β-hCG Levels Research Articles

P-29 HONEYMOON IN LATE PREGNANCY

Abstract Introduction During pregnancy there is a partial decrease in the function of immune system which would end with suppression of autoimmune diseases, even type 1 diabetes (T1DM) (1-2). We report a pregnant women with T1DM who was suffering from severe hypoglycemia even with very low insulin dosages in her third trimester. Clinical Case A 27 year old young lady was referred to our clinic with HbA1c level of 12.7%. She had no symptom other than slight nausea and dry mouth. Her β-HCG level was 55 mIU/ml and her plasma glucose level was 435 mg/dl. She was diagnosed with T1DM about one year ago, was started with intensive insulin regimen about 80 IU/day totally, which she did not use ever since. We hospitalized her and started intravenous (IV) hydration and IV insulin, which we switched to subcutaneous insulin. She was educated by our dietitian and by our diabetes-clinic nurse. As the insulin dosages increased, it was detected that she was pregnant. She was offered for therapeutic abortus but did not accept. Her blood glucose measurements improved and she was discharged with morning: 12 IU, afternoon:8 IU, evening:15 IU insulin aspart and night:18 IU insulin detemir dosages. In the follow up, her Hba1c level decreased to 8.7 % in the 2nd month and to 6.7% at the 20th week. Her fasting blood glucose levels were between 87-102 mg/dl and 1st hour postprandial levels were between 110-137 mg/dl. She dropped from the follow up by her own decision. At her 30th pregnancy week, she came with hypoglycemia and she had decreased her insulin dosages to morning: 2 IU, afternoon: 2IU, evening: 3IU insulin aspart and no insulin detemir. Her plasma cortisol level was 18 mcg/dl, alanine aminotransferase (ALT): 12 IU/L, gamma glutamyl transferase (GGT): 28 IU/L, creatinine (Cre):0.8 mg/dl, and Hba1c:5.3%. Her abdominal ultrasonography (USG) was normal. She was diagnosed with honeymoon period in T1DM and was informed about strict blood glucose measurement. Conclusion T1DM would disappear for a long while or regress greatly in some pregnant women even in the late years of their disease (2). Insulin -free period after the pregnancy would last even two and a half years or huge reduction in insulin dosage during pregnany period would even start after 20 years of T1DM (2). In our case, the patient started to use very low insulin dosages at around 30th pregnancy week and after one and half year of her diagnosis of T1DM.

