Serum hCG Concentrations Research Articles

Association of endocrine disrupting chemicals exposure with human chorionic gonadotropin concentrations in pregnancy

BackgroundHuman chorionic gonadotropin (hCG) is produced by the placenta and plays an essential role in the maintenance of pregnancy. Endocrine disrupting chemicals (EDCs) have the potential to interfere with functions related to the production and secretion of hCG; however associations between exposure to EDCs and hCG concentrations in humans remain to be elucidated. ObjectivesTo investigate the association of urinary, serum and plasma concentrations of EDCs during pregnancy with serum hCG concentrations. MethodsWe utilized data form the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study. We investigated the association of 26 EDCs measured in early pregnancy urine or blood with serum hCG concentrations using multi-variable adjusted linear regression models per EDC and Weighted Quantile Sum (WQS) regression with repeated holdout validation for the EDCs mixture. ResultsIn 2,039 included women, higher exposure to bisphenol A was associated with lower hCG (beta [95% CI]: −0.06 [−0.11 to −0.002]) while higher triclosan exposure was associated with a higher hCG (0.02 [0.003 to 0.04]). Higher exposure to several phthalates, including mono-ethyl and mono-butyl phthalates (MEP and MBP) as well as metabolites of di-2-ethylhexyl phthalate (DEHP) was associated with a lower hCG (beta [95% CI] for sum of DEHP metabolites: −0.13 [−0.19 to −0.07]). Likewise, higher exposure to several polychlorinated biphenyls (PCBs) was associated with a lower hCG. In the WQS regression, each quartile increase in the EDCs mixture was associated with −0.27 lower hCG (95% CI: −0.34 to −0.19). DiscussionHigher exposure to several EDCs during pregnancy was associated with a lower hCG; and despite the small effect sizes, still indicating that the exposure may negatively affect production or secretion of hCG by the placenta. Our results provide the impetus for future experimental studies to investigate the placenta as a target organ for adverse effects of EDCs.

Positive Association of the Number of Oocyte Retrieved with the Maternal hCG Concentration in Early Pregnancy Achieved by Vitrified-Warmed Embryo Transfer after In Vitro Maturation

Background: Human chorionic gonadotropin (hCG) is synthesized by trophoblast cells and play a critical effect in early pregnancy. The serum hCG concentration is significantly higher in early gestation period achieved through in vitro maturation (IVM) than that by traditional IVF. Since IVM does not involve ovarian hyperstimulation, we wonder whether the number of oocyte retrieved affect the hCG concentration in early pregnancy achieved by IVM. Methods: The retrospective analysis involved 51 women who delivered singletons were analyzed. The number of oocyte retrieved and the maternal hCG concentration were collected and analyzed. Results: 51 women had delivered singletons through IVM. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L and 10930.20 ± 7223.17 IU/L at day 14 and 21, respectively. After confounding factors adjusted, the concentration of serum hCG at day 14 and 21 associated significantly with the number of oocyte retrieved. The result of crude linear regression analysis exhibited a positive relationship between the number of oocyte retrieved and the hCG concentration in early gestation. Conclusions: Our results suggested that the number of oocyte retrieved associated positively with the serum hCG level in female with early pregnancies that underwent IVM.

The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital.

In response to the COVID-19 pandemic, a central London tertiary referral hospital's nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 - 15th of July 2020 (pandemic) and 5th of March 2019 - 15th of July 2019 (pre-pandemic). Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

Long-acting microspheres of Human Chorionic Gonadotropin hormone: In-vitro and in-vivo evaluation

Human Chorionic Gonadotropin (hCG) hormone is used to cause ovulation, treat infertility in women, and increase sperm count in men. Conventional hCG solution formulations require multiple administration of hCG per week and cause patient noncompliance. The long-acting PLGA depot microspheres (MS) approach with hCG can improve patient compliance, increase the efficacy of hCG with a lower total dose and improve quality of life. Therefore, hCG was encapsulated by a modified double emulsion solvent evaporation technique within PLGA MS by high-speed homogenizer and industrially scalable in-line homogenizer, respectively. MS was characterized for particle size, encapsulation efficiency (EE), surface morphology, and in-vitro release. The spherical, dense, non-porous microspheres were obtained with a size of 58.88 ± 0.18 µm. Microspheres showed high EE (77.4% ± 5.9%) with low initial burst release (12.82% ± 2.07%). Circular Dichroism and SDS-PAGE analysis indicated good stability and structural integrity of hCG in the microspheres. Its bioactivity was proven further by a bioassay study in immature Wistar rats. Pharmacokinetic analysis showed that the hCG PLGA MS maintained serum hCG concentration up to 13 days compared to multiple injections of a marketed conventional parenteral injectable formulation of hCG. Thus, it can be ascertained that the hCG PLGA MS may have great potential for clinical use in long-term therapy.

