Human Chorionic Gonadotropin Test Research Articles

Prompt diagnosis of ectopic pregnancy with the human chorionic gonadotropin test using exuded extract from endometrial curettings

Using saline solution including exuded extract from uterine curettings, hCG tests were performed in 63 women in whom there was a suspicion of ectopic pregnancy, and their results correlated highly with the microscopic existence of chorionic villi and trophoblasts. Ectopic pregnancy can be mostly excluded when the test is positive, and either ectopic pregnancy or complete abortion is probable when it is negative.

Low Risk of Impaired Testicular Sertoli and Leydig Cell Functions in Boys with Isolated Hypospadias

Isolated hypospadias may result from impaired testicular function or androgen end-organ defects or, alternatively, from hormone-independent abnormalities of morphogenetic events responsible for urethral seam. The objective was to evaluate the relative prevalence of hormone-dependent etiologies in boys with isolated hypospadias. We studied endocrine testicular capacity in 61 patients with isolated hypospadias and 28 with hypospadias associated with micropenis, cryptorchidism, or ambiguous genitalia. Serum anti-Müllerian hormone and inhibin B were used as Sertoli cell markers. A human chorionic gonadotropin test was performed to evaluate Leydig cell function. Testicular dysfunction was observed in 57.1% and androgen end-organ defects in 7.2% of patients with hypospadias associated with cryptorchidism, micropenis, or ambiguous genitalia. In the remaining 35.7%, the disorder was idiopathic. The presence of ambiguous genitalia predicted the existence of testicular or end-organ dysfunction with 81.8% specificity. Isolated hypospadias was associated in 14.8% of patients with testicular dysfunction and in 6.5% of cases with end-organ defects; in 78.7% of cases, the condition was idiopathic. The occurrence of isolated hypospadias ruled out the existence of testicular or end-organ disorders with 80.0% sensitivity. Altogether our data indicate that the risk for the existence of an underlying testicular or end-organ dysfunction is low in patients with isolated hypospadias (odds ratio, 0.13; 95% confidence interval, 0.05-0.36; P < 0.001). Boys with isolated hypospadias are more likely to have normal endocrine testicular and androgen end-organ functions, suggesting that transient disruption of morphogenetic events in early fetal life may be the predominant underlying cause.

The effect of the menstrual cycle on optic nerve head analysis in healthy women

To determine the effect of the menstrual cycle on optic nerve head topographic analysis in normally menstruating, healthy women. The study included single eyes selected randomly from each of 52 healthy women with regular menstrual cycles. All subjects underwent a complete ocular examination. Optic nerve head topographic analyses were performed using a confocal scanning laser ophthalmoscope, the Heidelberg Retinal Tomograph II (HRT II, software version 1.6). The analyses were repeated three times during the menstrual cycle: in the follicular phase (days 7-10 of the cycle), at ovulation, and in the late luteal phase (days 1-3 before menstrual bleeding). Serum oestradiol, progesterone and luteinizing hormone levels were measured at each menstrual phase. Fourteen subjects were excluded from the study. The mean age of the subjects (n = 38) was 25.6 +/- 3.7 years (range 21-34 years). Blood oestradiol levels were significantly lower in the late luteal phase (35.8 pg/ml) (p < 0.0001). The mean disc area of the subjects was 1.94 +/- 0.33 mm(2). The neuroretinal rim area decreased significantly during the luteal phase (p < 0.001). However, the linear cup : disc ratio, cup : disc area ratio and the cup area were significantly higher during the luteal phase (p < 0.001). These observations raise the possibility that sex hormone fluctuations which occur during a normal menstrual cycle in healthy women significantly alter neuroretinal rim area and cup variables of the optic nerve head. These findings should be taken into consideration in the clinical follow-up of young women with glaucoma.

