Serum beta-hCG Research Articles

Evaluation of the Relationship between Air Bubbles Depth and Pregnancy Rate in ICSI Cycles

Objective: to determine the relationship between embryo transfer outcome and the distance between fundal endometrial surface and air bubbles assessed by trans-abdominal ultrasound Design: Prospective (cohort) study Setting: This study was conducted in assisted reproductive technology (ART) unit of Ain Shams University Hospital from April 2015 to October 2016. Patient(s): Eighty two women undergoing ICSI were enrolled in and a written informed consent was obtained from each participant. Intervention(s): no patient received any additional procedure or intervention. Outcome measuers: The primary outcome was biochemical pregnancy rate based on serum beta-hCG level at 14 days after ET. Secondary outcome was clinical pregnancy rate using trans-vaginal US examination at 6 – 8 weeks of amenorrhea to detect the presence of fetal sac & pulsation. Results: Implantation, biochemical and clinical pregnancy rates were significantly higher in distance < 10 mm group than ≥ 10 mm group. Conclusion: air bubble used as an identifier of the position of the embryo at ET can be determinative for pregnancy rates. Clinical PRs were higher in cases with air bubbles < 10 mm from fundal endometrial surface.

A rare case of abdominal pregnancy

An extrauterine abdominal pregnancy is a very rare form of ectopic pregnancy in which implantation occurs within the peritoneal cavity, and outside the fallopian tube and ovary. It easily causes misdiagnosis and is closely related to maternal health. Only a few reported cases have been treated using laparoscopy. The authors report a case involving an extrauterine abdominal pregnancy diagnosed during laparoscopy located near the rectum. A 39-year-old gravida 3 para 1 who had a cesarean delivery 16 years ago was referred to the present department for evaluation of vaginal bleeding for 47 days. No abdominal tenderness was demonstrated on physical examination. The vaginal examination revealed an enlarged uterus. An ultrasound scan showed an empty uterine cavity. Adjacent to the right ovary, a mixed echo was noted in which a yolk sac was visible. A heart rate was detected. The serum beta hCG was 11,198 mIU/mL. Laparoscopic surgery was performed. On the right side of the sacral ligament there was a 3x3x2.5 cm purple-blue mass adherent to the rectum. The pregnancy was excised and removed from the abdomen in an endo-bag, and hemostasis was assured. During the postoperative course, intramuscular methotrexate therapy was administered (20 mg/m² twice a week x 5). The patient was discharged on the 26th post-operative day; she was asymptomatic and had no complaints. The serum beta hCG level was 3.98 IU/l at the time of discharge. This case shows that laparoscopic treatment of abdominal pregnancy is safe and feasible, and when necessary, can assist drug therapy.

Predictive value of some hematological parameters for non-invasive and invasive mole pregnancies

Aim: The aim of this study was to discriminate mole pregnancies and invasive forms among cases with first trimester vaginal bleeding by the utilization of some complete blood count parameters conjunct to sonographic findings and beta human chorionic gonadotropin concentration.Materials and methods: Consecutive 257 cases with histopathologically confirmed mole pregnancies and 199 women without mole pregnancy presented with first trimester vaginal bleeding who admitted to Zeynep Kamil Women and Children’s Health Training Hospital between January 2012 and January 2016 were included in this cross-sectional study. The serum beta HCG level at presentation, and beta hCG levels at 1st, 2nd and 3rd weeks of postevacuation with some parameters of complete blood count were utilized to discriminate cases with molar pregnancy and cases with invasive mole among first trimester pregnants presented with vaginal bleeding and abnormal sonographic findings.Results: Levels of beta hCG at baseline (AUC = 0.700, p < 0.05) and 1st (AUC = 0.704, p < 0.05), 2nd (AUC = 0.870, p < 0.001) and 3rd (AUC = 0.916, p < 0.001) weeks of postevacuation period were significant predictors for the cases with persistent disease. While area under curve for mean platelet volume is 0.715, it means that mean platelet volume has 21.5% additional diagnostic value for predicting persistency in molar patients. For 8.55 cut-off point for mean platelet volume, sensitivity is 84.6% and specificity is 51.6%. Area under curve for platelet/lymphocyte ratio is 0.683 means that platelet/lymphocyte ratio has additional 18.3% diagnostic value. For 102.25 cut-off point sensitivity is 86.6% and specificity is 46.2.Conclusions: Simple, widely available complete blood count parameters may be used as an adjunct to other risk factors to diagnose molar pregnancies and predict postevacuation trophoblastic disease.

