Measurement Of Chorionic Gonadotropin Research Articles

More invasive procedures are done to detect each case of Down's syndrome in younger women

To evaluate the performance of first-trimester combined screening in 5-year periods according to maternal age in a low-risk population. A prospective study. Multicenter study in Finland. A total of 76949 voluntary women with singleton pregnancies participated in first-trimester combined screening in public healthcare between 1 May 2002 and 31 December 2008. The serum samples were analyzed using the PerkinElmer AutoDELFIA® time-resolved fluoroimmunoassay kit for the measurement of pregnancy-associated plasma protein-A and free beta-human chorionic gonadotropin. Nuchal translucency was measured by trained personnel (midwives or physicians) in a university or central hospital. Performance, detection rate, false positive rate and the number of invasive procedures needed to detect a single case of Down's syndrome were analyzed. There was a direct connection between maternal age and the prevalence of Down's syndrome with a low prevalence in young women being 1:1 193 in the 25-29 age group and 1:150 in the 35-39 age group. Consequently, for a fixed false positive rate of 5%, the number of invasive procedures needed to detect one case of Down's syndrome is higher in younger women to achieve the same detection rate. In combined first trimester screening the risk for Down's syndrome is individual, varying with maternal age. This should be taken into consideration when counseling women.

A case of consistent discrepancies between urine and blood human chorionic gonadotropin measurements

Our laboratory was confronted with two successive urine samples from a single patient which tested positive for human chorionic gonadotropin (hCG) when tested with both qualitative and quantitative assays, combined with no detectable hCG in corresponding plasma samples. Serial dilution and recovery experiments were performed in order to investigate the presence of interfering substances or a high-dose hook effect. The ovarian cysts that were removed from this patient were immunohistochemically stained using polyclonal anti-human hCG antibodies. Furthermore, a urine sample was sent to the USA hCG Reference Service for hCG variant analysis. Dilution and recovery experiments in urine and plasma samples were unremarkable. The biopsy stained negative for human hCG and free β-subunit. hCG isoform analysis in the urine sample revealed that approximately 87.5% of the immunoreactive hCG lacked the β-subunit C-terminal peptide (CTP). We report a rare case in which two successive urine samples test positive for hCG whereas in corresponding plasma samples hCG is undetectable. The majority of the total hCG contained a degraded form of β-subunit that lacks the CTP. This hCG variant, possibly of pituitary origin, is thought to have an extreme fast clearance rate possibly explaining the discordance between the hCG results in urine and plasma samples.

Clinical features and microsurgical management of rare tumors in the sellar region

To investigate the clinical characteristics and microsurgical managements of rare tumors in the sellar region. Six rare cases of tumors in the sellar region treated by microsurgery from Jan 2000 to Jan 2010 were reviewed retrospectively. Subsequent treatments were according to the status of preoperative alpha fetal protein (AFP) and human chorionic gonadotropin (HCG) measurement as well as confirmed by histopathological examination in all six patients. Total resection of the tumor was achieved in 2 cases and subtotal resection in 4 cases. Postoperative histopathology confirmed that the lesions were tumors in 5 cases and fungal pseudotumor in 1 case. Moreover, variety of histological types were observed in the present series, including leiomyosarcoma, malignant yolk sac tumor, mixed germ cell tumor, embryonal carcinoma, pilocytic astrocytoma and fungal pseudotumor, respectively. The serum levels of AFP and HCG were elevated to some extent in the patients with malignant yolk sac tumor, mixed germ cell tumor or embryonal carcinoma. Follow-up was conducted in all patients for 1 month to 3 years. The patients with malignant yolk sac tumor and embryonal carcinoma as well as leiomyosarcoma died in 5, 6, 10 months after operation, respectively. Subarachnoid hemorrhage occurred in the case of fungal pseudotumor at 2 months after surgery. The other two patients were surviving well. Rare non-germinomatous malignant germ cell tumors are predominantly susceptible to the sellar region. Furthermore, High misdiagnosis rate and poor prognosis are characteristic in the present study. Dynamic AFP and HCG detection may play an important role in the diagnosis of those non-germinomatous malignant germ cell tumors located in the sellar region. The importance of awareness of the presence of such rare lesions in the sellar region is emphasized.

