Serum β-hCG Levels Research Articles

EP40.18: Medical versus surgical treatment of terminated first trimester pregnancies

The purpose of our study was to compare the efficacy and safety of vaginal misoprostol versus surgical evacuation in the management of first trimester aborted pregnancies. One G1 group received a drug procedure: misoprostol 800 ug vaginally repeated as needed 24 hours later. One G2 group underwent surgical evacuation. The main epidemiological characteristics of the patients were comparable between the two groups. Analysis of misoprostol efficacy by parity, gestational age, and serum BHCG level did not show significant differences. The success rate was comparable in G2. Immediate and short-term complications were less frequent with medical treatment with a cumulative rate of 8% versus 24% with surgical treatment. All these undesirable effects were well tolerated and transient and did not affect the acceptability of the medical treatment (88% of G1 patients were satisfied compared to 58% of G2). Vaginal misoprostol is a promising alternative to surgical evacuation of terminated first trimester pregnancies.

IL-6 of follicular fluid and outcome of in vitro fertilization.

The quality of an oocyte is influenced by its microenvironment, which includes cumulus cells and follicular fluid, as well as cells of the immune system and their products. The ovarian interleukins, which are secreted by the granulosa cells and other immune cells within the ovaries and follicles, regulate various functions between the cells. IL-6 is a cytokine that is present in the follicular fluid and may affect the quality of oocytes. There are some inconsistencies in the literature regarding the concentration of interleukin 6 in the follicular fluid.The main objective of this study was to examine whether the concentration of interleukin 6 in the follicular fluid affects the outcome of IVF.This study involved 83 patients who underwent IVF. Follicular fluid was used as the biological material for the analysis. Examination of the obtained follicular fluid and collection of oocytes under a stereomicroscope was performed in the embryological laboratory. The concentration of IL-6 in the follicular fluid was analyzed. IVF and ICSI methods were used as the fertilization methods. Pregnancy was confirmed by the positive serum β-hCG level. The software package SPSS 20 was used for statistical data processing.Analysis of the follicular fluid samples showed a correlation between the concentration of IL-6 in the follicular fluid and the outcome of IVF. The concentration of IL-6 in the follicular fluid was higher in patients with confirmed pregnancy (9.55 ± 7.47 ng/ml).Based on our results, we conclude that the concentration of IL-6 affects the outcome of IVF. If the range of IL-6 concentration is between 3,67 ng/ml and 10 ng/ml, we can expect good IVF outcome with vital pregnancy.

O-148 Does trophectoderm biopsy affect the initial level and rate of increase in serum ß-HCG levels? A comparison of preimplantation genetic testing (PGT) and non-PGT cycles