Tumor-induced injury of sensory nerve fibers in bone cancer pain

Statement of the Problem: Increased risks of congenital anomalies, spontaneous abortion, premature delivery, and thromboembolism are associated with intravenous sedation or general anesthesia for the pregnant patient. Knowing the pregnancy status of the female patient is essential with oral & maxillofacial surgical procedures. The purpose of this study was to assess the incidence of positive pregnancy testing despite a verbal confirmation of a nonpregnant state from the female patient prior to elective procedures with deep sedation or general anesthesia. Materials and Methods: All patients were tentatively booked for an elective oral surgical procedure with intravenous sedation or general anesthesia. Our practice is for all female patients of child bearing years (age 12 to 50 years) to receive a presurgical pregnancy test. Patients who admitted to being pregnant had their surgery postponed and those that had a hysterectomy were not tested. A qualitative (urine test/cost $46) or quantitative (serum test/cost $64) human chorionic gonadotropin test was performed. The test results and a cost analysis were examined.

Qualitative β-hCG urine assays may be misleading in the presence of molar pregnancy: a case report

Molar pregnancy is a rare complication of pregnancy and the diagnosis is usually confirmed with a markedly elevated β-hCG and a “snowstorm” appearance on pelvic ultrasound. Patients frequently present with a positive pregnancy test, vaginal bleeding, nausea and vomiting. A 23-year-old woman presented to our Emergency Department with a history of 7 weeks of intermittent vaginal bleeding and 1 h of peri-umbilical abdominal pain. She reported that 7 weeks before this visit she was diagnosed with a miscarriage. The bedside qualitative urine human chorionic gonadotropin (hCG) test that we performed was negative, but the quantitative serum hCG was markedly elevated. Ultrasound and operative findings confirmed the diagnosis of molar pregnancy. We conclude that rapid urine qualitative hCG assays may not be reliable in the presence of markedly elevated hCG levels found in molar pregnancy.

Molecular study of the 3 beta-hydroxysteroid dehydrogenase gene type II in patients with hypospadias.

To determine whether some patients with idiopathic hypospadias have HSD3B2 mutations, we genotyped this locus in 90 patients with hypospadias (age, 6.0 +/- 0.4 yr) and 101 healthy fertile male controls. We measured basal plasma renin activity and performed an ACTH test for determination of 17-OH-pregnenolone, 17-OH-progesterone, cortisol, dehydroepiandrosterone sulfate, and androstenedione and an human chorionic gonadotropin test for determination of androstenedione, testosterone, and dihydrotestosterone. We did not observe a clear steroidogenic pattern suggestive of 3 beta-HSD deficiency in any patient. DNA was extracted from peripheral lymphocytes; and exons 1, 2, 3, and 4 were amplified by PCR and analyzed by denaturing gradient gel electrophoresis. An abnormal electrophoretic migration pattern of exon 4 was observed in five patients. Two patients had missense heterozygous mutations (S213T and S284R). In another three patients, we observed heterozygous nucleotide variants in exon 4 that did not produce a change in amino acids (A238, T259, T320). In vitro enzymatic activity was diminished by 40% and 32% in the S213T and S284R heterozygous mutations, respectively. One control exhibited a heterozygous mutation in exon 3 (V78I), which did not alter in vitro enzyme activity. In addition, we observed possible polymorphisms in intron 1 in four patients and one control. We conclude that subtle molecular abnormalities in the HSD3B2 gene may be observed in some patients with apparent idiopathic hypospadias but that this finding is uncommon.

Heterophile antibody blocking agent to confirm false positive serum human chorionic gonadotropin assay

background Persistently false positive human chorionic gonadotropin (hCG) test results in the absence of an intrauterine pregnancy may lead to a diagnosis of ectopic pregnancy or gestational trophoblastic neoplasia and unnecessary testing and therapy. Cases A 38-year-old woman on oral contraceptives and a 53-year-old perimenopausal woman presented with persistently elevated serum β-hCG levels from 30 to 225 mIU/mL. Both women had a history of working with mice. Urine hCG testing was negative. Serum β-hCG levels for both patients were negative after pretreatment of their serum with a heterophile antibody blocking agent. Conclusion These cases illustrate that serum heterophile antibodies can interfere with the hCG enzyme immunoassay and result in false positive values. The addition of heterophile blocking agent to the serum can exclude false positives, thereby preventing unnecessary evaluation and treatment.