Repetitive Complete Molar Pregnancy in a 54-Year-Old Patient in a Time Distance of Eighteen Years from the First Incident: Case Report and Mini Review

We report a case of complete hydatidiform mole in a 54-year-old patient referred to Gynecology department of General Hospital of Athens “Laiko”, with history of previous molar pregnancy at the age of thirty-six. Our purpose was to indicate the advanced maternal age beside the long recurrence distance of the disease, which was eighteen years after the first molar pregnancy. Our diagnostic approach was through measurement of serum beta-human chorionic gonadotropin (β-HCG) and pelvic ultrasound evaluation, and the chosen therapeutic approach was abdominal hysterectomy and bilateral salpingoophorectomy.

Early Maternal Serum β-human Chorionic Gonadotropin Measurements After ICSI in the Prediction of Long-term Pregnancy Outcomes: A Retrospective Cohort Analysis

BackgroundInitial low maternal serum β-human chorionic gonadotropin (β-hCG) is a good predictor of early pregnancy demise. Our objective was to determine its predictive value in determining the long-term outcome in ICSI pregnancies.MethodsA retrospective cohort study was designed at the Saudi Center for Assisted Reproduction. Two hundred and sixty-one women with ICSI pregnancies were followed up from initial β-hCG level determination till the end of pregnancy. Accuracy of early β-hCG in predicting the occurrence of a live-birth, ongoing pregnancy, late miscarriage, ectopic pregnancy and early miscarriage following ICSI was measured.Resultsβ-hCG levels were significantly different in pregnancies that reached the stage of an ongoing pregnancy and live-birth as compared to early pregnancy loss. The ROC curves demonstrated a high sensitivity for identifying patients with ectopic pregnancies and early miscarriage (100% and 93.33% respectively). The remaining results ranged from a sensitivity of 69% to 79% and specificity of 62% to 75%.ConclusionsIn ICSI pregnancies, a single early β-hCG may help to identify pregnancies that will reach full-term and delivery.KeywordsICSI; Human chorionic gonadotropin; Outcome; Pregnancy

Mola hidatiforme parcial en gestante de 17 semanas con preeclampsia

Objectives To report a case of partial hydatidiform mole presenting as preeclampsia at 17 weeks of gestation and to review the data on the diagnosis and management of this entity. Case Rrport The patient was admitted for severe preeclampsia. Ultrasound and cytogenetic studies revealed a partial hydatiform mole. Abdominal uterine evacuation was performed and the patient was monitored until the process resolved. Discussion Partial hydatiform mole usually manifests as first-trimester metrorrhagia. This entity is not generally associated with specific fetal anomalies, but retarded fetal growth is almost always present. These moles rarely present with a picture of early-onset preeclampsia, as in the present case. Diagnosis is based on ultrasound, human chorionic gonadotropin (HCG) measurements and fetal karyotype, although the definitive diagnosis is histological. Partial hydatiform mole is considered a localized disease that usually resolves with uterine evacuation. However, in some patients, there can be persistent trophoblastic disease. Conclusion Diagnosis of partial hydatiform mole should be taken into account in patients with early onset preeclampsia.

Predictive power progesterone combined with beta human chorionic gonadotropin measurements in the outcome of threatened miscarriage

To investigate the predictive power of progesterone combined with beta human chorionic gonadotropin (β-HCG) measurements in the outcome of threatened miscarriage. This retrospective study was conducted on 245 intrauterine pregnant women from January 2006 to October 2008. 175 women with threatened miscarriages who consulted for vaginal bleeding received exogenous progesterone supplements. There were 108 patients with ongoing pregnancies until delivery and 67 patients with inevitable miscarriages. Control group included 70 pregnant women. Serum concentrations of progesterone and β-HCG were measured by Microparticle enzyme immunoassay between the fourth and fifth gestational weeks. The discrimination attained between the two study groups (ongoing pregnancies and inevitable miscarriages) was evaluated by logistic regression and receiver operating characteristic curve analysis. The mean serum levels of progesterone and β-HCG in patients with inevitable miscarriages (13.76 ± 5.52 ng/ml, 3,647.00 ± 2,123.00 mIU/ml, respectively) were significantly lower than these levels in normal intrauterine pregnancies (31.67 ± 5.86 ng/ml, 13,437.00 ± 6,256.00 mIU/ml, respectively) and ongoing pregnancies (25.47 ± 6.18 ng/ml, 8,492.00 ± 2,389.00 mIU/ml, respectively) (P < 0.001). Serum progesterone combined with β-HCG measurements, with a diagnostic accuracy of 85.7% (sensitivity 88.1%, specificity 84.3%), had the best prognostic reliability and significant differences were found when this parameter was compared with the predictive value of a single progesterone (diagnostic accuracy 72.5%, sensitivity 76.1%, specificity 70.4%) or β-HCG (diagnostic accuracy 74.8%, sensitivity 64.1%, specificity 81.4%) determinations. A combination of two biochemical parameters shows substantial improvement over a single-marker strategy. Progesterone combined with β-HCG measurements may be useful for predicting the outcome of threatened miscarriage.