Abstract Study question Does trophectoderm biopsy affect the initial level and rate of increase in ß-HCG levels after single frozen-thawed blastocyst transfer?A comparison of PGT and non-PGT cycles. Summary answer Initial serum β-hCG concentrations from cycles resulting in a live birth was significantly lower than that for the non-PGT group. What is known already β-hCG may serve as early predictor of pregnancy outcome and potentially assist in reducing stress related to the uncertainty of outcome in assisted reproductive technologies (ART) treatments and counselling. hCG is produced primarily by differentiated syncytiotrophoblasts. Due to removal of trophectoderm cells, the secretion of β-hCG may be affected. Little, however, is known about the influence of trophectoderm biopsy on serum β-hCG levels in early pregnancy. Therefore, it is important to investigate if the levels and pregnancy outcomes predictive values of β-hCG vary in PGT and non-PGT cycles. Study design, size, duration This was a single center retrospective cohort study conducted at Assisted Reproductive Technologies and Reproductive Genetics Center, Istanbul Memorial Hospital, Istanbul, Turkey between January 2012-January 2021. A cohort of women with frozen-thawed single blastocysts transfers and having positive serum ß-HCG results on day 9 following ET (≥20 IU/L) were allocated into two groups; PGT group (1777 cycles) and non-PGT group (1874 cycles). Participants/materials, setting, methods The serum ß-hCG levels on day 9 and 11 after embryo transfer (ET) and the rate of ß-hCG increase were compared between the PGT and non-PGT cycles with respect to biochemical pregnancy loss (BPL), clinical pregnancy loss (CPL), and live birth. The cutoff values of initial β-hCG levels and the rate of ß-hCG increase from day- 9 to day-11 were evaluated for live birth and compared between the two groups. Main results and the role of chance Initial β-hCG levels were significantly higher in pregnancies resulting in live birth (184.68±99.54 IU/L, p = <0.001) compared to BPL (66.65±55.29 IU/L) and CLP (140.51±88.98 IU/L) in the PGT group. Moreover, initial β-hCG levels were significantly higher in pregnancies resulting in live birth (192.53±97.93 IU/L, p = <0.001) compared to BPL (73.67±58.07 IU/L) and CLP (156.28±98.29 IU/L) in the non-PGT group. In addition, initial serum β-hCG concentrations from cycles resulting in a live birth was 184.68±99.54 IU/L for the PGT group, which was significantly lower than that for the non-PGT group (192.53±97.93 IU/L, p = 0.004). The diagnostic threshold of initial β-hCG levels predicting a live birth was 122.5 IU/L (sensitivity 70.1 %, specificity 60.1 %, PPV 84.7 %, and NPV 38.9 %) and 130.5 IU/L (sensitivity 71.7 %, specificity 61.6 %, PPV 82.2 %, and NPV 46.9 %) in the PGT and non-PGT groups, respectively. The rate of increase of serum β-hCG threshold predicting a live birth for the PGT group was 2.33 (sensitivity 73.8 %, specificity 59.9 %, PPV 85.3 %, and NPV 42 %) and 2.42 (sensitivity 64.6 %, specificity 60.1 %, PPV 80 % and NPV 40.7 %) for the non-PGT group. Limitations, reasons for caution This is a retrospective analysis. Wider implications of the findings Initial serum β-hCG values and the rate of β-hCG increase may be useful for predicting pregnancy outcomes in PGT cases undergoing trophectoderm biopsy. Trial registration number Not applicable

P-704 Post trigger progesterone levels as a predictor of oocyte recovery rate

Abstract Study question Do progesterone (P) levels the day after trigger for oocyte maturation impact the oocyte recovery rate? Summary answer A progesterone cutoff value of ≤ 5.0 ng/ml the day after trigger for oocyte maturation is associated with a lower oocyte recovery rate. What is known already Oocyte maturation and embryo development are controlled by intra-ovarian factors such as steroid hormones. P exists in the follicular fluid, and it is known to mediate some luteinizing hormone (LH)- initiated periovulatory events through autocrine/paracrine mechanisms that help mediate granulasa cell luteinization and oocyte maturation. More importantly, a rise in P levels is associated with an adequate follicular rupture. To date, no study has evaluated if lower P levels after oocyte maturation induction are a reflection of impaired physiological periovulatory mechanisms required for the oocyte release from the follicular wall. Study design, size, duration This monocentric retrospective analysis from January 2017 to December 2021 included 435 controlled ovarian hyperstimulation cycles for in vitro fertilization (IVF)/ egg freezing. Serum P, estradiol (E2), bHCG, and LH levels were measured the day after trigger for oocyte maturation to assure adequate luteinization. Participants/materials, setting, methods Women <4O years, that underwent controlled ovarian hyperstimulation with a GnRH antagonist protocol and final oocyte maturation (when ≥2 follicles reached ≥18 mm in diameter) induction with dual trigger (Leuprolide acetate and hCG) were segregated into two groups: Group 1: progesterone cutoff value of ≤ 5.0 ng/ml the day after trigger; Group 2: progesterone cutoff value of ≥ 5.1 ng/ml the day after trigger. Main results and the role of chance 147 cycles in Group 1 were compared with 288 cycles on Group 2. No significant differences were noted in mean patient’s age, BMI, baseline FSH, AMH, baseline antral follicle count, serum P and E2 levels the day of trigger, total dose of gonadotropins, day of trigger as well as serum E2, LH, and bHCG levels the day after trigger among cohorts. A total of 5765 oocytes were retrieved: 1703 corresponding to group 1 and 4692 to group B. Women with progesterone levels higher than ≥5.1 ng/ml the day after trigger had a greater number of oocytes retrieved compared to women with a progesterone cutoff value of ≤ 5.0 ng/ml (16.3 ± 9.1 versus 11.5 ± 7.4, p = < 0.0001). The oocyte/follicle rate was also significantly higher in women in Group 2 vs Group 1 (80.3% vs 63.7%, p = 0.003) However, the mature oocyte (MII) rate was comparable among cohorts (Group 1: 78.0 ± 20.2% vs Group 2: 78.8 ± 17.7%, p = 0.38). Limitations, reasons for caution The retrospective nature of the study, small sample size, selected progesterone cutoff value, and progesterone assay techniques compared to other ART centers may limit the external validity of our findings. Wider implications of the findings Our findings suggest for the first time that lower progesterone levels after final oocyte maturation induction may be a result of compromised mechanisms associated with the release of the oocyte from the follicular wall as demonstrated by a lower oocyte recovery rate. Trial registration number NA