Increased maternal serum hCG concentrations in the presence of a female fetus as early as 2 weeks after IVF-ET

BackgroundMaternal serum human chorionic gonadotropin (hCG) is produced in trophoblast cells during pregnancy. Whether there are sex-related growth differences of hCG concentrations in early pregnancy is still controversial. ObjectiveTo explore the association between hCG concentrations and fetal sex as early as 2 weeks after in vitro fertilization and embryo transfer (IVF-ET). MethodsThis study involved 6669 women ≤ 38 years of age. These 6669 patients all delivered singletons; 3531 had a male fetus and 3138 had a female fetus. The maternal serum hCG concentrations on Day 14 and Day 21 were determined using a Beckman DxI800 immunoassay system. ResultsAmong the 6669 patients who delivered singletons, 3531 had a male fetus and 3138 had a female fetus. The hCG concentrations on day 14 of gestation were 516.12 (342.12–757.34) IU/L in the group of male fetuses and 552.69 (359.35–772.83) IU/L in group of female fetuses. The hCG concentration on day 21 was 8839.60 (5975.00–12615.00) IU/L in male fetuses and 9289.10 (6162.00–13146.00) IU/L in female fetuses. Maternal serum hCG levels were significantly higher in those with female fetuses than those with male fetuses. After adjusting for confounding factors, the hCG levels were significantly associated with fetal sex. ConclusionsOur results showed pregnant women with female fetuses have significantly higher hCG levels than those bearing male fetuses.

Positive Association of the Number of Oocyte Retrievals With the Maternal hCG Concentration in Early Pregnancy After <i>in vitro</i> Maturation

In vitro maturation (IVM), which is widely used for infertile women, offers many benefits, and it does not involve ovarian hyperstimulation. In addition, the serum human chorionic gonadotropin (hCG) level is significantly higher in women with early pregnancies achieved by IVM than in those with pregnancies achieved by traditional IVF. In the present study, we explored the association between the number of oocyte retrievals and the maternal hCG concentration on days 14 and 21 after IVM. Data from 51 women who delivered singletons were analyzed. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L on day 14 and 10930.20 ± 7223.17 IU/L on day 21. After adjusting for confounding factors, the concentration of maternal serum hCG on days 14 and 21 associated significantly with the number of oocyte retrievals. Crude linear regression analysis showed a positive relationship between the number of oocytes retrieved and the hCG concentration. Our results showed that the number of oocytes retrieved associated positively with the serum hCG concentration in women with early pregnancies that underwent IVM. Our results partially explain the transient changes in the early maternal serum hCG concentration after IVM.

Residual concentrations of human chorionic gonadotropin in female whitespotted conger reared under low water temperatures after a single injection

To develop methods for inducing maturation of female whitespotted conger, Conger myriaster, a single injection of human chorionic gonadotropin (hCG; 2.5 IU/g body weight, BW) was administered to each of 7 females, which had ovarian oocytes with a larger diameter than 560 μm at a water temperature of 10 °C. Subsequent changes in the serum concentration of hCG and estradiol-17β (E2) and in their BW index [(BW/BW before the injection) × 100] were measured once a week until 9 weeks after the injection was administered. The serum concentration of hCG reached a peak value of 3.68 ± 0.37 IU/ml after one week, followed by a rapid decrease to 4 weeks later and then a gradual decrease thereafter, expressing its lowest value (0.1 ± 0.02 IU/ml) 9 weeks later. A week after administration, the serum E2 concentration rose to 6.1 times that before the administration and remained at that level for 3 weeks. Thereafter, the serum E2 concentration decreased sharply and reached approximately the pre-administration level after 8 weeks. Their BW index increased until 5 weeks after administration at a constant rate to 130% of the weight before injection and then gradually decreased. A booster injection of hCG (0.5 IU/g BW) was administered to each of 4 females exhibiting maximum ovarian oocyte diameter exceeding 850 μm at 9 weeks after the injection, followed by an injection of 17α-hydroxyprogesterone (2 μg/g BW) one day later for induction of ovulation. One of the females ovulated within 67 h of the final injection. These results indicate that a single injection of hCG (2.5 IU/g BW) has effects on promoting the maturation of female whitespotted conger eels for at least one month. In addition, the results suggest the possibility of developing a new method that reduces handling stress for females by increasing the dosing interval by one month or more.