Use of serum progesterone measurements to reduce need for follow‐up in women with pregnancies of unknown location

To assess the efficacy of a progesterone-based algorithm for the management of women with pregnancies of unknown location (PULs) and explore the feasibility of developing a single-visit strategy in those with a low risk of requiring medical intervention. All clinically stable women in whom pregnancy could not be identified on ultrasound scan were managed by a pre-defined protocol based on measurement of serum progesterone and beta-human chorionic gonadotropin (beta-hCG). Intervention in the form of surgery or medical treatment with methotrexate was offered to all women with persistent or worsening symptoms and non-declining serum beta-hCG. Decision-tree analysis was used to develop a protocol for the management of women with resolving pregnancies who are at low risk of requiring medical intervention. 1110 women were included in the data analysis: normal intrauterine pregnancy was diagnosed in 248 (22.3%; 95% CI, 19.9-24.8) women. 761 (68.6%; 95% CI, 65.8-71.3) abnormal pregnancies resolved spontaneously on expectant management, while the remaining 101 (9.1%; 95% CI, 7.4-10.8) women with abnormal pregnancies required some form of medical intervention. Intervention rates in patients presenting with initial serum progesterone levels of <or= 20 nmol/L and <or= 10 nmol/L, were 3.9% (95% CI, 2.4-5.4) and 2.1% (95% CI, 0.9-3.3), respectively. In women presenting with progesterone <or= 10 nmol/L and beta-hCG < 450 IU/L, the intervention rate was 1.3% (95% CI, 0.2-2.5). Women with PULs with progesterone <or= 10 nmol/L at presentation are at low risk of requiring medical intervention and may not benefit from attending routine follow-up visits.

Syncytin-1 and Glial Cells Missing a: Hypoxia-Induced Deregulated Gene Expression along with Disordered Cell Fusion in Primary Term Human Trophoblasts

Background/Aims: Pre-eclampsia, a major cause of perinatal morbidity, is characterized by alterations in placental oxygen availability and trophoblast differentiation. We investigated how different levels of hypoxia alter the expression of syncytin-1, glial cells missing a (GCMa) and syncytin-1 receptor ASCT2 and affect syncytialization in primary term human trophoblasts. Methods: Cells were incubated at 1, 3, 6 and 21% O₂ for 24, 48 and 72 h with or without cyclic adenosine monophosphate (cAMP). Gene expression was analyzed by real-time PCR. Syncytialization was assessed using β-human chorionic gonadotropin measurement and desmoplakin immunostaining. Results: Following incubation with cAMP at 21% O₂, peak gene expression of syncytin-1 and GCMa was found after 24 h along with syncytium formation at 72 h. Conversely, incubation at 1% O₂ led to a time-dependent reduction of GCMa and syncytin-1 at the transcriptional level. Cell fusion occurred at 21 and 6% O₂ and was suppressed at 1% O₂. ASCT2 mRNA levels were preserved at normoxia and downregulated at 1% O₂ after 48 h. Conclusion: Our data support the premise that the expression of GCMa and syncytin-1 precedes syncytialization of trophoblasts, e.g. at 6% O₂, which is assumed to resemble physiological conditions. Severe hypoxia is associated with reduced GCMa and syncytin-1 transcripts and altered fusion of primary trophoblasts.