P-400 Methotrexate versus expectant management for treatment of tubal ectopic pregnancy: an individual participant data meta-analysis (IPD-MA)

Abstract Study question Is medical management with methotrexate superior over expectant management in the resolution of tubal ectopic pregnancy in clinically stable women and low serum hCG? Summary answer In women with tubal ectopic pregnancy and low serum hCG, methotrexate was not better than expectant management. There were no subgroups benefiting from methotrexate. What is known already Women with tubal pregnancy who are clinically stable and have low hCG concentrations can be treated medically with methotrexate, an anti-folate drug that has a range of adverse effects and requires women to avoid conceiving three months after administration due to teratogenic effects. Expectant management with close monitoring is as effective compared to methotrexate in this subgroup of women. There are three randomised controlled trials (RCTs) not showing a statistically significant difference in uneventful resolution of ectopic pregnancy between methotrexate and expectant management. These studies were too small to define if certain subgroups could benefit from either treatment. Study design, size, duration We performed an individual participant data meta-analysis (IPD-MA) of RCTs based on a search of international scientific databases. We selected RCTs comparing methotrexate and expectant management in women with suspected tubal ectopic pregnancy. The primary outcome was treatment success, defined as resolution of clinical symptoms and decline in level of serum hCG to < 20 IU/L or a negative urine pregnancy test by the initial intervention strategy, without any additional treatment. Participants/materials, setting, methods Analyses were performed on an intention-to-treat basis. A one-stage IPDMA was performed to assess overall treatment effects of methotrexate and expectant management to generate a pooled intervention effect. This included a random intercept (for baseline differences between studies) and random slope (for differences in treatment effect between studies). A log-binomial model for dichotomous outcomes yielded a risk ratio (RR) with 95% confidence interval (CI). Subgroup analyses were undertaken according to baseline serum β-hCG levels. Main results and the role of chance We obtained data from two relevant trials reporting on 153 women with suspected tubal ectopic pregnancy who were randomised to expectant management or methotrexate. The third RCT was excluded as their inclusion criteria required declining titres of hCG 48 hours prior to treatment. The success rate was 65/82 (79.3%) after methotrexate and 48/70 (68.6%) after expectant management (IPD RR 1.16, 95%CI 0.71-2.38). 9/82 (11%) in the methotrexate group and 9/70 (12.8%) after expectant required additional methotrexate. 8/82 (9.8%) in the methotrexate group and 13/70 (18.6%) in the expectant group required surgical intervention (RR 0.65, 95%CI 0.66-3.54). The mean time to success was 21.2 days (95%CI 17.4 to 25.6) after expectant management and 19.7 days (95%CI 17.1-22.2) after methotrexate (p = 0.25). There was no interaction with treatment of maternal age, parity, previous ectopic pregnancy, and serum β-hCG on success rate. Serum hCG <1000 IU/l was associated with a higher success rate in both groups. Only one woman in the expectant group required a blood transfusion. Methotrexate users had side effects (N = 7/49) including vomiting, diarrhoea, mucositis, conjunctivitis and photosensitivity that were not seen in the expectant group (N = 0/49). Limitations, reasons for caution One of the trials had a higher proportion of pregnancy of unknown location (PUL) which were presumed to be tubal ectopic pregnancies due to plateauing serum hCG levels and caution is therefore advised on the application of these findings to ectopic pregnancies visualised on ultrasound. Wider implications of the findings Initial expectant management might be the preferred strategy for women with suspected tubal ectopic pregnancy in clinically stable women with lower hCG levels in view of less adverse effects, less cost and enabling women who wish to conceive soon after resolution of ectopic pregnancy to do so. Trial registration number Prospero ID: CRD42021214093

Biological relevance of trophectoderm morphology: initial β-hCG measurements correlate with trophectoderm grading on euploid frozen embryo transfers.