Rupture risk factors of fallopian tubal pregnancy

The present authors analyzed patients’ backgrounds and pre-surgical findings to clarify the risk factors of rupture of fallopian tubal pregnancy. The surgical findings 113 cases were clearly diagnosed as fallopian tubal pregnancy with or without rupture. Twenty-six cases of fallopian tubal pregnancy were ruptured and 87 cases were not ruptured at the time of operation. The risk factors of fallopian tubal rupture were assessed by Chi-square for independence test and multiple regression analysis. Obesity (BMI over 26), prior birth history, social welfare entitlement, ultrasonography findings of fetal heart movement, and pre-surgical serum beta-hCG level more than 3,000 mIU/ml patient were significantly higher risk in fallopian tubal rupture. Fertility treatment patient were at significantly lower risk for fallopian tubal rupture. Higher beta-hCG levels, especially >3,000 mIU/ml is associated with increased risk of fallopian tubal rupture in ectopic pregnancy.

G07 - The complex management and treatment of hydatidiform mole: our experience

Background: Hydatidiform mole (HM) is a rare disorder of trophoblast. HM comprises two distinct entities, the partial mole (PM) and complete mole (CM). The HM usually occurs with vaginal bleeding, increased serum levels of beta-hCG and, sometimes, uterus larger than typical gestational age. The PM comes up with a more moderate symptoms.Patients and methods: From April 2012 to April 2016 were evaluated all patients with histopathologic diagnosis of HM, partial or complete, and we monitored the progress of disease through beta-hCG, transvaginal ultrasonographic examination (TVUS) and abdominal ultrasound and chest x-ray in patients with indication for chemotherapy, and we have undergone them suction curettage (SC) at the moment of diagnosis. All patients were given the opportunity to psychological support.Results: In the 4 years of study we have been taken over by our center 10 patients, 5 with histopathologic diagnosis of MC and 5 patients with PM. Median age at diagnosis was 26 years. All patients were submitted in response to a symptomatology characterized by abdominal pain, bleeding and subsequent finding of miscarriage between 8 and 12 weeks of gestation. The dosage of beta-hCG serum before surgery presented values between 38689.0 mU/ml and 223900.0 mU/ml. Of all patients evaluated, 3, two with CM and one with PM, showed high levels after 8 weeks after SC and were then subjected to treatment with methotrexate 50mg im on days 1,3,5,7 and folic acid 7.5mg 2 tablets in the days 2,4,6,8 every 2 weeks until detection of 3 negative consecutive doses of beta–hCG. In all the patients the treatment was carried out for 6-8 weeks with negative levels of beta-hCG already after the first 2 weeks of treatment. The treatment was well tolerated and not burdened by side effects (expecially grade 3-4). At the end of chemotherapy patients have continued follow up with monthly beta-hCG for 6 months in the case of PM and for 12 months in the case of CM. A gynecological examination with TVUS was performed every 4 months. To date none of the patients showed signs of relapse.Conclusions: Given the young age of patients and the delicate nature of the disease, HM should be treated in reference institutions where a multidisciplinary team including oncologist, radiologist, gynecologist and psychologist can manage the diagnosis and the treatment of this pathology and any sequelae related to it. Background: Hydatidiform mole (HM) is a rare disorder of trophoblast. HM comprises two distinct entities, the partial mole (PM) and complete mole (CM). The HM usually occurs with vaginal bleeding, increased serum levels of beta-hCG and, sometimes, uterus larger than typical gestational age. The PM comes up with a more moderate symptoms. Patients and methods: From April 2012 to April 2016 were evaluated all patients with histopathologic diagnosis of HM, partial or complete, and we monitored the progress of disease through beta-hCG, transvaginal ultrasonographic examination (TVUS) and abdominal ultrasound and chest x-ray in patients with indication for chemotherapy, and we have undergone them suction curettage (SC) at the moment of diagnosis. All patients were given the opportunity to psychological support. Results: In the 4 years of study we have been taken over by our center 10 patients, 5 with histopathologic diagnosis of MC and 5 patients with PM. Median age at diagnosis was 26 years. All patients were submitted in response to a symptomatology characterized by abdominal pain, bleeding and subsequent finding of miscarriage between 8 and 12 weeks of gestation. The dosage of beta-hCG serum before surgery presented values between 38689.0 mU/ml and 223900.0 mU/ml. Of all patients evaluated, 3, two with CM and one with PM, showed high levels after 8 weeks after SC and were then subjected to treatment with methotrexate 50mg im on days 1,3,5,7 and folic acid 7.5mg 2 tablets in the days 2,4,6,8 every 2 weeks until detection of 3 negative consecutive doses of beta–hCG. In all the patients the treatment was carried out for 6-8 weeks with negative levels of beta-hCG already after the first 2 weeks of treatment. The treatment was well tolerated and not burdened by side effects (expecially grade 3-4). At the end of chemotherapy patients have continued follow up with monthly beta-hCG for 6 months in the case of PM and for 12 months in the case of CM. A gynecological examination with TVUS was performed every 4 months. To date none of the patients showed signs of relapse. Conclusions: Given the young age of patients and the delicate nature of the disease, HM should be treated in reference institutions where a multidisciplinary team including oncologist, radiologist, gynecologist and psychologist can manage the diagnosis and the treatment of this pathology and any sequelae related to it.

