beta-hCG Levels Research Articles

Treatment of a Cesarean Scar Pregnancy Using Microwave Ablation—a Novel Solution to a Complex Problem

<h3>Study Objective</h3> The aim of this presentation is to demonstrate a safe, minimally invasive, and immediately effective treatment option for cesarean scar pregnancy (CSP) using transvaginal microwave ablation. <h3>Design</h3> case presentation. <h3>Setting</h3> monitored care anesthesia, dorsal lithotomy position. <h3>Patients or Participants</h3> A 30-year-old G4P3 with severe obesity and three prior cesarean sections presented with a positive home pregnancy test, vaginal bleeding and cramping and was diagnosed with a CSP by transvaginal ultrasound. Imaging showed a fetal pole measuring 6w2d gestational age with fetal cardiac activity, and a 5 mm distance between the gestational sac and bladder serosa. The patient was extensively counseled regarding possible management options, at which time Interventional Radiology was consulted. Upon further evaluation and MRI imaging, she was deemed a candidate for novel treatment using transvaginal microwave ablation of the gestational sac. <h3>Interventions</h3> Using the Emprint™ Ablation System, an antenna needle was attached to a transvaginal ultrasound probe and directly inserted into the gestational sac. The ablation zone was adjusted to incorporate the entire gestational sac and microwave ablation was performed. Total treatment time was 72 seconds. <h3>Measurements and Main Results</h3> Immediate post-ablation ultrasound revealed total collapse of the gestational sac with only scant bleeding at the puncture site. Her overall postoperative recovery was unremarkable. Serial beta-hCG levels dropped precipitously from 13,048 before the procedure to 6,693 on postprocedure day 1 and 1,059 on postprocedure day 2, eventually resolving completely by postprocedure day 13. <h3>Conclusion</h3> The goal of this presentation is to demonstrate the novel use of transvaginal microwave ablation for cesarean scar pregnancies. This is a minimally invasive procedure that is quick, safe, and provides immediate resolution of a CSP without requiring prolonged surveillance after treatment. Further studies are required to showcase the true efficacy and safety of this technology as well as to determine its effects on future fertility.

Incomplete abortion with elevated beta-human chorionic gonadotropin levels mimicking a molar pregnancy

Abstract Rationale: Incomplete abortion often causes a lot of bleeding and may lead to severe anemia. The elevated beta-human chorionic gonadotropin (beta-hCG) level is often associated with a molar pregnancy. We report a case of incomplete abortion with elevated beta-hCG levels mimicking a molar pregnancy. Patient concerns: A 29-year-old woman experienced prolonged vaginal bleeding for several months. She had an artificial abortion one year before, however, vaginal bleeding was noted, and the local clinic prescribed progesterone and transamine to stop the bleeding. The amount of bleeding decreased after medication, but persistent bleeding was noted. Diagnosis: She visited our hospital where the urine pregnancy test was positive. Ultrasound and computed tomography showed a hematometra (4.5 cm × 4.3 cm), thickened endometrium, and mild ascites. An elevated serum beta-hCG level of 32980.4 mIU/mL was observed along with a hemoglobin level of 7.2 g/dL. Incomplete abortion or molar pregnancy was suspected. Interventions: Endometrial curettage was performed. Outcomes: Pathology showed the gestational product and chromosome analysis showed normal karyotyping. Incomplete abortion was diagnosed. Postoperative follow-up was uneventful and the beta-hCG level returned to normal after 3 months. Lessons: Incomplete abortion with elevated beta-hCG levels is a rare condition that mimics a molar pregnancy. Transvaginal ultrasound, quantitative serum hCG evaluation, and other laboratory tests (e.g., complete blood count) are essential preoperative investigations.