Maternal human chorionic gonadotrophin concentrations in very early pregnancy and risk of hyperemesis gravidarum: A retrospective cohort study of 4372 pregnancies after in vitro fertilization

ObjectiveWe investigated the association of human chorionic gonadotrophin (hCG) concentrations on a fixed day in very early pregnancy with development of hyperemesis gravidarum. Study designThis retrospective cohort study included 3107 singleton and 1265 twin pregnancies after in vitro fertilization treated at Department of Reproductive Medicine, Rikshospitalet, Oslo University Hospital, Norway in the period 1996–2013. Maternal serum hCG concentrations was measured on day 12 after embryo transfer. Information about development of hyperemesis gravidarum was obtained by individual linkage to the Medical Birth Registry of Norway. We studied hCG concentrations in very early pregnancy according to development of hyperemesis gravidarum, in singleton and twin pregnancies separately. We estimated the odds ratios for hyperemesis gravidarum with 95% confidence intervals according to quartiles of hCG concentrations. ResultsIn twin pregnancies as compared to singleton pregnancies, we found higher mean maternal hCG concentrations (219 IU/L versus 130 IU/L, p<0.001 Student’s t-test) and higher prevalence of hyperemesis gravidarum (2.7% versus 1.4%, p=0.002 chi-squared test). However, both in singleton and in twin pregnancies, we found no significant difference in mean hCG concentrations between women who developed hyperemesis gravidarum and women who did not (Singletons: 122 IU/L versus 130 IU/L, p=0.504. Twins: 234 IU/L versus 219 IU/L, p=0.417 Student’s t-test). We found no significant differences in odds ratios for developing hyperemesis gravidarum according to quartiles of hCG concentrations. ConclusionsWe found no association of maternal hCG concentrations on a fixed day in early pregnancy with development of hyperemesis gravidarum.

Effect of laser-assisted zona thinning, during assisted reproduction, on pregnancy outcome in women with endometriosis: randomized controlled trial.

To compare the ICSI-ET outcomes in patients with endometriosis with or without laser-assisted zona pellucida thinning. Randomized controlled trial. The study was conducted in the Obstetrics & Gynecology Department, Cairo University hospital, and two private IVF centers in Cairo & Beni-Suif from July 2015 to January 2017 upon infertile and known endometriosis patients who planned to do ICSI-ET. Before randomization, all patients received the same ovarian stimulation preparation, oocyte retrieval procedures, and the same intracytoplasmic sperm injection procedures. After randomization, laser-assisted hatching was performed only for embryos of 158 patients, while the other group (n=150) no laser-assisted hatching was made. The verification of pregnancy was achieved by the serum hCG concentration 14days after the embryo transfer, and the clinical pregnancy was confirmed 2weeks later by the presence of gestational sac with pulsating fetal pole on vaginal ultrasonography. The main outcome measures were the clinical pregnancy rate and the clinical implantation rate. Both groups were comparable with regard their baseline characteristics, baseline hormonal profile, the ovarian stimulation characteristics, and the ovulation characteristics. The mean number of embryos developed per patient and the mean transferred number of embryos per patient were comparable between groups (p value>0.05). The implantation rate was significantly higher (p value 0.002) in the study group than the control group with an odds ratio of 1.86 (CI 95% 1.24-2.80) and NNT 13.81 (CI 95% 8.35-39.94). The clinical pregnancy rate, was significantly (p value 0.022) higher in the study group than in the control group with an odds ratio of 1.79 (CI 95% 1.05-3.06) and NNT 9.57 (CI 95% 5.03-98.99). That laser-assisted hatching by thinning of the zona pellucida may be a suitable method to improve the ICSI-ET outcomes, in term of the implantation and the pregnancy rates, in cases of endometriosis. Pan African Clinical Trials Registry (PACTR), http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201502001022393 , PACTR201602001467322.