Research on the trend of the decrease of human chorionic gonadotropin in the treatment of cesarean scar pregnancy by different surgical treatments

To explore the clinical effect of different surgical methods in the treatment of cesarean scar pregnancy, the decline trend of human chorionic gonadotropin (hCG) and the indications of different treatment methods. This study was a prospective cohort study. The clinical data of 120 patients with cesarean scar pregnancy who were treated with four different surgical methods in the Beijing Obstetrics and Gynecology Hospital from June 2013 to December 2014 were collected. Seven cases ultrasonic curettage, 63 cases uterine arterial embolization (UAE) with hysteroscopic pregnancy embryo removal surgery, 41 cases UAE + B-ultrasound or laparoscopic monitoring hysteroscopic pregnancy embryo clearance surgery and 9 cases UAE + hysteroscopic and laparoscopic removal of pregnancy scar and uterine repair. The clinical efficacy of different surgical methods and the decrease trend of serum HCG in postoperative period were analyzed. (1)The levels of serum beta hCG in patients with cesarean scar pregnancy after different surgical treatments decreased (84.5±9.7)%, (97.7±3.2)% and (99.6±1.2)% after the 2 days, 7 days and 14 days respectively. The average time of blood beta hCG level dropped to normal was (22.4±6.7) d. (2)There was a significant difference in the amount of bleeding and the time of hospitalization among the patients treated with different surgical methods. (3)There was a significant difference in the analysis of the decline percentage rate of serum beta hCG under the interactive effect between different surgical methods and postoperative recovery time (P<0.01). The level of serum beta hCG in patients with cesarean scar pregnancy were reduced to normal range after 3 weeks of operation. The choice of surgical approach should be based on the degree of implantation of embryo sac scar, the thinnest muscle thickness, local blood flow, serum beta hCG levels, gestational sac size, process to the bladder and fertility desire to determine.