P110: Transvaginal Color Doppler (TVCD) in evaluation of patients with positive Human Chorionic Gonadotropin (hCG) test (in excluded intrauterine pregnancy)

Purpose: To determine the diagnostic role of TVCD in patients with positive hCG test in cases when intrauterine pregnancy is excluded. To definite the correlation of the TVCD findings with the level of hCG. Material and methods: 101 patients with positive hCG test were examined. These included: Ectopic pregnancy (EP-27.7%), recent spontaneous abortion (RSA-9.9%), molar pregnancy (MP-31.7%), hemorrhagic or ruptured corpus luteum cyst (OH/OR-14.9%), ovarian torsion (OT-15.8%). Results: The negative hCG test excluded developing EP. The exception was a chronic EP (17.7%), when the level of test was correlated with vascularity of the EP. In clinically suspected EP cases, when hCG >2000 mIU/mL and TVCD failed to disclose intrauterine gestational sac, the patient had an EP or RSA. When hCG <2000 mlU/ml, serial hCG test was performed (on 48 h. intervals) and the TVCD was repeated once the discriminatory level was reached. In cases of MP with ‘‘snow storm’’ sign, high vascularization and low RI/PI, a hCG was not decreased (uncommonly increased). After the MP extraction the abovementioned findings were correlated with hCG level. In cases of OH, OR, OT the increased level of hCG was not so significant, as clinical manifestation (pelvic pain) and TVCD findings. Conclusion: The TVCD has significant role in management of patients with positive hCG test.

ACOG Committee Opinion No. 278: Avoiding Inappropriate Clinical Decisions Based on False-Positive Human Chorionic Gonadotropin Test Results

Clinically significant false-positive human chorionic gonadotropin (hCG) test results are rare. However, some individuals have circulating factors in their serum (eg, heterophilic antibodies or nonactive forms of hCG) that interact with the hCG antibody and cause unusual or unexpected test results. False-positive and false-negative test results can occur with any specimen, and caution should be exercised when clinical findings and laboratory results are discordant. Methods to rule out the presence of interfering substances include using a urine test, rerunning the assay with serial dilutions of serum, preabsorbing serum, and using another assay. Physicians must decide whether the risks of waiting for confirmation of results outweigh the risks of failing to take immediate medical action. Patients should be notified if they are at risk for recurrent false-positive hCG test results, and this information should be included in the patient's medical record.

Endocrine Screening in 32 Consecutive Patients with Hypospadias

Various endocrine studies performed in the hypospadias population show an unsatisfactory response to the human chorionic gonadotropin (HCG) test and abnormal androgen biosynthesis with possible enzyme defects. We evaluated the incidence of disorders in androgen production in boys with isolated hypospadias. A total of 32 consecutive children (46,XY) with hypospadias were prospectively enrolled in the study. Severity of the defect was assessed with a new classification based on the location of the division of the corpus spongiosum. Endocrine evaluation consisted of measuring luteinizing hormone, follicle-stimulating hormone, anti-müllerian hormone (AMH), testosterone, dihydrotestosterone, progesterone, 17alpha-hydroxypregnenolone, 17alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate and delta4-androstenedione. In all but 3 patients gonadal stimulation with 1,500 IU HCG every other day for 12 days was performed and steroid concentrations were reassessed after the test. An adrenocorticotropic hormone test was performed in 2 patients and molecular study of the androgen receptor was performed in 28. An increase to 37.37 nmol./l. progesterone (normal 0.1 to 0.5) and 17alpha-hydroxyprogesterone to 25.48 nmol./l. (normal 1.18 +/- 0.66) before HCG stimulation was noted in 1 patient. These abnormal results were not found after HCG stimulation but reappeared after the adrenocorticotropic hormone test. This result might be related to a partial mix of 17alpha-hydroxylase/17,20-lyase deficiency but no mutation was found after complete sequencing of gene CYP17. Of the 32 patients 4 had an insufficient response to HCG stimulation (testosterone less than 10 nmol./l.), including 1 with a low AMH level of 180 pmol./l. (normal 451 +/- 198) and an increased dehydroepiandrosterone sulfate level of 1,995 nmol./l. (normal 59 +/- 41) before HCG stimulation. Partial androgen insensitivity was suspected in 1 patient because he had a high testosterone response (29.96 nmol./l.) after HCG stimulation but no mutation of the gene of the androgen receptor was detected. Two patients with proximal hypospadias had isolated decreased AMH levels, which was evidence of Sertoli cell insufficiency. Although our series of 32 patients had several abnormal endocrine screenings, these results indicate no significant endocrine defects.