Human chorionic gonadotropin measurements in parathyroid carcinoma

Preoperatively, it is difficult to differentiate between parathyroid cancer (PtCa) and severe primary hyperparathyroidism (PHPT) due to a benign tumor. Human chorionic gonadotropin (hCG) is a tumor marker in trophoblastic and nontrophoblastic cancers and hyperglycosylated hCG is increased in hCG-secreting malignancies. We investigated whether hCG can distinguish PtCa cancer from benign disease and add prognostic information. Observational study. Measurement of urinary hCG (total and malignant isoforms) and serum malignant hCG in 8 subjects with PtCa and in 18 subjects with PHPT (measurement of urine in ten and serum in eight). Total urinary hCG was normal in the benign PHPT control subjects (range: 0-17 fmol/mg Cr; nl<50). In the PtCa subjects, three had normal total urinary hCG levels and survived complication free for at least 2 years; three had persistently elevated total urinary hCG levels (range: 217-1986 fmol/mg Cr) and sustained hip fracture (n=3) and died (n=2) within 3 and 6 months respectively; two had a rise in total urinary hCG and had hip fracture (n=1) and died (n=2) within 4 and 10 months respectively. Elevated urinary hCG was of the malignant hyperglycosylated isoform. Serum malignant hyperglycosylated hCG values in all of the cancer patients exceeded the maximal serum malignant hCG level of the PHPT subjects with benign disease (3.77 pmol/l). hCG, especially its hyperglycosylated isoform, might add diagnostic and prognostic information in PtCa. Further studies would help to elucidate the role of hCG as a potential tumor marker in this disease.

The management of Cesarean scar ectopic pregnancy following treatment with methotrexate—a clinical challenge

We present a case of Cesarean scar ectopic pregnancy, complicated by the persistence of clinical symptoms despite a rapid and complete biochemical response to a single systemic injection of methotrexate. A 34-year-old woman with three previous Cesarean sections was diagnosed with a Cesarean scar ectopic pregnancy following in-vitro fertilization treatment. The diagnosis was suggested by three-dimensional (3D) ultrasound scan and confirmed with magnetic resonance imaging (MRI). Management involved administration of a single systemic injection of methotrexate and follow-up with serial ultrasound assessments and serum beta-human chorionic gonadotropin (beta-hCG) measurements. The main challenge was the persistence of clinical symptoms despite adequate medical treatment, as judged by complete resolution of biochemical trophoblastic activity, which resulted in repeated admissions to the hospital. Serial transvaginal ultrasound scans showed an initial increase in the size of the mass, which led to increasing anxiety in the couple. Eventually, 15 weeks after the administration of methotrexate, the couple requested surgical intervention. An uneventful surgical resection of the abnormal area, which showed appearances suggestive of trophoblastic tissue, was undertaken to good effect. In summary, despite a rapid normalization of serum beta-hCG following the administration of methotrexate, the patient remained symptomatic and had ultrasound appearances suggestive of incomplete resorption of trophoblast, necessitating surgical intervention.

Hyperglycosylated‐hCG (h‐hCG) and Down syndrome screening in the first and second trimesters of pregnancy

To validate Down syndrome screening protocols that include hyperglycosylated-hCG (h-hCG) measurements. Measuring h-hCG in 21 641 fresh first- and second-trimester maternal serum samples, but not for clinical interpretation. Nuchal translucency (NT) and pregnancy associated plasma protein-A (PAPP-A) measurements were available in the first trimester; alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG) measurements in the second trimester. Of the 23 first- and 26 second-trimester Down syndrome pregnancies identified, 52 and 65% of h-hCG measurements were above the 95th centile, respectively. At a 3% false positive rate, maternal age, NT, PAPP-A and h-hCG detected 78% of cases (95% CI, 56-93%). Other combinations were consistent with previous modeling utilizing stored samples. A literature summary indicates h-hCG is as strong a marker as free-beta between 10 and 13 weeks' gestation. Down syndrome screening performance of h-hCG using fresh samples meets published expectations based on stored samples. h-hCG could replace free beta measurements, at gestational ages as early as 10 weeks.

Development, validation and application of a chemiluminescent immunoassay for the measurement of circulating chorionic gonadotropin levels in the laboratory macaque

Methods for the measurement of chorionic gonadotropin for pregnancy detection in laboratory macaques chorionic gonadotropin (mCG) have been limited by the paucity of specific reagents. Current assays use reagents developed for human chorionic gonadotropin (hCG) assays and have been limited to radio- or enzyme-immuno assays. This report describes an automated assay for mCG using reagents for hCG detection that has been adapted to the automated chemiluminescence platform of the Bayer ACS-180 autoanalyzer. This automated assay performs similarly to previous assays in terms of sensitivity and specificity but provides additional speed, reliability, and more easily accessible reagents compared with previous formats. When implemented broadly, this assay could provide standardization of mCG measurements for both research and colony management purposes.