Mid-luteal phase injection of subcutaneous leuprolide acetate improves live delivered pregnancy and implantation rates in younger women undergoing in vitro fertilization-embryo transfer (IVF-ET)

Purpose: To determine if a single injection of one-mg leuprolide acetate three days after embryo transfer (ET) in younger women causes an increase in pregnancy rates, and if so, is it associated with a higher initial serum hCG level? Materials and Methods: A prospective study was initiated where women aged ≤ 35 years were offered the option of taking the leuprolide or not. Results: Though a significant difference was not found, there was a trend for higher live delivered pregnancy rates in those taking the leuprolide supplement (47.8%) vs. those not taking it (38.6%). There was no difference in the first serum beta hCG level. Conclusions: The trends is interesting enough to continue with a higher powered study.

A Case of Ruptured Ovarian Ectopic After Embryo Transfer With Low Serum hCG and Fertility Conserving Laparoscopy

Ovarian pregnancy is a rare form of ectopic pregnancy that remains a diagnostic enigma. We report a 39-year-old nulliparous female undergoing in vitro fertilization (IVF) and presenting with severe abdominal pain to a hospital after embryo transfer. Serum beta-hCG after embryo transfer was low at 5.4 IU/L. Repeated serum beta-hCG in the hospital was elevated at 1,528 IU/L. Transabdominal ultrasound revealed a 9.8 cm complex mass in the midline in the pouch of Douglas. No intrauterine gestational sac was seen. She underwent emergency diagnostic laparoscopy revealing a small 2 × 2 cm ruptured right ovarian ectopic pregnancy with active hemorrhage seen. A wedge resection of the right ovarian ectopic was performed and hemoperitoneum was drained. Ovarian tissue sent for histopathology confirmed the diagnosis of a ruptured ovarian ectopic. Post-operative hCG level was negative after follow-up. Consequently, the patient was treated successfully with fertility-conserving laparoscopy. J Med Cases. 2016;7(4):150-152 doi: http://dx.doi.org/10.14740/jmc2464w

Gestational trophoblastic disease in Abuth Zaria, Nigeria: A 5-year review

Gestational trophoblastic diseases (GTD) includes a spectrum of diseases (tumor or tumor-like conditions) characterised by aberrant growth and development of the trophoblasts that may continue even beyond the end of pregnancy. It encompasses the benign trophoblastic disease (complete and partial moles), and the malignant trophoblastic diseases including the invasive mole (chorioadenoma destruens), choriocarcinoma, and Placental Site Trophoblastic Tumor (PSTT). This study was to determine the prevalence, risk factors, clinical presentation, diagnosis, treatment options and outcomes of GTD in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. A five-year retrospective study of patients with GTD managed at ABUTH, North-west Nigeria, from 1 st January 2008 to 31 st December, 2012 was undertaken. Data of all cases of GTD in the hospital over the 5 year period were obtained. The gynaecology ward and labour ward registers also provided information on the total number of gynaecological admissions and deliveries respectively. The data processing and analysis were carried out using the SPSS software version 16. The data obtained were expressed in percentages, means, and standard deviations. During the period of study there were 8,138 deliveries and 2,453 gynaecological admissions. There were 59 cases of GTD with 41 having choriocarcinoma, 18 molar pregnancies and no case of invasive mole or PSTT. Out of the 41 case folders retrieved, 23 were choriocarcinoma and 18 of molar pregnancies. The prevalence of GTD was 7.2 per 1000 deliveries (0.72% or 1 in 138 deliveries) and constituted 2.4% of gynaecological admissions. Hydatidiform mole (HM) occurred in 1 in 452 deliveries and choriocarcinoma occurred in 1 in 198 deliveries. Ages ranged from 19-49 years with mean of 32.5+ 5.0 years. Most (66.7%) cases of HM were 19-29years while 60.9% of choriocarcinoma cases were 30-39years. Majority of cases were multiparous. The antecedent events predating choriocarcinoma were Hydatidiform mole (31.7%), abortions (29.3%) and 2.4% followed term pregnancy. History of amenorrhea was present in all cases while vaginal bleeding occurred in 97.6%, pallor (87.8%), hyperemesis gravidarum (48.8%) and 4.9% came in shock. Consequently, common complications reported were haemorrhage (90.2%), anemia (87.8%) and shock (12.2%). Pregnancy test was positive in 90.2% of cases and serum beta hCG was done in 24.4% with more than half having a level >12,000miu/ml. All patients had pelvic ultrasound scan and snowstorm appearance occurred in 41% of benign GTD cases. Histology was used to confirm 56.1% cases of choriocarcinoma and 43.9% of molar gestation. Most (94.4%) of HM had suction evacuation while 95.6% of choriocarcinoma cases had chemotherapy, one case (2.4%) had Total Abdominal Hysterectomy. Contraception was used in 78% and common methods were male condom (41.5%) and 36.6% used combined oral contraceptive pills. Less than half (43.9%) had follow up for 6 months and 9.8% were seen for more than a year. Eight patients had subsequent pregnancies and there was one death in the series giving a case fatality of 2.4%. Gestational trophoblastic disease is a significant source of maternal morbidity with increased risk of mortality from complications if not detected early and treated promptly.