To analyze the correlation between TE grading and initial β-hCG serum level after single euploid embryo transfer. Secondarily, to explore the association between TE grading with subsequent IVF outcomes. Retrospective cohort analysis. Single, academic, private infertility and assisted reproductive care institute. Infertility patients who underwent a single euploid embryo transfer that resulted in a positive pregnancy test. β-hCG measurements. Correlation between TE grade with first β-hCG measurement. Second outcome measurements included ongoing pregnancy, biochemical pregnancy loss, and clinical pregnancy loss rates. 2,798 cases were analyzed. A significant difference in initial β-hCG measurement among groups (TE A: median 143.4 mIU/mL IQR 79.2-211.2; TE B: 119 mIU/mL IQR 57.1-177.8; TE C: 82.4 mIU/mL IQR 36.3-136.4, p ≤ 0.0001) was observed. There was a significant correlation found between the TE grade and β-hCG measurements (p ≤ 0.0001, r2 = 0.10). TE grade was not associated with higher odds of biochemical pregnancy loss (TE A vs. TE B: aOR 1.01 CI95% 0.97-1.05; TE A vs. TE C: aOR 1.03 CI95% 0.98-1.08), or higher odds of clinical pregnancy loss (TE A vs. TE B: aOR 1.02 CI95% 0.98-1.05; TE A vs. TE C: aOR 1.03 CI95% 0.98-1.07). In patients with euploid embryos, TE grade correlates with the first pregnancy test measurement of β-hCG. We propose this finding helps to appoint a relevant link between morphology assessment and early embryo development in vivo.

Diagnostic value of a single β-hCG test in predicting reproductive outcomes in women undergoing cleavage embryo transfer: a retrospective analysis from a single center

PurposeThe present study investigated the role of β-hCG in predicting reproductive outcomes and established optimal β-hCG cutoff values in women undergoing cleavage embryo transfer.MethodsThe patients were transferred with fresh or frozen-thawed embryos and had serum β-hCG levels tested on the 14th day post-embryo transfer. Serum β-hCG levels were compared between different groups. Different cutoff values of β-hCG were established and used to divide the patients into different groups. Reproductive outcomes between groups based on β-hCG levels were compared.ResultsSignificant discrepancies in general characteristics were observed in the subgroups. The cutoff values of β-hCG for predicting the presence/absence of pregnancy, biochemical pregnancy/clinical pregnancy, presence/absence of adverse pregnancy outcomes, and singleton/twin live birth in the cleavage groups were 89.6, 241.1, 585.9, and 981.1 mIU/L, respectively. Biochemical pregnancy rates and adverse pregnancy outcome rates significantly decreased from the low β-hCG group to the higher β-hCG group in sequence. Significantly higher full-term live birth rates were observed in the highest β-hCG group (P < 0.001).ConclusionSerum β-hCG levels were strongly associated with reproductive outcomes. However, the interpretation of β-hCG levels must consider the number and quality of embryos and transfer protocols. When β-hCG was tested on a fixed day post-ET, different cutoff values were required for the prediction of early clinical outcomes. The association between β-hCG and obstetric outcomes must be investigated.

In missed abortion the decrease of IGF-1 down-regulates PI3K/AKT signaling pathway reducing the secretion of progesterone and β-hCG

ObjectiveTo explore whether the reduction of IGF-1 in missed abortion down-regulates PI3K/AKT signaling pathway, thereby causing trophoblast cell apoptosis and reducing the secretion of β-hCG and progesterone. Design12 pairs of serum and villous tissues were selected from missed abortion patients and normal early pregnant women who had terminated pregnancy by artificial abortion. The subjects in two groups had same age and gestational week. Wes Simple Western system and qRT-PCR were used to detect the expression of IGF-1, IGF-1R, PI3K/AKT signaling pathway and apoptosis-related factors in villous tissues. Radioimmunoassay and Enzyme-linked immunosorbent assay were used to detect β-hCG, progesterone and IGF-1 in serum. ResultsThe serum levels of β-hCG, progesterone and IGF-1 were decreased in missed abortion group than those in normal early pregnant women. In addition, compared with normal early pregnant women, the genes and proteins levels of IGF-1 and PI3K/AKT signaling pathway and anti-apoptosis related factors were significantly decreased. ConclusionsOur results suggested that the reduction of IGF-1 in missed abortion patients could down-regulate the expression of PI3K/AKT signaling pathway, thereby increasing the apoptosis of trophoblast cells, leading to decreased secretion of β-hCG and progesterone, which may be one of the important mechanisms of missed abortion.