Single-dose pharmacokinetic study comparing the pharmacokinetics of recombinant human chorionic gonadotropin in healthy Japanese and Caucasian women and recombinant human chorionic gonadotropin and urinary human chorionic gonadotropin in healthy Japanese women.

PurposeRecombinant hCG (r‐hCG) was approved in Japan in 2016. As a prerequisite for a Phase III study in Japan related to this approval, the pharmacokinetic (PK) profile of r‐hCG was investigated.MethodsAn open‐label, partly randomized, single‐center, single‐dose, group‐comparison, Phase I PK‐bridging study was done that compared a single 250 μg dose of r‐hCG with a single 5000 IU dose of urinary hCG (u‐hCG) in healthy Japanese women, as well as comparing a single 250 μg dose of r‐hCG in Japanese and Caucasian women. The Japanese participants were randomized 1:1 to receive either r‐hCG or u‐hCG, while the Caucasian participants were weight‐matched to the Japanese participants who were receiving r‐hCG in a 1:1 fashion. The primary PK parameters were the area under the serum concentration–time curve from time 0 extrapolated to infinity (AUC 0–∞) and the maximum serum concentration (Cmax).ResultsThe mean serum hCG concentration–time profiles of r‐hCG in the Japanese and Caucasian participants were a similar shape, but the level of overall exposure was ~20% lower in the Japanese participants. For the Japanese participants, r‐hCG resulted in an 11% lower Cmax but a 19% higher AUC 0–∞ compared with u‐hCG. No new safety signal was identified.ConclusionThis study cannot exclude a potential difference in the PK profile of r‐hCG between Japanese and Caucasian participants. However, this study does not indicate that there are clinically relevant differences in the serum PK of r‐hCG and u‐hCG in the Japanese participants.

Serum human chorionic gonadotropin (HCG) trends following single embryo transfers in obese patients

The objective of this study was to determine whether body mass index (BMI) impacts initial serum hCG values and rates of hCG rise in pregnancies conceived following single embryo transfer. Retrospective cohort study. Patients undergoing autologous single embryo transfers (day 3 or day 5, fresh or frozen) from 10/2007 to 2/2015, resulting in one gestational sac on early ultrasound and singleton live birth at >24 weeks of gestation, with initial serum hCG levels measured exactly 16 days after oocyte retrieval (or the equivalent in frozen cycles), were included (n=248). Mean initial hCG values and 2-day percent hCG rises (between the first and second measurements) were calculated among patients with BMI below 30 kg/m2, and those with class I obesity (30-34.9 kg/m2), class II (35-39.9 kg/m2) and class III (>40 kg/m2). Linear regression models adjusted for oocyte age and day of embryo transfer were used to estimate the linear regression beta and 95% confidence interval (CI) of mean initial hCG values and 2-day percent hCG rises. Mean initial serum hCG values were inversely correlated with BMI class (Table) (P-value test for linear trend <0.001). Obese women were more likely to have low initial serum hCG values (<100 mIU/mL) and this increased across BMI classes, ranging from 1.4% of normal weight patients to 25% of patients with BMI >40 kg/m2 (p-value test for linear trend=0.002). However, mean 2-day percent hCG rises were similar between normal weight and obese patients, and were normal (>53%) in all groups.Tabled 1Body mass index (BMI) and serum human chorionic gonadotropin (hCG) hCG valuesOutcomeBMI < 30 kg/m2 (n=211) ReferentClass I: BMI 30-34.9 kg/m2 (n=18)Class II: BMI 35-39.9 kg/m2 (n=11)Class III: BMI >40 kg/m2 (n=8)P-value test for linear trendMean initial hCG, Mean (SD), RangeLinear regression beta(95% CI)394.9 (208.4)78.0-1245.01.00 (referent)287.8 (149.6)62.0-592.0-108.7 (-205.9,-11.5)236.7 (84.5)92.0-364.0-167.1 (-288.7,-45.5)188.9 (102.2) 57.0-300.0-222.8 (-366.2,79.4)<0.001Initial hCG < 100 mIU/mL,n (%)OR(95% CI)3 (1.4%)1.00 (referent)1 (5.6%)4.3 (0.4-45.6)1 (9.1%)8.8 (0.8-99.4)2 (25.0%)36.9 (3.69-368.3)0.002Mean percent hCG rise in 2-days (first to second value), Mean (SD), RangeLinear regression beta(95% CI)171.3 (101.3) 38.3-728.41.00 (referent)140.2 (47.6) 77.5-256.5-39.4 (-86.7,7.90)154.1 (84.7) 76.2-345.6-14.4 (-73.6,44.8)150.6 (75.6) 64.9-300.0-32.8 (-102.6,37.0)0.11 Open table in a new tab When compared with normal weight patients, obese patients had significantly lower initial serum hCG values, but still achieved singleton live births. Mean 2-day percent rises in hCG were normal across all BMI classes. Rate of hCG rise remains the mainstay of monitoring early pregnancies following IVF, particularly as initial hCG values may lack sensitivity for live birth in obese patients. Elevated BMI is associated with increased blood volume, which may affect serum hCG concentration. Given the impact of BMI on this crucial blood test, future studies should explore whether BMI impacts the interpretation of other serum analytes.