The Role of Serum Beta hCG in Early Diagnosis and Management Strategy of Ectopic Pregnancy.

The presentation of Ectopic Pregnancy (EP) can be highly variable and serum Beta hCG estimation plays an important role in early diagnosis. Aim of the study was to determine the trends of hCG levels in EP and to explore the role of hCG in decisions related to management and follow-up of EPs. A retrospective study of women who had EPs from January 2006 to December 2012 at an advanced tertiary care centre in southern India was carried out. These women had undergone treatment based on the hospital protocol. The study identified 337 women with EP. Thirty one surgically confirmed cases were diagnosed below the discriminatory zone of 1500 mIU/ml. Among women who had Beta hCG estimations 48 hours apart, plateauing was observed in 22.5% while decrease >15% was noted in 26.8%. Almost half (47.9%) of the cases had an increase >15% and a few (2.8%) demonstrated an initial fall followed by a rise in titres. In 23.9% of these women, there was a rise >53% similar to intrauterine pregnancy. The average pre-treatment Beta hCG was 429.8, 3866.2 and 12961.5 mIU/ml for those who received expectant, medical and direct surgical treatment respectively. 43 women with relative contraindications received medical management and 39 were lost to follow-up after medical and expectant management. Excluding them, the success rate of these two modalities was 76.6% and 85.0% respectively. No single level of Beta hCG is diagnostic of EP and serial levels can demonstrate atypical trends in some cases. Hence, interpretation of these results should be done in conjunction with clinical and sonographic findings to arrive at a correct diagnosis.

A Case of Ruptured Ovarian Ectopic After Embryo Transfer With Low Serum hCG and Fertility Conserving Laparoscopy

Ovarian pregnancy is a rare form of ectopic pregnancy that remains a diagnostic enigma. We report a 39-year-old nulliparous female undergoing in vitro fertilization (IVF) and presenting with severe abdominal pain to a hospital after embryo transfer. Serum beta-hCG after embryo transfer was low at 5.4 IU/L. Repeated serum beta-hCG in the hospital was elevated at 1,528 IU/L. Transabdominal ultrasound revealed a 9.8 cm complex mass in the midline in the pouch of Douglas. No intrauterine gestational sac was seen. She underwent emergency diagnostic laparoscopy revealing a small 2 × 2 cm ruptured right ovarian ectopic pregnancy with active hemorrhage seen. A wedge resection of the right ovarian ectopic was performed and hemoperitoneum was drained. Ovarian tissue sent for histopathology confirmed the diagnosis of a ruptured ovarian ectopic. Post-operative hCG level was negative after follow-up. Consequently, the patient was treated successfully with fertility-conserving laparoscopy. J Med Cases. 2016;7(4):150-152 doi: https://doi.org/10.14740/jmc2464w

Occult Langerhans Cell Histiocytosis Presenting with Papillary Thyroid Carcinoma, a Thickened Pituitary Stalk and Diabetes Insipidus.