Gestational sac aspiration: A novel alternative to Dilation and Evacuation for management of early pregnancy failure

Study objective To explore the effectiveness (success, safety, and complications) of a novel technique of gestational sac aspiration in the management of early pregnancy failure as an alternative to dilation and evacuation (D&E) and conservative management. Design Prospective historical cohort study comparing effectiveness of gestational sac aspiration (study group) to conservative management (control group) with follow-up until negative quantitative beta human chorionic gonadotropin testing is achieved (Canadian Task Force classification II-1). Setting An infertility treatment center. Patients Among 60 women with failed early pregnancies that were achieved by in vitro fertilization or intrauterine insemination, 20 underwent gestational sac aspiration, whereas 40 chose conservative management. Interventions Gestational sac aspiration was done by transvaginal ultrasound–guided needle aspiration under conscious sedation. Aspirated tissue was sent for karyotyping. Both study and control (conservative management) groups received close follow-up with ultrasound and serial beta human chorionic gonadotropin measurements. Measurements and main results There was no significant difference in age, infertility factor, or treatment between study and control groups. Mean gestational age was 8 versus 6 weeks in study and control groups, respectively (p < .05). One and 11 patients required D&E in the study and control groups, respectively (p < .05). Karyotyping was successful in all except one patient in the study group. Chromosomal abnormalities were found in 36% of products of conception. No significant complications occurred Conclusion Gestational sac aspiration is a simple and safe outpatient technique that is more effective than conservative management of early pregnancy failure and less invasive than D&E. Moreover, the technique provides a high probability of obtaining a noncontaminated adequate gestation tissue sample for chromosomal study.

Three‐stage contingent screening for Down syndrome

To demonstrate the potential value of three-stage sequential screening for Down syndrome. Protocols were considered in which maternal serum pregnancy associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (hCG) measurements were taken on all women in the first trimester. Those women with very low Down syndrome risks were screened negative at that stage and nuchal translucency (NT) was measured on the remainder and the risk reassessed. Those with very low risk were then screened negative and those with very high risk were offered early diagnostic testing. Those with intermediate risks received second-trimester maternal serum alpha-fetoprotein, free beta-hCG, unconjugated estriol and inhibin-A. Risk was then reassessed and those with high risk were offered diagnosis. Detection rates and false-positive rates were estimated by multivariate Gaussian modelling using Monte-Carlo simulation. The modelling suggests that, with full adherence to a three-stage policy, overall detection rates of nearly 90% and false-positive rates below 2.0% can be achieved. Approximately two-thirds of pregnancies are screened on the basis of first-trimester biochemistry alone, five out of six women complete their screening in the first trimester, and the first-trimester detection rate is over 60%. Three-stage contingent sequential screening is potentially highly effective for Down syndrome screening. The acceptability of this protocol and its performance in practice, should be tested in prospective studies.

Risk Factors Associated with the Rupture of Tubal Ectopic Pregnancy

Objective: To identify risk factors that may lead to the rupture of ectopic pregnancies. Study Design: A retrospective chart review was performed on patients with ectopic pregnancies at the University of Miami/Jackson Memorial Hospital between 1/1/1995 and 3/1/2002. 738 patients were identified with ectopic pregnancies. Women with tubal rupture were compared to those without rupture. Variables analyzed were demographic data, patient-related risk factors (history of pelvic surgery, bilateral tubal ligation, history of pelvic inflammatory disease, previous ectopic pregnancy, intrauterine device use) and β-human chorionic gonadotropin (βhCG) measurement. Results: There were 439 (59%) cases with a ruptured and 299 (41%) cases with an unruptured ectopic pregnancy. Multivariate logistic regression analysis revealed that previous ectopic pregnancy (OR 2.88; 95% CI 1.92, 4.33) and βhCG level ≧5,000 mIU/ml (OR 1.85; 95% CI 1.12, 3.06) were the only significant risk factors for tubal rupture. Conclusion: Patients with βhCG levels ≧5,000 mIU/ml and patients with a history of a previous ectopic pregnancy are significantly more likely to experience a tubal rupture.