Evaluation of Tubal Pregnancy After Treatment With Methotrexate by Ultrasound Elastography.

The purpose of this study was to evaluate the application of ultrasound elastography in the assessment of methotrexate (MTX) treatment for tubal pregnancy and the association with the elasticity score and human chorionic gonadotropin (hCG) concentration. A total of 73 cases of unruptured tubal pregnancy were diagnosed and treated systemically with MTX. The sonographic characters of conventional transvaginal sonography and elastography and serum hCG concentrations before and after MTX therapy were retrospectively reviewed and analyzed. The mean elasticity score was statistically significantly lower for the ectopic tubal masses of the success group (mean ± SD, 2.58 ± 0.68) than for the failure group (3.33 ± 0.47) on day 7 (P < .001) and similar on day 0. The median elasticity score for the success group on day 7 was 3, and for the failure group, it was 4. When elasticity scores of 3 and 2 were used for the criterion of successful MTX treatment, the elastography had 94.5% sensitivity, 61.1% specificity, 88.1% positive predictive value, and 78.6% negative predictive value. Elastography of the ectopic masses and subsequent hCG concentration at 1 week after the MTX injection in the success group had a strong relationship. Our results suggest that transvaginal elastography was a useful tool in the evaluation of tubal pregnancy after pharmacologic management.

Is a high serum copper concentration a risk factor for implantation failure?

BackgroundCopper-containing contraceptive devices may deposit copper ions in the endometrium, resulting in implantation failure. The deposition of copper ions in many organs has been reported in patients with untreated Wilson’s disease. Since these patients sometimes exhibit subfertility and/or early pregnancy loss, copper ions were also considered to accumulate in the uterine endometrium. Wilson’s disease patients treated with zinc successfully delivered babies because zinc interfered with the absorption of copper from the gastrointestinal tract. These findings led to the hypothesis that infertile patients with high serum copper concentrations may have implantation failure due to the excess accumulation of copper ions. The relationship between implantation (pregnancy) rates and serum copper concentrations has not yet been examined. The Japanese government recently stated that actual copper intake was higher among Japanese than needed. Therefore, the aim of the present study was to investigate whether serum copper concentrations are related to the implantation (pregnancy) rates of human embryos in vivo.MethodsWe included 269 patients (age <40 years old) who underwent vitrifying and warming single embryo transfer with a hormone replacement cycle using good blastocysts (3BB or more with Gardner’s classification). Serum hCG, copper, and zinc concentrations were measured 16 days after the first date of progesterone replacement. We compared 96 women who were pregnant without miscarriage at 10 weeks of gestation (group P) and 173 women who were not pregnant (group NP).ResultsNo significant differences were observed in age or BMI between the groups. Copper concentrations were significantly higher in group NP (average 193.2 μg/dL) than in group P (average 178.1 μg/dL). According to the area under the curve (AUC) on the receiver operating characteristic curve for the prediction of clinical pregnancy rates, the Cu/Zn ratio (AUC 0.64, 95% CI 0.54–0.71) was a better predictor than copper or zinc. When we set the cut-off as 1.59/1.60 for the Cu/Zn ratio, sensitivity, specificity, the positive predictive value, and negative predictive value were 0.98, 0.29, 0.71, and 0.88, respectively.ConclusionsOur single-center retrospective study suggests that high serum copper concentrations (high Cu/Zn ratio) are a risk factor for implantation failure.

Serum Human Chorionic Gonadotropin Normogram for the Detection of Gestational Trophoblastic Neoplasia.