Should expectant management of heterotopic pregnancy be considered?

Both expectant and interventional managements are acceptable in selected cases, when heterotopic pregnancy is diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries. Heterotopic pregnancy, though relatively rare, is potentially a life-threatening condition. The aim of the study is to compare expectant versus interventional management of heterotopic pregnancies. This is a retrospective cohort study including all women diagnosed with heterotopic pregnancy on ultrasound from March 2011 to December 2020 in a single medical center. Expectant and interventional management outcomes were compared. Primary outcome was defined as live birth. Forty-one women were diagnosed with heterotopic pregnancy during the study period. Management was expectant in 10 (24.4%) and interventional in 31 (75.6%) of the women. Expectant management was considered when the patient was stable, and the attending physician decided that the ectopic pregnancy did not continue to develop. Interventions included laparoscopic salpingectomy (n = 26), laparoscopic cornual resection (n = 2), laparotomic cornual resection (n = 1) and gestational sac aspiration (n = 2). The intra-uterine pregnancy continued to develop in 6 (60.0%) and 22 (81.5%) of the women in the expectant and interventional groups, respectively (p = 0.52). All women managed expectantly reached term delivery, as opposed to 17/22 (77.3%) in the intervention management group (p = 0.60). Multivariate analysis found serum β-hCG level as the only independent parameter associated with ongoing pregnancy rate (B = 0.001, p = 0.04). Both expectant and interventional management were found to be acceptable when heterotopic pregnancy was diagnosed, with high ongoing intra-uterine pregnancy rate and term deliveries.

Effectiveness and Safety of Toripalimab Combination Therapies for Patients With Chemo-Resistant Choriocarcinoma.

Toripalimab as a novel PD-1 inhibitor has presented its promising efficacy in patients who developed chemo-refractory carcinomas, whereas no study has ever investigated the effectiveness of toripalimab in chemo-resistant choriocarcinoma. Here we reported the effectiveness and safety data of 4 patients with chemo-resistant choriocarcinoma who underwent PD-1 antibody therapy by toripalimab and individualized chemotherapies. From January 2019 to August 2020, 4 patients with choriocarcinoma were admitted in Shengjing Hospital of China Medical University. The patients’ age ranged from 29 to 52 years with a median of 36 years. All the patients achieved CR after the combined therapy of toripalimab with individualized chemotherapies according to the decreased serum β-hcg level. Two of the four patients were observed with treatment-related adverse events (AEs), including one grade I skin rash and one grade I pruritus. Our cases showed that toripalimab combined with chemotherapy presented a tolerable safety profile and promising effectiveness in patients with chemo-resistant choriocarcinoma, indicating its potential as salvage therapy for this subset of patients.

Tubal ektopik gebeliklerde çoklu doz metotreksat tedavisinin analizi

Purpose: The study aimed at determining the success rate of sequential multi-dose methotrexate treatment in tubal ectopic pregnancy (EP) patients and the prognostic factors affecting the treatment success.&#x0D; Materials and Methods: Clinical, laboratory, and demographic data of 63 patients -hospitalized with the diagnosis of EP in our tertiary center between 2017-2020 and administered sequential multiple-dose methotrexate treatment protocol- were analyzed in this retrospective study.&#x0D; Results: Based on research findings, medical treatment was successful in 45 of the patients. It was found that 16 out of 18-patient, 88.8% of the patients in the failed group with methotrexate treatment, were operated on due to tubal rupture during follow-up. The mean of sonographic free fluid in Douglas of the successful group with methotrexate treatment was found to be 2.40±0.70 mm (Mean±SE), while it was 10.38±3.05 mm (Mean±SE) in the failed group at the first consultation. The initial β-hCG value of the successful group with methotrexate treatment was measured 3668.55±440.55 IU/L (Mean±SE), while it was 4929.72±752.65 IU/L (Mean±SE) in the failed group.&#x0D; Conclusion: The success rate of the sequential multiple dose methotrexate protocol was 71.4%. Both the initial serum β-hCG level and the amount of sonographic free fluid in the pouch of Douglas were found high in the failed group with medical treatment at the first consultation.