Gastric teratomas in paediatric population: A case series from a tertiary care centre of Northern India

A retrospective analysis of all paediatric patients diagnosed and treated for gastric teratomas in our hospital over the past 20 years was carried out (1997–2017). A database of the clinic-pathological characteristics of these patients was developed. In all, 7 patients were identified. All the patients underwent resection and were followed up every 6 months. The investigations performed included routine blood investigations, X-ray, alpha fetoproteins (AFP), beta HCG levels and a CT scan of the abdomen. There were seven patients with gastric teratomas and all of them were male except one female. Their ages ranged from 1 day to 4 years. Six (85.7%) patients presented during infancy. The manifestations were as follows: a palpable abdominal mass followed by anemia, respiratory distress, abdominal distension, gastric outlet obstruction with recurrent vomiting, and abdominal pain, anorexia, and melena. Histopathology was mature type in five (71.4%) cases, and immature Grades 1 and 2 in one (14.2%) each. Complications were seen in four (57.1%) cases, and there was one (14.2%) mortality in our series. Recurrence was seen in two of our cases. The preoperative diagnosis of Gastric teratoma may be challenging, but with recent advances in imaging an accurate diagnosis and staging is possible. Complete surgical excision is curative in all cases, with close observation and follow-up. • Gastric teratoma is an exceptionally rare embryonic neoplasm occurring in neonatal period and infancy. • Due to the paucity of the number of cases, the natural history of the disease is not fully understood and its preoperative diagnosis remains elusive. • Complete surgical excision is curative in all cases, with close observation and follow-up being recommended in Grade 2 and 3 immature teratomas. • The detection of immature component carries a prognostic implication and hence, extensive sampling is essential. • Postoperatively, the prognosis is excellent. • Long term follow-up with AFP and beta hCG depending on the type is the standard protocol to be adopted.

Can the Additional Dose Requirement be Determined before the Seventh Day to Successfully Treat Tubal Ectopic Pregnancy with a Single-dose Methotrexate Protocol?

To investigate the relationship of beta-hCG changes between the first, fourth and seventh days as a predictor of the additional dose requirement in single-dose methotrexate protocol in tubal ectopic pregnancy. Observational study. Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Training and Research Hospital, between January 2017 and June 2020. Data of 123 patients with tubal ectopic pregnancy, treated with a single-dose methotrexate protocol, were retrospectively analysed. Patients who received methotrexate on the first day and achieved treatment success constituted one group. Patients who received additional doses on the seventh day and achieved treatment success, constituted the other group. Treatment success was defined as normalisation of beta-hCG levels without surgical intervention. The percentage of beta-hCG change between day-one and day-four was a significant independent variable for the additional dose treatment requirement (OR:1.07, CI:1.01-1.13, p=0.022). The cut-off value of the beta-hCG change percentage between the first and fourth day, was calculated as 4% (sensitivity 72.9%, specificity 78.9%, positive predictive value [PPV] 88.6%, negative predictive value [NPV] 56.6%). In the single-dose methotrexate protocol applied in the medical treatment of tubal ectopic pregnancy, the change in beta-hCG value between the first and fourth days may predict the need for additional doses. Administration of an additional dose of methotrexate on the fourth day may be considered, if there is less than a 4% decrease or any increase in beta-hCG value between the first and fourth days. Key Words: Ectopic pregnancy, Methotrexate, Beta human chorionic gonadotropin, Tubal pregnancy, Single-dose protocol.

Conservative Management of Placenta Previa-Accreta in a First Trimester Missed Abortion.

The incidence of placenta accreta has been increasing along with the incidence of caesarean sections. There have only been a few case reports of placenta accreta diagnosed in the first trimester, and none in association with a missed abortion in a woman without risk factors. At a routine prenatal visit, a 33 year old G2P0101 at 12+6 weeks had an ultrasound demonstrating a fetus with a crown-rump length of 8+0 weeks, no fetal heart tones, a placenta previa, and a morbidly adherent placenta. The patient requested conservative management to help preserve her fertility. Imaging demonstrated an anterior placenta previa with extension of the placenta past the inner endometrium into the superficial myometrium wall and the myometrium adjacent to the superior surface of the bladder. Consultation with Maternal Fetal Medicine (MFM) at another institution similarly demonstrated a suspicion of vascular invasion of the uterine wall with no increased vascularity extending to the maternal bladder using color flow Doppler. The opinion from this second MFM team recommended expectant management with serial beta-hCG, ultrasounds, and serial physician visits as well. Her beta-hCG levels declined serially from 55262 to 4874 mIU/mL over eight weeks. Her serial ultrasounds showed involution of the placenta and reasborption of the fetus during that time. After nine weeks of conservative management, the patient underwent an uncomplicated suction dilation and curettage. Postoperatively, the patient did well and did not have any complications. A first trimester missed abortion with a placenta previa and accreta can be managed conservatively in the attempt to preserve future fertility.