Early intrauterine pregnancy failure: A randomized trial of medical versus surgical treatment

Objective: The purpose of this study was to determine whether medical treatment of early pregnancy failure represents a reasonable alternative to surgical therapy. Study Design: Patients who were diagnosed with pregnancy failure before 12 weeks of gestation were randomly assigned to receive either medical (intravaginal misoprostol) or surgical therapy (dilatation and curettage). In the medical arm of the study, 800 μg of misoprostol was placed within the posterior vaginal fornix. Patients subsequently were seen 24 and 48 hours after the initial dosing; intravaginal misoprostol was readministered only if ultrasound images revealed evidence of persistent pregnancy tissue. By 72 hours after initial study entry, if either a gestational sac or placental tissue was present, the medical treatment was considered a failure, and uterine curettage was performed. Statistical analysis was performed with the two-tailed unpaired t test, χ2 analysis, Fisher exact test, and Mann-Whitney U test; a probability value of <.05 was considered statistically significant. Results: A total of 50 women were enrolled, with 2 patients in the surgical arm experiencing spontaneous pregnancy loss before their scheduled procedures. Twenty-five women received medical therapy; 25 women were randomized to surgical procedure. Fifteen patients in the medical group (60%; 95% CI, 0.41-0.79) had successful pregnancy termination and did not require curettage. There were no significant differences between the medical and surgical groups with respect to either posttreatment hematocrit level or the time needed to achieve negative human chorionic gonadotropin test results. Conclusion: Intravaginal misoprostol is an effective agent for the treatment of early pregnancy failure. Medical treatment of early pregnancy failure represents a reasonable alternative to immediate surgical therapy. (Am J Obstet Gynecol 2002;187:321-6.)

Vaginal bleeding patterns among rural highland Bolivian women: relationship to fecundity and fetal loss

Among the most common reasons given for discontinued use of some contraceptive methods is a disturbance in the menstrual cycle, particularly changes in vaginal bleeding. Work to date suggests marked populational variation in menses duration, but few data have been collected from South America. This longitudinal study of non-contracepting Aymara women (n = 189 providing 837 non-truncated bleeding episodes) identified conceptions and fetal loss via urine tests for human chorionic gonadotropin and classified episodes accordingly to test the hypotheses that (a) vaginal bleeding patterns differ between lactating and non-lactating women, (b) duration of vaginal bleeding accompanying fetal loss differs from that of menstruation, (c) menses preceding a conception are longer than those not followed by a conception. Compared to published values, mean menses duration (3.5 days) in these women was relatively short. Menses duration was not significantly correlated with current age, age at menarche or first birth, parity, time postpartum, or menstrual segment length. Mean menses duration (not preceding a conception) was comparable for lactating and non-lactating women. Mean duration of fetal loss bleeding did not differ from that of menses. Pre-conception episodes were significantly longer than those not followed by conception. Thus, because the rate of conceptions was twice as great among lactating than non-lactating women, the mean duration of all menses (irrespective of conception) was significantly longer in lactating women. Bolivian, and perhaps other South American, women may be particularly disinclined to accept contraceptives (e.g., intrauterine devices) that modify an otherwise relatively brief menses duration. Therefore, a wide variety of contraceptive choices accompanied by population-specific informed counseling is essential. In addition, these findings suggest that studies of fecundability limited to non-lactating women may be biased toward those of relatively lower fecundity and that menses duration may be predictive of risk for some cancers.

The postmenopausal ovary is not a major androgen-producing gland.

