of free beta-human chorionic gonadotropin and NT showed that GA dating by CRL resulted in significantly higher, albeit slightly, mean log MoM values compared with DOA dating. The reverse was the case for mean log MoM pregnancy-associated plasma protein-A. The SDs were similar for CRL and DOA dating. According to Monte Carlo simulation, the use of DOA or CRL for GA dating did not appreciably influence the performance of first-trimester screening. CONCLUSIONS DOA and CRL are practically equivalent when calculating GA for first-trimester screening. The correct method of GA dating for other purposes (e.g. estimated time of delivery) in IVF/ICSI pregnancies is still unresolved.
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Affiliation(s)
- A C Gjerris
- Department of Fetal Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
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Anckaert E, Schiettecatte J, Sleurs E, Devroey P, Smitz J. First trimester screening for Down's syndrome after assisted reproductive technology: non-male factor infertility is associated with elevated free beta-human chorionic gonadotropin levels at 10–14 weeks of gestation. Fertil Steril 2008; 90:1206-10. [DOI: 10.1016/j.fertnstert.2007.08.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/21/2007] [Accepted: 08/21/2007] [Indexed: 10/22/2022]
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