Etiologies of a thickened stalk include inflammatory, neoplastic, and idiopathic origins, and the underlying diagnosis may remain occult. We report a patient with a thickened pituitary stalk (TPS) and papillary thyroid carcinoma (PTC) whose diagnosis remained obscure until a skin lesion appeared. The patient presented with PTC, status postthyroidectomy, and I131 therapy. PTC molecular testing revealed BRAF mutant (V600E, GTC>GAG). She had a 5-year history of polyuria/polydipsia. Overnight dehydration study confirmed diabetes insipidus (DI). MRI revealed TPS with loss of the posterior pituitary bright spot. Evaluation showed hypogonadotropic hypogonadism and low IGF-1. Chest X-ray and ACE levels were normal. Radiographs to evaluate for extrapituitary sites of Langerhans Cell Histiocytosis (LCH) were unremarkable. Germinoma studies were negative: normal serum and CSF beta-hCG, alpha-fetoprotein, and CEA. Three years later, the patient developed vulvar labial lesions followed by inguinal region skin lesions, biopsy of which revealed LCH. Reanalysis of thyroid pathology was consistent with concurrent LCH, PTC, and Hashimoto's thyroiditis within the thyroid. This case illustrates that one must be vigilant for extrapituitary manifestations of systemic diseases to diagnose the etiology of TPS. An activating mutation of the protooncogene BRAF is a potential unifying etiology of both PTC and LCH.

Hysteroscopically-guided subchorionic methotrexate administration: A new technique for termination of cesarean scar pregnancy

Introduction: cesarean scar pregnancy (csP) is a rare but life-threatening condition, due to the risk of uterine rupture or for the development of placenta previa/accreta. the mainstay of management to spare fertility is early diagnosis and pregnancy termination. Although several conservative treatments have been experienced, no consensus on the best therapeutic approach is currently shared. the medical therapy for csP termination is based on systemic or local Methotrexate (MtX) administration. Hysteroscopy allows the precise visualization of placental implantation and it can be used to drive MtX injection selectively within the intervillous placental spaces. this procedure increases drug concentration delivered to the target tissue, potentially improving its therapeutic index. case report: A 36-year-old female with a history of cesarean section was admitted to our department with a diagnosis of viable 7th weeks csP. the patient gave her consent to pregnancy termination by a hysteroscopically-guided MtX administration within the cervico-isthmic placental implantation site, followed by its resectoscopic removal. In an office setting, 80 mg of MtX were injected through a needle adaptable to the 5-Fr operative channel of hysteroscope, Giancarlo Garuti1, Stefania Calabrese1, Lorenzo Quirino1, Marco Di Mario1 Affiliations: 1MD, Obstetrics and Gynecology Department, Public Hospital of Lodi, Via Savoia 1, 26900-Lodi, Italy. Corresponding Author: Giancarlo Garuti (MD), Obstetrics and Gynecology Department, Lodi Hospital, via Savoia n° 1, 26900-Lodi, Italy; E-mail: giancarlo.garuti@tiscali.it Received: 03 October 2015 Accepted: 02 December 2015 Published: 27 February 2016 under the chorionic membrane of placental implantation site. the duration of the procedure took three minutes and it resulted easy, painless and uneventful. An early embryo demise was obtained; the human chorionic gonadotropinbeta subunit (beta-hcG) serum trend showed a rapid pregnancy termination and no patient complaints were recorded. After 28 days, a resectoscopic removal of the gestational sac and placenta was safely accomplished. conclusion: selective hysteroscopic administration of MtX within intervillous spaces of the ectopic placental implantation is effective and it can be considered for csP termination.

Mid-luteal phase injection of subcutaneous leuprolide acetate improves live delivered pregnancy and implantation rates in younger women undergoing in vitro fertilization-embryo transfer (IVF-ET)