Outcomes and prognostic factors of placental-site trophoblastic tumor: a retrospective study of 58 cases

Our goal was to assess the outcomes and explore the prognostic factors for patients with placental-site trophoblastic tumor (PSTT) through this retrospective analysis. 2043 patients with gestational trophoblastic neoplasia (GTN) were registered at two tertiary hospitals between January 2003 and March 2021, of whom 58 (2.8%) were diagnosed with PSTT. We retrospectively analyzed the clinico-pathological characteristics, treatments, outcomes and prognostic factors. Only 4 patients died and 5 patients experienced a recurrence. Patients (n = 49) with stage I disease had a favorable prognosis, surgery with (n = 21) or without (n = 28) chemotherapy made no significant difference in overall survival (OS) (p = 0.251) or disease-free survival (DFS) (p = 0.425). 3 patients with stage I had fertility preserving surgery and successful pregnancy was achieved in 2 of them. The outcome of patients with advanced disease was poor. Univariate analysis revealed serum β-hCG levels at diagnosis, FIGO stage IV and metastatic disease were significant predictors of both overall survival and disease-free survival. However, multivariate analysis indicated stage IV was the only significant independent predictor of adverse OS, while metastatic disease was the only significant independent predictor of adverse DFS. Surgery alone is sufficient for patients with stage I disease without high-risk factors. Theprognosis of patients with advanced stage disease remains poor. Stage IV and metastatic disease were the most critical risk factors.

Trophectoderm Biopsy Differentially Influences the Level of Serum β-Human Chorionic Gonadotropin With Different Embryonic Trophectoderm Scores in Early Pregnancy From 7847 Single-Blastocyst Transfer Cycles.

ObjectiveTo evaluate whether trophectoderm (TE) biopsy differentially influence the level of serum β-human chorionic gonadotropin (β-hCG) with different TE-scored blastocysts transferred in early pregnancy.MethodsThis retrospective cohort study contained 7847 single-blastocyst transfer cycles executed between January 2019 and June 2020, including 2657 preimplantation genetic testing (PGT) cycles and 5190 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. All cycles were classified into biopsy and control groups, and further stratified based on the TE morphological scores into three subgroups: grades A, B, and C for TE scores, respectively. Intra-group and inter-group analyses were performed on serum β-hCG levels on the 12th day after blastocyst transfer (HCG12), and obstetric and neonatal outcomes.ResultsFor cycles with a live birth, in grade A TE score subgroups, the HCG12 level did not exhibit statistical significance between the control and biopsy groups after adjustment (769 mIU/mL vs. 753 mIU/mL, P=0.631). In contrast, in grade B and C TE score subgroups, the control group showed a significantly higher level of HCG12 relative to the biopsy group (690 mIU/mL vs. 649 mIU/mL, P=0.001; 586 mIU/mL vs. 509 mIU/mL, P<0.001, respectively). We observed no statistically significant differences in obvious adverse obstetric and neonatal outcomes between the same TE-score subgroups of the biopsy group and control group.ConclusionsWhile blastocysts with higher TE grades produced higher serum β-hCG levels in early pregnancy, TE biopsy might exert a negative impact on serum β-hCG levels by blastocysts with a grade-B TE score and below. TE biopsy did not increase the risk for adverse obstetric and neonatal outcomes.

Uterine Artery Embolization on Serum β-HCG Levels, Fertility Function and Clinical Efficacy in Patients With Cesarean Uterine Scar Pregnancy.