A fine tuning of embryo loading technique by eliminating the air bubble in the outer sheath of embryo catheter among women undergoing IVF treatment.

The role of air bubbles in bracketing the embryo-containing medium in inner catheter during embryo transfer (ET) has already been established. However, the role of air bubbles in outer catheter (OC) during implantation is yet to be determined. This study aimed to compare the implantation rates between women who have undergone ET with or without ASP (Vitrolife®; Sweden), a medium use for oocyte retrieval and rinsing in OC embryo catheter. The purpose of introducing the ASP medium to the OC was to eliminate air bubbles in that space during implantation. A total of 312 women were randomly divided into two groups with 156 participants each group. In Group A, ASP medium was used during ET, whereas in Group B, no ASP medium was utilized. Positive implantation was defined as serum beta-hCG level >5 mIU/mL taken on the 7th day following ET. The average age of the majority of the participants was 30-39 years and had at least 4-5 years of subfertility. The unexplained subfertility was the prominent cause of ET failure in both groups. In most of the participants in both groups, ET was done using fresh embryo cycles with good to excellent embryo grades. After the ASP medium was manipulated in the OC in both groups, the positive implantation rate was not different in both groups (p>0.05). The elimination of air bubbles in OC by using the ASP medium during ET did not confer an additional benefit nor exert a negative impact on implantation rate.

Conservative Management of Placenta Previa-Accreta in a First Trimester Missed Abortion

The incidence of placenta accreta has been increasing along with the incidence of caesarean sections. There have only been a few case reports of placenta accreta diagnosed in the first trimester, and none in association with a missed abortion in a woman without risk factors. At a routine prenatal visit, a 33 year old G2P0101 at 12+6 weeks had an ultrasound demonstrating a fetus with a crown-rump length of 8+0 weeks, no fetal heart tones, a placenta previa, and a morbidly adherent placenta. The patient requested conservative management to help preserve her fertility. Imaging demonstrated an anterior placenta previa with extension of the placenta past the inner endometrium into the superficial myometrium wall and the myometrium adjacent to the superior surface of the bladder. Consultation with Maternal Fetal Medicine (MFM) at another institution similarly demonstrated a suspicion of vascular invasion of the uterine wall with no increased vascularity extending to the maternal bladder using color flow Doppler. The opinion from this second MFM team recommended expectant management with serial beta-hCG, ultrasounds, and serial physician visits as well. Her beta-hCG levels declined serially from 55262 to 4874 mIU/mL over eight weeks. Her serial ultrasounds showed involution of the placenta and reasborption of the fetus during that time. After nine weeks of conservative management, the patient underwent an uncomplicated suction dilation and curettage. Postoperatively, the patient did well and did not have any complications. A first trimester missed abortion with a placenta previa and accreta can be managed conservatively in the attempt to preserve future fertility.