It is currently believed that the postmenopausal ovary remains a gonadotropin-driven, androgen-producing gland. However, the adrenal contribution to circulating androgen levels may explain some conflicting results previously reported. In addition, the steroidogenic potential and gonadotropin responsiveness of the postmenopausal ovary have not been recently reassessed. Plasma T, bioavailable T, free T, androstenedione (Adione), and dehydroepiandrosterone sulfate levels were measured in postmenopausal or ovariectomized women with complete adrenal insufficiency, compared with women with intact adrenals. A stimulation human chorionic gonadotropin test (on d 0, 3, and 6) was performed in postmenopausal women with adrenal insufficiency. Dexamethasone was administered for 4 d in postmenopausal women with intact adrenals. Intraovarian T and androstenedione were also measured in homogenates of ovarian tissue from postmenopausal women. Immunocytochemistry was performed on postmenopausal ovaries and premenopausal controls to detect the presence of steroidogenic enzymes (P-450 aromatase, P-450 SCC, 3beta HSD, and P-450 C17) and gonadotropin receptors. Plasma androgen levels were below or close to the limit of the assay in all women with adrenal insufficiency. They were similar in postmenopausal and oophorectomized women with normal adrenals. No hormonal changes were observed after human chorionic gonadotropin injections in women with adrenal insufficiency. In contrast, a dramatic decrease of all steroids was observed after dexamethasone administration in postmenopausal women with intact adrenals. Intraovarian T and androstenedione levels were negligible in postmenopausal ovarian tissue. P-450 aromatase was absent from the 17 ovaries studied, and the enzymes for androgen biosynthesis were either absent (n = 13) or present in very low amounts (n = 4). In all the postmenopausal ovaries, FSH and LH receptors were completely absent. In the absence of adrenal steroids, postmenopausal women have no circulating androgens. This result is consistent with the immunocytochemical studies showing the almost constantly absent steroidogenic enzymes and LH receptors in the postmenopausal ovary. Thus, the climacteric ovary is not a critical source of androgens. The arrest of androgen secretion after menopause may impact significantly on women's health.

Effects of Long-Term Erythropoietin Therapy on the Hypothalamo–Pituitary–Testicular Axis in Male Capd Patients

Gonadal dysfunction has been recognized for a long time in uremic male patients. The present study assesses the hypothalamo-pituitary-testicular axis and growth hormone status in male continuous ambulatory peritoneal dialysis (CAPD) patients, before and after recombinant human erythropoietin (rHuEPO) therapy. Single-center prospective study. Ten anemic male patients with chronic renal insufficiency, and 11 healthy volunteers with normal renal function, matched for age, were included in the study. All patients were on CAPD therapy and none had received rHuEPO treatment previously. Blood samples were collected between 0800 and 0900 hr from all patients for the determination of basal follicle stimulating hormone (FSH), luteinizing hormone (LH), and growth hormone (GH) levels. A luteinizing hormone-releasing hormone (LH-RH) stimulation test was carried out using LH-RH 100 microg intravenous as a bolus injection. Blood for FSH, LH, and GH determinations was drawn every 30 minutes during the 3-hour test period. Human chorionic gonadotropin (hCG) test was performed after 48 hours. After estimations of basal serum total and free testosterone levels, 2000 IU hCG was administered intramuscularly and repeated 48 hours later. Total and free testosterone levels were measured in blood samples collected before and 48 hours after two injections of hCG. After improvement in anemia with exogenous rHuEPO, LH-RH and hCG tests were repeated. Baseline FSH concentrations before and after rHuEPO treatment were slightly higher in CAPD patients than in healthy volunteers (p = 0.85 and p = 0.70, respectively). Areas-under-the-curve (AUCs) for FSH secretion before and after rHuEPO treatment were also slightly higher in patients than in healthy volunteers (p = 1.00 and p = 0.75, respectively). The pretreatment basal LH levels in patients were significantly higher than in controls (p < 0.001). After the improvement in anemia with rHuEPO, serum LH levels declined significantly (p < 0.05). The AUCs for LH secretion before and after rHuEPO treatment were significantly higher in patients than in controls (p < 0.05). All patients had elevated basal levels of GH with paradoxical response to LH-RH. Baseline GH levels in patients were significantly higher than those in healthy subjects (p < 0.001) before rHuEPO treatment. After treatment with rHuEPO, basal GH levels declined but did not normalize, and baseline levels of free testosterone increased significantly (p < 0.05). Anemic uremic male patients on CAPD have normal levels of testosterone with normal response to hCG administration, elevated basal levels of GH, and elevated basal levels of LH, with exaggerated response to LH-RH administration. Improvement in anemia with rHuEPO reduced the basal levels of LH and GH, but exaggerated the LH response; paradoxical GH response to LH-RH administration persisted. These results indicate a defect at the level of the hypothalamus and pituitary gland in uremic male patients undergoing CAPD, and that the improvement in anemia with rHuEPO partially restores some of these endocrine abnormalities.