Vaginal fluid β‐human chorionic gonadotropin level in the diagnosis of premature rupture of membranes

To determine whether the measurement of beta-human chorionic gonadotropin (beta-HCG) level in the vaginal washing fluid could be useful for the diagnosis of premature rupture of membranes. Totally, 120 pregnant women were enrolled in this study. Subjects were divided into four groups [group I, no preterm labor and term delivery (n = 38); group II, preterm labor and term delivery (n = 12); group III, preterm labor and consequent premature delivery (n = 24); group IV, preterm labor with premature rupture of membranes (PROM) and consequent premature delivery (n = 46)]. After irrigating the posterior vaginal fornix with 3 ml of sterile saline and the obtained vaginal washing fluid, we measured beta-HCG levels. The median and range of vaginal fluid beta-HCG levels were 3.60 (0.09-30.52), 4.42 (0.33-10.02), 15.50 (0.25-378.62), and 512.53 (26.95-3507.20) mIU/ml in group I, group II, group III, and group IV, respectively. Vaginal beta-HCG level was significantly higher in patients with PROM followed by premature delivery (group IV) than patients in other groups (P < 0.01). From the receiver operating characteristic curve, 39.8 mIU/ml was set as a cutoff value. Sensitivity, specificity, positive predictive value, and negative predictive value were 95.5, 94.7, 91.3, and 97.3%, respectively. Our study demonstrated that the measurement of vaginal fluid beta-HCG may be reliable, simple, and rapid test in diagnosing PROM and used as a adjunctive test in equivocal cases.

Placental-site trophoblastic tumour: an unusual presentation with bilateral ovarian involvement

A 33-year-old woman presented in August, 2000, with a 7-week history of amenorrhoea and a positive urine pregnancy test. She had had an early-pregnancy failure 3 years previously and a subsequent pregnancy 15 months later, which resulted in the delivery of a healthy baby girl by emergency caesarean section. Transvaginal ultrasonography showed no evidence of an intrauterine gestation sac and was otherwise unremarkable. At this time, measurement of serum human chorionic gonadotropin (hCG) was 104 IU/L. Subsequent transvaginal ultrasonography 1 month later showed a heterogeneous 21-mm mass adjacent to the right ovary and repeat hCG was 140 IU/L. She was given 50 mg/m methotrexate intramuscularly for a presumed failed ovarian ectopic pregnancy. However, subsequent serial serum hCG concentrations did not show the expected decline. A further dose of intramuscular methotrexate was therefore given in September, 2000; however, serum hCG continued to rise reaching a maximum of 214 IU/L in October, 2000. Repeat transvaginal ultrasonography at this time showed an abnormally vascular right ovary, which measured 50 29 34 mm. Laparoscopy showed a grossly abnormal right ovary and a right salpingo-oophorectomy was done. Histopathological examination showed an ovary infiltrated by a poorly circumscribed tumour that consisted of sheets and nests of mononuclear cells, with vacuolated or eosinophilic cytoplasm. Focal hyperchromatic nuclei and multinucleate cells were present. There were focal regions of necrosis and stromal hyalinisation (figure 1). On immunostaining, tumour cells were strongly positive for human placental lactogen with weak focal staining for hCG and placental alkaline phosphatase (figure 1). The features were strongly Lancet Oncol 2005; 6: 59–61

Low risk of relapse after achieving undetectable HCG levels in women with complete molar pregnancy.

Complete hydatidiform molar pregnancies occur in approximately 1 of 1,000 conceptions. After uterine evacuation of the trophoblastic tissue, women are followed up with serial serum human chorionic gonadotropin (hCG) measurements. Patients are considered to have attained remission when their hCG level spontaneously declines to an undetectable level and remains there during a 6-month follow-up period. This standard effectively detects all disease recurrence; however, it is resource intensive, delays child bearing, and is subject to significant noncompliance. Our objective was to determine the risk of disease recurrence after hCG spontaneously declines to undetectable levels. We used a database from the New England Trophoblastic Disease Center to analyze hCG levels in patients with complete molar pregnancies. Among 1,029 women with complete molar pregnancy and complete data, 15% developed persistent gestational trophoblastic neoplasia. The rate of persistent neoplasm among those whose hCG level fell spontaneously to undetectable levels was 0.2% (2/876, 95% confidence interval 0-0.8%). No women developed persistent gestational trophoblastic neoplasia after their hCG level fell to undetectable levels using an assay with a sensitivity of 5 mIU/mL (n = 82, 95% confidence interval 0-4.5%). Based on our experience with women with complete hydatidiform molar pregnancies whose hCG values spontaneously fell to undetectable levels after molar evacuation, we conclude that the risk of recurrent neoplasm after hCG levels fall to less than 5 mIU/mL approaches zero.

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

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