SPONTANEOUS HETEROTOPIC PREGNANCY WITH UNSTABLE VITALS: A CASE REPORT

A spontaneous heterotopic pregnancy is a rare obstetric entity which can be life threatening if early diagnosis is missed. There is co-existing intra uterine and extra uterine pregnancy, most often tubal and rarely cervical or ovarian. It is extremely rare in spontaneous conception but incidence is increasing with the use of ART’s. Early diagnosis is difcult probably because of the lacking clinical symptoms. It usually presents as a ruptured ectopic pregnancy. Timely diagnosis and intervention is of utmost importance to prevent maternal morbidity and mortality. Abdominal pain, swelling, peritoneal irritation, enlarged uterus, vaginal bleeding, pallor, tachycardia, features of shock may be a few presenting features. With the advances in technology, transvaginal ultrasound proves to be a great diagnostic tool in early diagnosis of heterotopic pregnancy. Serum beta-hcg levels is of importance. Intervention can be medical or surgical depending on the hemodynamic condition of the patient and the viability of the intrauterine pregnancy. Heterotopic pregnancy is an unusual diagnosis and so is often ignored in the presence of an intrauterine pregnancy. But as it can prove to be life threatening so its diagnosis as a differential should always be kept in mind. Early diagnosis and prompt and effective treatment can save a life or two!

Transient Thyrotoxicosis in Molar Pregnancy

Introduction: Thyroid function abnormalities commonly occur in pregnancy. Due to the structural homology between beta-human chorionic gonadotropin (beta-hCG) and thyrotropin (TSH), some of these changes may be physiologic, while others can be from pathologic causes. Molar pregnancies represent a unique etiology, as beta-hCG levels are often markedly elevated due to trophoblastic hyperplasia and can cause hyperthyroidism. Case Description: A 20-year-old pregnant female presented at 18 weeks estimated gestational age for persistent nausea and vomiting, which had worsened over the past one to two weeks. She also noted palpitations and heat intolerance. On initial presentation, her heart rate was 145 beats per minute, blood pressure was 135/86 mmHg, oxygen saturation was 98% on room air, and temperature was 98.3 F. Exam was notable for sinus tachycardia; no thyromegaly, palpable thyroid nodules, lower extremity edema, or tremors were appreciated. Transvaginal ultrasound was performed, and an approximately 17-week fetus with no cardiac activity was identified; an enlarged and hydropic placenta and bilateral theca lutein cysts were also seen on imaging, concerning for a partial molar pregnancy. Laboratory data revealed plasma beta-hCG >1,000,000 mIU/mL. Due to her symptoms and tachycardia that were refractory to intravenous hydration, thyroid function tests (TFTs) were assessed: TSH of 0.01 uIU/mL and free T4 (FT4) 6.85 ng/dL. She was started on methimazole and beta blockade in the pre-operative period. She received mifepristone and underwent dilatation and evacuation. Histopathology was consistent with a partial mole, given the presence of fetal somatic differentiation. Beta-hCG and FT4 levels rapidly trended down in the post-operative setting, and methimazole was discontinued. Levels were monitored closely after discharge. Atenolol was stopped when her TFTs normalized. Approximately six weeks after surgery, her TSH was 0.523 uIU/mL and FT4 was 0.70 ng/dL. Three months after surgery, the beta-hCG level had decreased to 4 mIU/mL. Discussion: In North America, the incidence of hydatidiform moles is approximately 100 per 100,000 pregnancies. Hydatidiform moles compromise two distinct entities: complete moles and partial moles, which are distinguishable based on karyotype and histopathological features. In molar pregnancies, the trophoblastic tissues, which produce hCG, are hyperplastic; thus, markedly elevated hCG levels can be seen. Due to its structural similarity to TSH, beta-hCG can activate TSH receptors and drive production of thyroid hormone, which can subsequently result in a thyrotoxic state. Surgical management of the mole is key, as the hyperthyroidism usually resolves with uterine evacuation, though hCG levels must be monitored closely afterwards to ensure gestational trophoblastic neoplasia does not develop.