Prevalence of Positive Preoperative Pregnancy Testing in Teenagers Scheduled for Orthopedic Surgery

The pregnancy status of female teenagers presenting for orthopaedic surgery is often unknown. Anesthetics may have teratogenic or abortive effects. The authors report the results of a screening program for unrecognized pregnancy in 532 female teenagers presenting for orthopaedic surgery. Five patients with a positive urine human chorionic gonadotropin test were identified, for a prevalence of 1 positive result in 106 patients tested (0.9%). Surgery was cancelled in each case.

Use of an automated database to evaluate markers for early detection of pregnancy.

The objective of this study was to develop and validate algorithms to detect pregnancies from the time of first clinical recognition by using Kaiser Permanente automated databases from Portland, Oregon. In 1993--1994, the authors evaluated these databases retrospectively to identify markers indicative of initial clinical detection of pregnancy and pregnancy outcomes. Pregnancy markers were found for 99% of the women for whom pregnancy outcomes were included in the automated databases, and pregnancy outcomes were identified for 77% of the women for whom there were pregnancy markers. The earliest marker most predictive of a pregnancy outcome was a positive human chorionic gonadotropin test; least predictive was an obstetric outpatient visit. Medical record review indicated that in a sample of women with pregnancy markers in the database, an estimated 6% of pregnancy outcomes (primarily early fetal deaths and elective terminations) were lost. Pregnancies were first captured in automated databases 6--8 weeks after the last menstrual period, and a combination of a positive human chorionic gonadotropin test and an outpatient obstetric visit was the most sensitive and specific early marker of pregnancy. When combined with automated pharmacy records, these databases may be valuable tools for evaluating prescription drug effects on all major outcomes of clinically recognized pregnancies.

ETIOLOGICAL STUDIES OF SEVERE OR FAMILIAL HYPOSPADIAS

Hypospadias is a congenital anomaly occurring in 1250 to 1830 live male births, of which 20% involve a severe type. The recurrence risk in families is high. In the majority of cases the underlying etiology remains unknown, which hampers further management based on the specific requirements associated with a specific etiology. In a single center study 63 unselected cases of severe hypospadias were studied for all presently known causes of hypospadias using clinical as well as molecular biological techniques. Also, 16 families with hypospadias were analyzed for possible androgen receptor gene mutations. In 31% of cases of severe hypospadias the underlying etiology was identified. Of these 31% of cases 17% were due to complex genetic syndromes, 9.5% were due to chromosomal anomalies, and 1 involved the vanishing testes syndrome, the androgen insensitivity syndrome and 5alpha-reductase type 2 deficiency, respectively. Based on hormone stimulation tests Leydig cell hypoplasia and disorders of testosterone biosynthesis were suspected in some patients but not confirmed by mutation analysis of the respective genes. Familial hypospadias was due to androgen insensitivity in only 1 family but no other etiologies were identified in this group. Using patient history, physical examination, karyotyping, hormonal evaluation, including human chorionic gonadotropin testing in prepubertal cases and additional biochemical and molecular genetic evaluation, an etiological diagnosis was made in 31% of cases of severe hypospadias. This diagnosis has implications for further patient treatment. In addition, familial hypospadias is rarely due to the androgen insensitivity syndrome.