ObjectiveTo analyze the therapeutic effect of uterine artery embolisation (UAE) in patients with cesarean section pregnancy (CSP) delivered by cesarean section and the effect on serum human chorionic gonadotrophin (β-HCG) levels and reproductive function.MethodsIn total 142 patients with CSP, The control group (n = 71) received Methotrexate (MTX) with ultrasound monitoring after admission and the research group (n = 71) was treated with UAE on basic of the control group. The two groups were compared in terms of treatment outcome, intraoperative bleeding, bed activity, vaginal bleeding and length of hospital stay, and serum follicle stimulating hormone (FSH), oestradiol (E2), luteinising hormone (LH) and β-HCG levels at 1 month postoperatively. The clinical symptoms (normalization of β-HCG and return of menstruation) and clinical outcomes (normal pregnancy, recurrent scar pregnancy) were compared between the two groups, as well as the occurrence of post-operative complications in both groups.ResultsCompared with the control group, the research group had a higher overall near-term effective rate, a lower recurrence rate of CSP in pregnancy, and a lower complication rate (P < 0.05); meanwhile, the time to get out of bed, postoperative vaginal bleeding, length of hospital stay, normalization of serum β-HCG, and return to menstruation were shorter in the research group than in the control group (P < 0.05); In addition, serum FSH, E2, LH and β-HCG levels improved better in the research group compared with the control group 1 month after surgery (P < 0.05).ConclusionThe treatment of CSP patients with UAE can reduce the amount of intraoperative bleeding and the duration of vaginal bleeding, promote the improvement of patients' clinical symptoms, have less impact on the disruption of patients' sex hormone balance, reduce patients' surgical risks to a greater extent, preserve patients' normal fertility, and have better application.

Detection of ectopic pregnancy and serum beta hCG levels in women undergoing very early medical abortion: a retrospective cohort study

Objective To evaluate the outcome of the very early medical abortion (VEMA) protocol and whether it could increase early diagnosis and treatment of an asymptomatic ectopic pregnancy (EP). To investigate serum β-hCG levels correlated to ultrasound findings, and decline in β-hCG after successful VEMA. Study design A retrospective case-note review. The population consisted of all women undergoing a VEMA during 2004–14 in Austria and 2012–13 in Sweden. Two cohorts identified based on sonography findings; 106 women with an empty uterine cavity were classified as a pregnancy of unknown location (PUL) and 576 women with an intrauterine sac-like structure without a yolk sac or foetal structure were classified as probable intrauterine pregnancy (probable IUP). Results Overall, 660 women (97.6%) had a successful VEMA, 94/101 women (93.1%) in the PUL group and 566/575 women (98.4%) in the probable IUP group (p < 0.001). We identified six asymptomatic EP (0.88%). A gestational sac (< 10 mm) was detected at a median/range β-hCG level 2728 (1600–4497) IU/l. The mean decline in β-hCG was 93%, (95% CI 91.7–94.2) 5–10 days after successful abortion. Conclusions VEMA may be of particular clinical benefit for women. Apart from offering a possibility to start an abortion without delay as soon as the woman has sought abortion care, it may also offer an opportunity to detect and treat EP at an early gestational age. However, the rate of EP was very low.

Differential-diagnostic and therapeutic challenges in the management of ruptured corpus luteum cyst with undiagnosed intrauterine pregnancy in the early first trimester and ruptured ovarian pregnancy

Background: The similarities in clinical features between ruptured corpus luteum cyst (RCLC) with undiagnosed intrauterine pregnancy in the early first trimester (RCLC-P) and ruptured ovarian pregnancy are well established. However, the identification of differences between these two morbid conditions is important to determine the causes and manage the hemoperitoneum without devastation of pregnancy in RCLC-P. Furthermore, the pregnancy outcomes after laparoscopic surgery in women with RCLC-P are not recognized. Methods: Retrospective observational study of six women with RCLC-P and seven women with ruptured ovarian pregnancy. Results: All cases were referred under strong suspicion of ruptured ectopic pregnancy due to lower abdominal pain and positive urinary pregnancy test after spontaneous conception. The estimated median number of gestational weeks in RCLC-P (5 weeks) was significantly lower than that for ruptured ovarian pregnancy (7 weeks). At triage, the median serum levels of beta-human chorionic gonadotropin (β-hCG) were significantly lower in RCLC-P (592 IU/L) than ruptured ovarian pregnancy (3723 IU/L) (p = 0.01). In all six cases with RCLC-P, laparoscopic ovary-sparing surgery was performed. Among the four women who received postoperative supplementation of progesterone, uneventful vaginal delivery occurred at term in three cases. Conclusions: Early gestational age and lower serum β-hCG levels at triage, as well as non-declining levels of serum β-hCG on the day after surgery, were significant predictors of RCLC-P rather than ruptured ovarian pregnancy. Laparoscopic surgery was a feasible option for the management of RCLC-P with appropriate postoperative luteal support to achieve successful obstetric outcomes.