The aim of this study was to develop a serum human chorionic gonadotropin (hCG) normogram for both uneventful complete and partial hydatidiform moles in the first-trimester ultrasound era. An hCG normogram for both complete and partial hydatidiform moles was constructed, based on 639 patients with uneventful serum hCG regression after evacuation between 1990 and 2014. Serum hCG was measured by an in-house-developed radioimmunoassay, detecting both intact hCG and free β-subunit. It has been in use for all serum measurements sent to the Dutch Central Registry for Hydatidiform Moles since 1977. Since introduction of routine first-trimester ultrasonography, lower pre-evacuation and follow-up serum hCG concentrations were observed. When compared with complete hydatidiform moles, patients with a partial hydatidiform mole had significantly lower pre-evacuation serum hCG concentration (median, 4400 and 875 ng/mL, respectively; P < 0.001) and earlier hCG normalization (median, 7 and 6 weeks, respectively; P < 0.001) but higher gestational age (mean, 11.5 and 13.0 weeks, respectively; P < 0.001). For both complete and partial hydatidiform moles, 95% of patients reached normal serum hCG concentrations within 14 weeks after evacuation. A normogram for the detection of gestational trophoblastic neoplasia was developed for complete and partial hydatidiform moles. Although interesting from a scientific perspective, the small divergence in hCG regression between complete and partial hydatidiform moles will be of little importance in clinical practice, as actual differences in regression will encompass only days. To promote clarity and unity in daily practice, we therefore propose a combined normogram to be used as a reference guideline for follow-up after evacuation of a hydatidiform mole. This normogram will be compliant with patients in today's clinical practice.

Predictive value of serum HCG concentrations in pregnancies achieved after single fresh or vitrified-warmed blastocyst transfer

Possible differences between serum HCG levels in pregnancies achieved after transfer of a single fresh or a vitrified-warmed blastocyst were evaluated. Out of 1130 single blastocyst transfers resulting in positive HCG results, 789 were single fresh blastocyst transfers and 341 single vitrified-warmed blastocyst transfers. The initial serum HCG levels of 869 clinical intrauterine pregnancies were evaluated, 638 after the transfer of a single fresh blastocysts and 231 after the transfer of a single vitrified-warmed blastocysts. The HCG levels from cycles resulting in a clinical intrauterine pregnancy were significantly higher after the transfer of a single vitrified-warmed blastocyst (383 ± 230 IU/l) versus a fresh transfer (334 ± 192 IU/l; P = 0.01). Threshold values for predicting a clinical pregnancy for a fresh blastocyst were 111 IU/l and for a vitrified-warmed blastocyst 137 IU/l. Our study shows that the overall beta-HCG levels are comparable after the transfer of a fresh or vitrified-warmed blastocyst, suggesting that vitrification most probably does not affect the ability of the embryos to produce beta-HCG. This study further shows that when clinicians counsel patients, they should take into account that higher HCG levels are needed after a vitrified-warmed blastocyst transfer to predict a clinical intrauterine pregnancy.

Human Chorionic Gonadotropin Does Not Correlate with Risk for Maternal Breast Cancer: Results from the Finnish Maternity Cohort.

Human chorionic gonadotropin (hCG) is necessary for the maintenance of early pregnancy and promotes normal breast cell differentiation. Administered hCG reduces risk of carcinogen-induced breast cancer in animal models, and higher circulating hCG concentrations were associated with significantly lower long-term risk of breast cancer in a prior nested case-control study. In this study, we investigated early-pregnancy hCG concentrations and subsequent breast cancer risk. We conducted a nested case-control study with 1,191 cases and 2,257 controls (matched on age and date at blood collection) in the Finnish Maternity Cohort, a cohort with serum samples from 98% of pregnancies registered in Finland since 1983. This study included women with a serum sample collected early (<140 days gestation) in their first pregnancy resulting in a live, term birth. Breast cancer cases were identified via the Finnish Cancer Registry. Age at breast cancer diagnosis ranged from 22 to 58 years (mean: 41 years). hCG was measured using a solid-phase competitive chemiluminescence assay. Odds ratios (OR) were calculated using conditional logistic regression. We observed no association between hCG and breast cancer risk, overall [Quartile 4 vs. 1, OR, 1.14; 95% confidence interval (CI), 0.94-1.39], by estrogen and progesterone receptor status, or by ages at first-term birth or diagnosis. Associations did not differ by time between pregnancy and diagnosis (e.g., <5 years, ORQ4 vs. Q1, 1.10; 95% CI, 0.64-1.89; ≥15 years, ORQ4 vs. Q1, 1.36; 95% CI, 0.86-2.13; pheterogeneity = 0.62). This large prospective study does not support an inverse relationship between early pregnancy serum hCG concentrations and breast cancer risk. Cancer Res; 77(1); 134-41. ©2016 AACR.