Purpose: To see if the single injection of one mg of the gonadotropin releasing hormone agonist (GnRHa) leuprolide acetate given in the mid-luteal phase can increase live delivered pregnancy and implantation rates. Furthermore the purpose was to determine if improvement was found, did the mechanism involve increased secretion of human chorionic gonadotropin (hCG). Materials and Methods: A prospective study was conducted in women aged ≤ 35 who were undergoing in vitro fertilization-embryo transfer (IVF-ET). They were advised of data from Tesarik et al. and a previous pilot study conducted in the present IVF center showing improved pregnancy rates with the injection of a GnRHa three days after embryo transfer. They were offered the option of returning for a one-mg injection s.c. of leuprolide acetate or not. Clinical and live delivered pregnancy rates were compared according to those taking or not the leuprolide acetate one-mg injection. Chi-square analysis was used for statistical comparisons. Serum beta-hCG levels were compared between those conceiving with or without the extra injection of leuprolide. Results: There was a non-significant trend for higher live delivered pregnancy rates in those taking leuprolide (47.8%, 64/134) vs. those not taking it (38.6%, 76/197). For those pregnant there was no difference in hCG levels according to taking the GnRHa or not. Conclusions: The 25% increased live delivered pregnancy rate per transfer was insufficiently powered to detect a significant difference. The results do justify continuing the study. Perhaps the difference could be wider using a slightly older age group whose embryos are frequently less hearty.

Improved implantation and live delivered pregnancy rates following transfer of embryos derived from donor oocytes by single injection of leuprolide in mid-luteal phase

To determine if the use of a single injection of one-mg leuprolide acetate in mid-luteal phase can increase pregnancy rates in donor oocyte recipients.Prospective study where couples were made aware of a study using the gonadotropin releasing hormone agonist (GnRHa) triptorelin that in the mid-luteal phase found improved pregnancy rates following embryo transfer in donor oocyte recipients. They were given the option of a single one-mg injection of the GnRHa leuprolide acetate. Pregnancy outcome was compared according to whether leuprolide was given or not. Also compared were the average first serum beta-hCG level in those who conceived according to taking leuprolide or not.Chi-square analysis showed a significantly higher clinical and live delivered pregnancy rate (63.9% and 52.8%) in those supplementing with leuprolide than those who did not (39.5% and 32.9%). Similarly implantation rates were significantly higher (44.2% vs. 25.2%). The average first serum beta-hCG level for those conceiving and taking leuprolide was 294 mIU/mL vs. 325 mIU/mL for those who did not.Similar to triptorelin the mid-luteal injection of leuprolide acetate improves pregnancy outcome in donor oocyte recipients.

Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles

ABSTRACTBackgroundBoth selective estrogen receptor modulators, tamoxifen and clomiphene have been used for ovulation induction for patients with anovulatory infertility. The aim of this study is to compare the effectiveness of tamoxifen to clomiphene on clinical outcome in intrauterine insemination (IUI) cycles.Materials and methodsIt is a retrospective clinical study. Two hundred and seven women undergoing IUI cycles from July 2013 to July 2014 at Milann—The fertility centre, Bengaluru, India were analyzed. Tamoxifen was administered in the dose of 40 mg starting from day 2/3 of the menstrual cycle for a period of 5 days and clomiphene citrate (CC) was administered in the dose of 100 mg from day 2/3 of menstrual cycle for 5 days. Monitoring of ovulation was done by transvaginal ultrasound from day 5/6 till dominant follicle size was more than 18 mm. Highly purified human chorionic gonadotrophin (hCG) in the dose of 5000 IU was given. Double insemination was done at 24 and 36 hours. Luteal phase support was given in form of dydrogesterone 10 mg twice a day for 14 days. Serum beta-hCG was done after 14 days.ResultIn our study, 76 patients recieved clomiphene citrate (37%) and 126 patients received tamoxifen (62.9%). Both the groups were comparable in terms of age, period of infertility, FSH, LH, antral follicle count and their human menopausal gonadotropin (hMG) requirement (Table 1). Thirteen patients (23.6%) in CC group and 42 patients (76.4%) in tamoxifen group had positive serum beta hCG result. p-value was found to be significant (p = 0.016) (Table 2).ConclusionTamoxifen was associated with better endometrial thickness and pregnancy rate when compared to clomiphene citrate in ovarian stimulation in IUI cycles.How to cite this articleMajeed A, Divyashree PS, Rao KA. Clinical Outcomes of Tamoxifen and Clomiphene Citrate in Intrauterine Insemination Cycles. Int J Infertil Fetal Med 2015;6(3):118-121.