Choriocarcinoma Induced Thyrotoxicosis in a Male Adult

Introduction: Germ cell tumors normally occur in the gonads but may be found in extragonadal sites (due to abnormal migration of germ cells during embryogenesis). Metastatic choriocarcionomas are non-seminomatous germ cell tumors which overproduce beta Human Chorionic Gonadotropin (hCG). Rarely, thyrotoxicosis can be driven by germ cell tumor-mediated hCG excess. This hormone binds to the TSH receptor with reduced potency compared to intact TSH. Paraneoplastic thyrotoxicosis, driven by extremely high levels of hCG, is a rare condition which can be associated with choriocarcinomas. Case Presentation: We present a case of 29-year-old man with metastatic extragonadal choriocarcinoma under active treatment with oxaliplatin, paclitaxel, gemcitabine (2 cycles completed), right upper lobe resection and whole brain radiation. He was admitted for small bowel obstruction and persistent tachycardia which prompted evaluation of thyroid function. His initial labs were remarkable for TSH <0.01 mclU/mL (0.27-4.20 mclU/mL), FT4 of 6.38 ng/dL (0.93-1.70 ng/dL), total T3 261 ng/dL (75-170 ng/dL), and beta hCG 578,259 mlU/ML (0-2 mlU/ML). His most recent round of chemotherapy was 7 days prior to admission. He was started on atenolol and methimazole but his FT4 rapidly declined, hence methimazole was stopped after one dose of 40 mg. Sevenfold decrease in FT4 to 0.93 ng/dL correlated with fivefold decrease in beta hCG levels to 98,921 mlU/ML. A week later his FT4 increased to 2.42 ng/dL along with increase of beta hCG to 448,116 mlU/ML. At this point he developed multiple complications due to progressive metastatic disease including acute urinary retention, shortness of breath, abdominal pain, tachycardia, acute anemia and thrombocytopenia, anxiety and was started on methimazole as part of palliative treatment for symptom relief. Unfortunately, he passed away three weeks after initial presentation of thyrotoxicosis due to widespread disease. Discussion: Choriocarcinoma is very rare and aggressive germ cell tumor especially in males. Unfortunately, the widespread nature of choriocarcinomas at the time of diagnosis is a major main reason for poor prognosis. Clinical manifestations of thyrotoxicosis associated with choriocarcinoma such as tachycardia, anxiety, tachypnea are variable and often can overlap with constitutive symptoms in widespread malignancy. Even if a definitive cure of choriocarcinoma is not attainable, recognizing an associated paraneoplastic thyrotoxicosis can provide an important pathway to provide palliative symptom relief.

Diagnostic and prognostic significance of serum beta hCG level in various gestational trophoblastic diseases

Introduction: Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. Risk factors of GTD include extreme of reproductive age, multiparity, smoking, alcohol consumption, lower socioeconomic class etc. Materials and Methods: The present study was descriptive, observational, analytical type done in Department of Pathology at M.P. Shah Medical College Jamnagar. All cases clinically suspected of GTD were included and its correlation with serum beta hCG was studied. The cases of GTD were classified according to WHO classification. Estimation of serum beta hCG level was done by using Indirect Sandwich Enzyme Linked Immunosorbent Assay (ELISA). Results: During study period of 1 year from October 2019 to September 2020, 150 sample received out of which 16 cases were diagnosed as GTD. Most of the cases were of hydatidiform moles, few cases of choriocarcinoma and Placental Site Trophoblastic Tumour (PSTT). The common clinical presentation was per vaginal bleeding and amenorrhea. In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD was done. Conclusion: Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination and serum beta hCG level are helpful for confirmatory diagnosis. Follow up beta hCG level is very useful indicator to detect these lesions and its recurrences.

Role Of Prolactin And B-Hcg In Female Infertility

The World Health Organization (WHO) describes infertility as a disability for couples in childbirth to attain pregnancy within 12 months of daily sexual intercourse. The reproductive years of women starts when she starts her menstrual cycle during puberty and capacity to have a child typically ends about age (45) years. However, it may be possible for a woman to become pregnant before her cycles end with menopause. Infertility affects 13–20 per cent of couples worldwide, regardless of race or ethnicity. The present study aim was To study the levels of prolactin and beta hCG in female infertility. And To correlate the levels of prolactin and beta hCG in infertile womens and healthy controls. The present study was conducted in the departments of biochemistry and dept. of obstetrics and gynaecology. The study was conducted on two groups of 40 infertile Females and 40 healthy controls. Serum sample used for estimation of prolactin and hCG, assessed by dry chemistry analyzer. Serum prolactin levels in infertile females is 33.96±11.46 and hCG levels was 86.38±12.45, which was higher in infertile female as compared to healthy control with a p-value of&lt;0.05. The present study concludes that Hyperprolactinemia is a major contributing hormonal factor in infertility among infertile women and, as such, prolactin and hCG should be measured in infertile women.