A Response to Human Chorionic Gonadotropin Test in Boys with Normal Gonadal Function and with Hypogonadism.

Data on standard values of human chorionic gonadotropin (hCG) stimulation in normal boys are limited. Moreover, data on participants definitely diagnosed with hypogonadism are rarely reported. Peak plasma testosterone (T) levels after hCG stimulation in a group of boys (2.0~20.9 years) with definitive primary hypogonadism (PH), secondary hypogonadism (SH) and normal gonadal function (N) were analysed. Peak T in groups of PH, SH and N were <0.1~1.9 ng/ml (below 2.0 ng/ml), 0.3~4.5 ng/ml, and 2.2~11.3 ng/ml, respectively. The lower cut-off point of response to hCG stimulation was 2.0 ng/ml and this value may be useful in the diagnosis of PH. Peak T in normal boys showed a tendency to increase after puberty, so a difference between PH and N might be more pronounced in the pubertal period than in the prepubertal period. On the other hand, it was sometimes difficult to make a diagnosis of SH based only on the hCG test, especially during pubertal period, since the T values for pubertal period overlapped between the SH and the N group. The evaluation of SH might be easily done during the pubertal period, if GnRH test were added in diagnosing SH.

Clinical experience with IVIg Rx in patients with prior failed IVF pregnancies: report of 30 consecutive patients.

This study reviews one practitioner's experience with intravenous immunoglobulin (IVIg) therapy in the in-vitro fertilization (IVF) cycles of 30 patients with previous IVF failures. Thirty patients had undergone 82 prior assisted reproductive technology (ART) cycles (mean 3.9 +/- 2 failed ART cycles, median 3.0, range 1-8) yielding one term birth, one loss at 22.5 weeks, and five chemical pregnancies. These patients underwent comprehensive clinical and laboratory evaluation, including immunologic workup, and were accepted for IVIg therapy in their next IVF cycle. A total of 40 cycles were treated. Twenty-four (60%) of the IVIg-treated IVF cycles showed a positive human chorionic gonadotropin test. Comparing the IVIg cycles to the untreated ART cycles, there were no differences in the number of embryos transferred, fertilized embryos, or eggs. Eighty-six percent of the cases with confirmed implantation delivered; there was one chemical pregnancy, one 20-week spontaneous fetal death, and one trisomy. Five (24%) of the 21 pregnant patients delivered at 30-36 weeks. The remaining 13 delivered at term. Only three (11%) had no positive immune test. In what may be a selected population of IVF patients (with high incidence of abnormal immune testing), early IVIg therapy may be associated with the improved success of IVF, and the high rate of live birth.

The expectant management of early abnormal pregnancy: a pilot study

Objective: The traditional management of early nonviable pregnancy is surgical evacuation. Lately, we have seen a trend in favor of expectant management. The objectives of this pilot study were to: (1) compare surgical evacuation with expectant management, (2) improve patient counseling, and (3) determine if randomization is feasible in a study of this nature.Methods: This was a prospective cohort study. Patients from our public clinic, emergency department, and perinatology referral center were identified with nonviable early pregnancy of less than 8 weeks size. Patients could elect surgery or expectant management treatment, or could choose to be randomized into a treatment group. Surgical management followed standard guidelines. Expectant management included an ultrasound examination after passage, and a quantitative human chorionic gonadotropin test 2 weeks later. If there was no resolution after 8 weeks, surgery was recommended. All patients kept a diary of symptoms. Patients completed a satisfaction survey afterwards. A follow-up phone call determined onset of next menses.Results: Seventeen women enrolled. No woman elected randomization. Six chose surgery, while 11 chose expectant management. There were eight successful natural passages, averaging 6 days, and three crossovers to surgery. There were no differences in blood loss, pain medications, number of days of pain and cramping, return of menses, or patient satisfaction. The expectant management group had more days of bleeding.Conclusions: Expectant management is a reasonable alternative to surgery. Patients can be counseled as to what they might expect during this time. It is unlikely that a large randomized comparison trial is feasible.