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Successful Outcomes of Fresh and Frozen Donor Ovum Cycles Among Recipients Using Oral Estradiol and Vaginal Progesterone Gel vs. Intramuscular and Vaginal Progesterone

Background: There is a paucity of data evaluating the efficacy of vaginal progesterone replacement in both fresh and frozen transfers of recipients of oocyte donors. Method: This was a multicenter, IRB approved, retrospective analysis from January 2009 through June 2013 of 255 cycles among women less than 55 years of age who were oocyte recipients in an anonymous donor program. Oocyte recipients from fresh and frozen cycles received vaginal progesterone gel (Crinone 8%) 90 mg twice daily and oral estradiol 2 mg 2–3 times daily in a step-up protocol. The comparative groups of fresh and frozen donor oocyte cycles took progesterone intramuscular 50 mg once a day, 5 days prior to transfer, Progesterone 200 mg vaginal capsule beginning the day of transfer and Estrogen 2 mg orally three times daily continuing until the tenth week of pregnancy. Subjects were monitored via transvaginal ultrasound, serum estradiol and progesterone levels, both on baseline and the week prior to transfer. A serum beta-hCG, estradiol, and progesterone were obtained 10 days after Blastocyst transfer. Hormone levels and pregnancy rates were summarized with descriptive statistics. Results: It was showed that the fertility interventions did not significantly differ with regard to number of positive pregnancy tests, χ²(3)=4.41, p=0.220. Results also showed that the fertility interventions did not significantly differ with regard to number of clinical pregnancies, χ²(3)=4.68, p=0.196. Conclusion: Preparing the endometrium with oral estradiol and vaginal progesterone gel among recipients treated in a contemporary donor oocyte program is highly effective.

Pitfalls on Screening in Clinical Trials: Positive Pregnancy Test in a Nonpregnant Woman with Metastatic Breast Cancer

We report on a rare case of a premenopausal female patient with metastatic breast cancer that was excluded from a clinical trial conducted in our institution after the detection of an elevated serum beta-hCG during the trial screening. Despite proving that the patient was not pregnant and that this serum beta-hCG elevation was a paraneoplastic phenomenon (tumor cells showed secretion of beta-hCG by IHC), the patient was ultimately excluded from trial entry. Some tumors, including breast cancer, can elevate serum beta-hCG as a paraneoplastic phenomenon, which sometimes correlates with prognosis in metastatic disease. We demonstrate through this case report that an elevated beta-hCG in a cancer patient is not always indicative of pregnancy, and that the possibility of a false positive result should be taken into account in clinical trial protocols as to avoid unnecessary exclusion of potential trial candidates.

Successful Management of Live Cervical Ectopic Pregnancy: A Case Report

Cervical pregnancy is a rare form of ectopic pregnancy with potential grave consequences occurring in approximately 1:9,000 deliveries. It is life-threatening as the pregnancy is implanted in the endocervical canal and the trophoblast can penetrate through the cervical wall and into the uterine blood supply resulting in catastrophic haemorrhage. Historically, the treatment had been hysterectomy because of the considerable risk of life-threatening haemorrhage, but in the recent past various conservative management modalities have been applied to preserve fertility. Here, we report a case of successful (both medical and surgical) management of cervical ectopic pregnancy in a young woman. A 29-year-old, gravid 2, para1 and living 1 with previous caesarean section had presented with mild bleeding per vagina for 5 days following 7 weeks of amenorrhoea. Past menstrual, medical, surgical and family history were unremarkable except the previous caesarean section. On examination vital signs were normal but pelvic examination revealed a distended cervix with bulky uterus, without anyadnexal mass or tenderness and no cervical motion tenderness. Further transvaginal sonography showed a live cervical gestation of 7 weeks and 4 days and serum beta-HCG value of 1,03,113mIU/ml. Patient received conservative approach with combination of intraamniotic potassium chloride and methotrexate and suction curettage. Due to conservative approach emergency hysterectomy and blood transfusion was avoided.