Resolution of chronic ectopic pregnancy with letrozole

: Two patients of chronic ectopic were treated with a new drug letrozole with resolution of the mass and decrease in beta hCG levels. Patient was followed up for 6 months with no recurrence.

Choriocarcinoma in post-menopausal women- 3 case reports with review of literature

Gestational trophoblastic neoplasia is of uncommon occurrence in postmenopausal women, unlike in the reproductive age group. The diagnosis is based on levels of beta-human chorionic gonadotropin (hCG) in serum. The management is similar to that in premenopausal women. First case, fifty-two-year-old, P8 L4A3 postmenopausal female, presented with postmenopausal bleeding. Diagnosis of choriocarcinoma was made in view of raised serum betah-CG levels with uterine lesion with lung metastasis. The patient started on Multi-agent chemotherapy. The patient succumbed to death due to Grade III hematological toxicity while on the first cycle of the EMA/CO regimen. Second case, forty-two-year-old, P2 L2, postmenopausal, with a history of Choriocarcinoma 20 years, back presented with postmenopausal bleeding. After metastatic workup, the patient started on EMACO regimen. She is asymptomatic and on regular follow-up after 8 cycles of chemotherapy. Third case, forty-seven-year-old, P4 L4, postmenopausal, presented with histopathology report suggestive of choriocarcinoma after hysterectomy. After evaluation, lung metastasis was detected. The patient responded to eight cycles to Multi-agent chemotherapy and is on regular follow-up. Choriocarcinoma is a rare gynecological malignancy in postmenopausal women. High index of suspicion is required for its diagnosis. The prognosis of the disease is not encouraging as compared to the premenopausal woman

B-hCG and H-hCG levels in patients with gestational trophoblastic neoplasia

Objective: Gestational trophoblastic disease is a term that encompasses a spectrum of disorders all arising from the placenta. Human chorionic gonadotropin (hCG) hormone has an essential role in the diagnosis and management of gestational trophoblastic neoplasia. Measuring beta-hCG (B-hCG) levels is the only standard method of monitoring treatment response in patients on chemotherapy. Serial B-hCG levels are also helpful in defining the suitable approach and the dosage of chemotherapeutic drugs. Unfortunately, this marker may not be helpful in some cases. Therefore, the present study was conducted to determine the results of the ratio of B-hCG and hyperglycosylated human chorionic gonadotropin (H-hCG) in patients with gestational trophoblastic neoplasia. Materials and methods: This was a cross-sectional study in 22 patients with gestational trophoblastic neoplasia who were referred to an oncology clinic of an academic hospital of Mashhad University of Medical Sciences in Iran from December 2017 to May 2018. Inclusion criteria were plateau level of B-hCG (during 4 weeks) or persistent low level of hCG. After ruling out other etiologies, H-hCG level was measured and the H-hCG/total hCG ratio was evaluated. If the proportion was more than 20%, active gestational trophoblastic neoplasia was diagnosed, and if it was less than 20%, quiescent gestational trophoblastic neoplasia was diagnosed. In patients with active gestational trophoblastic neoplasia, interventional procedures involved a change in the dose intensity or chemotherapy or proposing a surgery. However, only serial follow-up was recommended in patients with quiescent gestational trophoblastic neoplasia. Then, the patients were followed during the therapy and the condition of patients was followed and recorded. Results: The mean age of patients was 31.36 ± 8.01 years. Hydatidiform mole was the most common diagnosis, accounting for approximately 64% (14) of patients. A total of 81% of patients were undergoing chemotherapy. The interval time between the onset of chemotherapy until plateau or persistent low level of hCG was 11.26 ± 4.03 weeks. The mean B-hCG level was 36.6 mIU/mL and the mean H-hCG/total hCG ratio was 6.24%. This proportion was less than 20% in 82% of patients. Among these patients, 14 patients (77.8%) had spontaneously normalized levels of B-hCG during a 6-month follow-up. Two cases underwent chemotherapy due to increased B-hCG. Other patients are still under follow-up without disease progression. Among 4 patients with a H-hCG/total hCG ratio &gt;20%, hysterectomy was recommended to one patient duo to multiparity and the fact that the tumor was localized in the uterus. In the other patients, an increase in the dose of methotrexate or a change of chemotherapy regimen was performed, which caused a decrease in B-hCG level to normal. All patients are still under follow-up without disease progression. Conclusion: The data in this study suggests the use of H-hCG as a tumor marker in patients with persistent low level of B-hCG, which is useful to distinguish between quiescence gestational trophoblastic neoplasia, which does not need treatment, from active gestational trophoblastic neoplasia. However, further studies with larger sample size are needed to confirm and generalize the above findings. Keywords: gestational trophoblastic