Serum β-hCG level on day 7 of frozen-thawed embryo transfer: association with the clinical pregnancy outcomes in artificial cycles

Serum β-hCG level on day 7 of frozen-thawed embryo transfer: association with the clinical pregnancy outcomes in artificial cycles

Can biochemical pregnancy be determined 5 days after frozen-thawed embryo transfer?

ObjectiveTo study the predictive value of serum β-hCG on day 5 after frozen-thawed embryo transfer (FET) to predict pregnancy outcomes and to establish cut-off values for very early biochemical pregnancy diagnosis.MethodsThis retrospective cohort study was performed at a private reproductive medicine centre and we reviewed the medical records of women who underwent FET cycles from January 2018 to June 2019. A total of 116 evaluated cycles had serum β-hCG levels measured on days 5 and 10 after FET. The predictive value of serum β-hCG levels measured on day 5 after FET was investigated for very early biochemical pregnancy diagnosis.ResultsThe standard biochemical pregnancy diagnosis was defined as a β-hCG ≥25 IU/L on day 10 after FET. We then generated a receiver operating characteristic curve, and the cut-off value of β-hCG on day 5 for predicting biochemical pregnancies was 4.0 IU/L, with 93.4% sensitivity and 92.7% specificity (AUC, 0.960; 95% confidence interval, 0.923-0.997).ConclusionsValues for β-hCG at day 5 after FET ≥4.0IU/L are accurate for the diagnosis of biochemical pregnancy. The use of very early biochemical pregnancy diagnosis in clinical practice enables earlier management, patient counselling, and appropriate follow-up.

Invasive Mole of the Uterus: A Case Report

Invasive mole is a rare subgroup of gestational trophoblastic disease characterized by the invasion of molar tissue into the myometrium or uterine vasculature. In this paper, we report the third case of invasive mole described in the Malagasy literature. A 33-year-old woman was referred to the Soavinandriana Hospital, her complaint was persistent vaginal bleeding during 2 months, occurring at 3 months of pregnancy with biological anemia without hemodynamic repercussions. The human chorionic gonadotropin (HCG) level was 385,931 mIU/ml. A haemostasis hysterectomy was performed. Histological examination showed an enlarged uterus and endometrial cavity containing edematous chorionic villi with trophoblastic proliferation invading the myometrium. The diagnosis was an invasive mole, stage I, FIGO score 6. Chemotherapy was prescribed but was not honored. After 45 days of follow-up, the serum βHCG level decreased to 1803 mIU/ml, without clinical symptoms. The patient then lost sight. Persistent vaginal bleeding after pregnancy may be the only clinical symptom of an invasive mole and should raise suspicion. Histological examination establishes the diagnosis. As this is an unusual cause of vaginal bleeding, our case should remind physicians that when faced with this symptom, the possibility of an invasive mole should be considered in order to make an early diagnosis for less aggressive treatment.

Rare Case of Caesarean Scar Pregnancy with Soaring β-hCG Levels: A Therapeutic Challenge

Caesarean Scar Pregnancy (CSP) is a life-threatening form of ectopic pregnancy characterised by abnormal implantation of embryo within the myometrium and fibrous tissues of a previous scar on the uterus. This is the case report of a 24-year-old pregnant lady who underwent previous caesarean section presented at eight weeks gestation with bleeding per-vaginum. Ultrasound of pelvis revealed an intrauterine gestational sac with a live foetus at the site of previous caesarean scar with very high levels of serum beta-human Chorionic Gonadotropin (β-hCG) of 88789 mIU/mL. To prevent surgical complications, a conservative approach was employed, involving injection methotrexate and uterine artery embolisation. Serial measurements of serum β-hCG and transvaginal sonography were used for monitoring. Treatment was successful and the β-hCG levels returned to normal on day 48. This case report highlights that conservative management is successful even with extremely high serum β-hCG levels, and an early recognition and timely intervention is the key to prevent poor outcomes.