Simultaneous Bilateral Tubal Ectopic Pregnancy after Intracytoplasmic Sperm Injection and Embryo Transfer, in a Patient with Stage 3 Endometriosis

Objective: To describe a simultaneous bilateral tubal ectopic pregnancy after intracytoplasmic sperm injection and embryo transfer: A case report. Setting: Department of Reproductive Medicine, Femme- Mère-Enfant University Hospital, Bron, France. Introduction: The incidence of extra-uterine pregnancy increases to 2% to 12% following IVF-ET; several pathogenic theories have been suggested, including abnormal hormonal secretion or exogenous hormones administered in assisted reproductive technology (ART). Patient and method: A 32year-old nulliparous woman, with primary infertility and endometriosis stage 3, was treated by ART with intracytoplasmic sperm injection and embryo transfer. Result: The patient showed simultaneous bilateral extrauterine pregnancy, managed by laparoscopic salpingectomy. Discussion: The various possible pathophysiological mechanisms are described, with a review of the literature on simultaneous bilateral extra-uterine pregnancy following ART. Conclusion: In pregnancies following ART, ectopic pregnancy should always be screened for by serum hCG monitoring and transvaginal ultrasound until the implantation site can be confirmed, as incidence is higher than in spontaneous pregnancy. Even if serum hCG concentration increases normally, possible bilateral EP should always be investigated if no intrauterine gestational sac can be seen.

Estimating the hCGβcf in urine during pregnancy

ObjectiveElevated urine concentrations of hCG beta core fragment (hCGβcf) are known to cause false negative qualitative point-of-care hCG test results, but limited information is available regarding urine hCGβcf. In this study, we evaluate the relationship between serum and urine hCG concentrations and the frequency of elevated urine hCGβcf concentrations. Design and methodsPaired serum and urine specimens were obtained from 60 women at various stages of pregnancy and hCG was measured using the Abbott Architect and Roche Cobas e602 assays. Urine specimens with the greatest difference in urine hCG concentrations between these two instruments were tested using a qualitative point-of-care device and hCGβcf was quantified using LC–MS/MS. ResultsUrine hCG concentrations were lower than serum and the magnitude of the difference depended on whether the hCG assay detected hCGβcf. Elevated hCGβcf concentrations (>280,000pmol/L) were observed in 12% of specimens from an unselected patient population. There was a significant correlation (r=0.97; p<0.0001) between the difference (Roche hCG–Abbott hCG) and the hCGβcf concentration as measured by LC–MS/MS (Roche–Abbott difference IU/L=(hCGβcf (pmol/L)∗0.131+656)). ConclusionsA correlation exists between serum and urine hCG concentrations but this correlation is variable. hCGβcf concentrations can be estimated using two automated assay reagent platforms that differ in their recognition of hCGβcf.

Novel pathological findings of placenta with fetal heart failure associated with congenital heart disease

Novel pathological findings of placenta with fetal heart failure associated with congenital heart disease

Persistent Human Chorionic Gonadotropin After Methotrexate Treatment and an Emergency Surgical Procedure for Ectopic Pregnancy.

The case study is a 33-year-old white female with persistently elevated serum human chorionic gonadotropin (hCG) levels following methotrexate treatment and emergency surgery for ectopic pregnancy. At the time of the first methotrexate dose, the serum hCG concentration was 27,995 IU/L. The laboratory was consulted 3.5 months after the surgery, because serum hCG levels had stopped declining and had leveled off to around 80 to 90 IU/L but with negative urine pregnancy tests. Laboratory studies ruled out heterophile antibody interference and hook effect by multiple methods including analysis by different serum hCG assays, treatment with heterophile antibody blocking agents, and dilution studies. Three additional doses of methotrexate over six months were required for serum hCG concentrations to decline to undetectable levels. This case illustrates challenges that may arise with serum hCG measurements in management of ectopic pregnancies. Close collaboration between the laboratory and clinical service is key for optimal patient care.