Association between blastocyst morphology and maternal first trimester serum markers in ongoing pregnancies obtained after single fresh blastocyst transfer

ObjectiveIs 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 designThis 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. ResultsFemale 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. ConclusionOur 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.

Factors that may interfere in estradiol-progesterone plasmatic concentration in the mid-luteal phase of hyperstimulated cycles for IVF/ICSI

Research question: We have demonstrated that plasmatic estradiol in mid-luteal phasel has prognostic value for clinical and ongoing pregnancy rate. This study investigated the possible factors that could interfere in the value of estradiol-progesterone in the mid luteal phase of cycles of IVF/ICSI Design: Retrospective study, including patients ≤39years old and with dosage of estradiol-progesterone and beta hCG 6-7 days after fresh embryo transfer and the influence of several factors or variables upon these hormones. Results: Of 189 cycles of IVF/ICSI with complete hormonal evaluation in mid-luteal phase, we studied the probably influence of ten factors upon plasmatic concentration of estradiol-progesterone. Only four factors had significant influence. Of them, the most important variable was beta hCG concentration (consequence of trophoblastic mass and number of implanted embryos), followed for number collected oocytes, and of litlle importance, scheme of final maturation with luteal phase correction (did not reach statistical difference), and day of transfer. Conclusion: The estradiol-progesterone in the mid-luteal phase, in this research, were influenced by hCG, number of collected oocytes, scheme for final maturation, but the main influence factor was the beta hCG concentration, although not had been a good correlation coefficient between these hormones, due to a large difference in the their concentrations, as seen in the high values observed on the Standard Deviation. The high percentages of clinical and ongoing pregnancies in the ≥500g/ml group, were the result of higher beta hCG levels, due to the larger number of twin pregnancy in this group.

Large Solitary Luteinized Follicle Cyst of Pregnancy and Puerperium: a Rare Post-partum Clinical Presentation

Abstract Introduction/Objective In literature, all large solitary luteinized follicular cysts of pregnancy and puerperium (LSLFCPP) recognized were removed before or during delivery. This would be the first case in literature describing the clinical behavior of the LSLFCPP in the post-partum period. Methods We herein report a rare case of 21-year-old G2P2 female who underwent a full-term uneventful spontaneous vaginal delivery (39w0d, APGARS 9,9) without removal of the undiagnosed LSLFCPP, which nearly doubled in size post-partum. Her past medical history was significant for treated syphilis and normal Pap Test of the cervix. Three months after delivery, the patient presented with LSLFCPP exhibiting mass effect (retroverted uterus, mild right-sided obstructive uropathy, compressed bladder and intermittent pain). The antepartum ultrasound showed 14 cm pelvic mass that had grown to 30 cm on CT scan, in largest dimension. Beta-hCG levels returned to pre- pregnancy levels. Treponema pallidum antibody, FTA-ABS and RPR were reactive. Alpha-fetoprotein, inhibin B, CA- 125, CEA, and CA 19-9 screen were unremarkable. The patient underwent exploratory laparotomy cyst removal with right salpingo-oophorectomy. Results Grossly, the tumor weighed 22 lbs with a diameter of 28 cm; excrescences were not noted. Intraoperative consultation revealed a unilocular benign cyst. Histologically, the cyst was not only lined by luteinized cells but nests of luteinized cells infiltrated the fibrous wall. These cells were positive for Inhibin A and calretinin. A rare mitotic figure was noted. A diagnosis of LSLFCPP was rendered. Conclusion High levels of gonadotropin in pregnancy are implicated in the pathogenesis of LSLFCPP; however, in our case, the cyst doubled in size three months after delivery with undetectable beta-hCG levels. This indicates that the pathogenesis of this cyst relies on more than beta-hCG stimulation. LSLFCPP is important to recognize because it can mimic a malignant proliferation on frozen section and can potentially compromise fetal viability with mass effect.

Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report

BackgroundNitrous oxide has become a popular inhalant as abused substance by young Chinese people in recent years. It has been mainly associated with medical conditions including megaloblastic anemia and myeloneuropathy.Case presentationWe report a case of a 25-year-old high school graduate who had been abusing nitrous oxide for twenty months. She had a history of peripheral neuropathy and subacute combined degeneration in between. The young woman presented with headache, motor aphasia and right arm paralysis of eight hours after intermittently consuming nitrous oxide for one week. D-dimer was increased (1.1 mg/ml). Blood vitamin B12, folate, homocysteine and beta-HCG levels were normal. Head CT showed hemorrhagic infarction and subarachnoid hemorrhage. MR angiography and venography were normal. Head MRI identified left frontal isolated cortical vein thrombosis. Her muscle strength and verbal fluency significantly improved after initiation of Low Molecular Weight Heparin and serial head MRI showed continuous reduction in the size of thrombus.ConclusionsFor the first time nitrous oxide use is found to be related to isolated cortical vein thrombosis. Public education regarding the potential consequences of abusing nitrous oxide especially in high-risk individuals is urgently needed.

Antithyroid antibodies may predict serum beta HCG levels and biochemical pregnancy losses in euthyroid women with IVF single embryo transfer

Objective To investigate the relationship between thyroid autoimmunity and early pregnancy serum β-HCG levels in intracytoplasmic sperm injection patients. Methods The study subjects were 85 female euthyroid patients undergoing intracytoplasmic sperm injection embryo transfer cycles with GnRH antagonist treatment. Patients who received transfer of more than one embryo, those with serum TSH levels of greater than 2.5 IU/ml and subjects using levothyroxine were excluded. Normal responder patients under the age of 40 years were randomly selected from the patient files retrospectively. Subjects were divided into two groups: those with autoimmune thyroid disease (thyroid autoimmunity group; n = 39) and those without the disease (control group; n = 46). Results The age, body mass index, trial number, total rFSH treatment dose, the number of cumulus oophorus complexes, number of metaphase II oocytes, and number of 2-pronuclei embryos were similar in the thyroid autoimmunity and control groups. Serum β-HCG levels measured on the 14th day after oocyte pickup were significantly lower in the thyroid autoimmunity group than in the control group (93.8 ± 35.8 versus 128.5 ± 55.8 mlU/ml, respectively; p < .001). The miscarriage rate was higher in the thyroid autoimmunity group than in the control group (34.4% versus 21.7%, respectively; p = .034). Conclusion We found that early-stage pregnancy serum β-HCG hormone levels among euthyroid patients undergoing intracytoplasmic sperm injection were lower in subjects with thyroid autoimmunity than in those without thyroid autoimmunity. This result, reported for the first time in the literature on euthyroid pregnant women with thyroid autoimmunity, may be predictor of early pregnancy losses in pregnant women with thyroid autoimmunity. Key message In intracytoplasmic sperm injection (ICSI)/IVF patients, due to lack of evidence-based data about the relationship between thyroid autoimmunity and pregnancy loss the current research was conducted. Early-stage pregnancy serum β-HCG hormone levels in euthyroid ICSI patients with thyroid autoimmunity are lower than those without autoimmunity which may be associated with early pregnancy losses.