O-04 A CASE OF FUNCTIONAL GONADOTROPINOMA PRESENTING WITH OVARIAN MASSES

Abstract Introduction Most gonadotropinomas are nonfunctional macroadenomas, usually diagnosed by immunohistochemical staining. Here, a rare case of functional gonadotropinoma will be presented. Clinical Case A 37-year-old female patient applied to the neurology clinic with a severe headache, and a macroadenoma was detected on cranial magnetic resonance imaging(MRI). She was referred to our endocrinology clinic. Her menstrual cycle was irregular, and she had frequent intermenstrual bleeding for about a year. She has never had galactorrhea, and there were no features of acromegaly or Cushing’s disease on physical examination that would suggest a functional adenoma. The biochemical evaluation showed an elevated estradiol (E2) level of 2900 ng/L (normal 12,5 –166 ng/L) and an elevated prolactin(PRL) level of 203 µg/L (normal 2,8-29,2 µg/L) with normal follicular-stimulating hormone (FSH), luteinizing hormone (LH) and beta-human chorionic gonadotropin (b-hCG) levels of 2,8 IU/L, 6,6 IU/L and 0.1 mIU/mL respectively. PRL level was 196 µg/L after dilution. The low-dose dexamethasone suppression test was 2.1 µg/dL.The patient’s laboratory results are given in Table 1. Pituitary MRI revealed a 31*20*28 mm lesion invading both cavernous sinuses and compressing the optic nerve on the left side(Figure 1A). Visual field testing showed no visual field defects. The patient was consulted with the gynecology and obstetrics clinic due to high estradiol levels. Pelvic MRI revealed 5-6 cystic lesions, the largest of which was 45*30 mm in the right ovary and 41*37 mm in the left ovary, which did not enhance contrast and did not contain solid components (Figure 1B). The patient, who was considered for surgery due to suspicion of malignancy, was planned to be closely followed up by gynecology because tumor markers were negative and the lesions did not enhance contrast. While the patient’s gynecological examinations were continuing, the patient was started on cabergoline one tablet/week. After the gynecology department decided to follow up on the lesions, the patient underwent TSS for macroadenoma. Immunohistochemical staining was positive for FSH and LH, negative for PRL and adrenocorticotropic hormone (ACTH), and the ki-67 index was %2. The patient’s E2, cortisol, and PRL levels became in the normal range after the operation, and her hormone levels are given in Table 1. A pelvic ultrasound performed six months after the operation revealed that the previously detected lesions in the ovaries had disappeared. At this stage, the patient was considered to have functional gonadotropinoma and cortisol elevation has been linked to the effect of estradiol. Conclusion In patients with pituitary macroadenoma, it would be beneficial to check pituitary-gonadal axis hormones even if they are not in the follicular phase to avoid missing functional gonadotropinomas and prevent unnecessary surgeries for ovarian pathologies that may be observed in patients with functional gonadotropinomas.Figure 1:Pituitary and pelvic MRI images of the patientA: Pituitary MRI revealed a 31*20*28 mm lesion invading both cavernous sinuses and compressing the optic nerve on the left side. B: Pelvic MRI revealed 5-6 cystic lesions, the largest of which was 45*30 mm in the right ovary and 41*37 mm in the left ovary, which did not enhance contrast and did not contain solid components. Table 1:Laboratory results of the patientTSS: transsphenoidal surgery, ACTH: Adrenocorticotropic hormone, FSH: follicle stimulating hormone, LH: luteinizing hormone, IGF-1: Insülin-like growth factor, TSH: Thyroid stimulating hormone, fT4: free thyroxie fT3: free triiodothyronine, beta HCG: beta-human chorionic gonadotropin

Predictive value of prenatal screening markers combined with serum placental growth factor in early pregnancy for preeclampsia

Objective: To observe the predictive value of prenatal screening markers combined with serum placental growth factor(PLGF) in early pregnancy for preeclampsia(PE). Methods: This was a prospective study. A total of 369 pregnant women undergoing early pregnancy examinations were selected at Jingmen Central Hospital from August 2024 to January 2025 and divided into the PE group(n=43) and the normal group(n=326) according to the presence of PE during the follow-up. The levels of prenatal screening markers alpha-fetoprotein(AFP), serum PLGF, β-human chorionic gonadotropin(β-hCG) and pregnancy-associated plasma protein-A(PAPP-A) were compared between the two groups. Results: There were 43 patients experiencing PE, with an incidence of 11.65%. The levels of PLGF, β-hCG and PAPP-A were significantly decreased in the PE group compared with those in the normal group, and the differences between the groups were statistically significant (all P<0.05). Logistic regression analysis showed that increased prenatal screening markers AFP, serum PLGF, HCG and PAPP-A were independent risk factors for PE, with statistically significant differences between the groups (all P<0.05). Finally, the results of ROC curve analysis showed that the AUCs of AFP, PLGF, β-hCG and PAPP-A were 0.618, 0.645, 0.690, and 0.645, respectively, and the AUC of combined prediction was 0.825, which was significantly increased compared with that of each marker alone, with statistically significant differences(P<0.05). Conclusion: The development of PE in pregnancy is closely related to the levels of AFP, PLGF, β-hCG and PAPP-A. The predictive efficiency of combined detection of AFP, PLGF, β-hCG and PAPP-A for PE in pregnancy significantly increases. Project Title: sFlt-1/PlGF based combined early pregnancy prenatal screening marker Nursing Strategies and Application in Preeclampsia Risk Assessment, Project Number: 2024YFYB111, Year: 2024. doi: https://doi.org/10.12669/pjms.41.2.9794 How to cite this: Shu Z, Wang W. Predictive value of prenatal screening markers combined with serum placental growth factor in early pregnancy for preeclampsia. Pak J Med Sci. 2025;41(2)598-602. doi: https://doi.org/10.12669/pjms.41.2.9794 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sudden death due to right fallopian tube tear in ectopic pregnancy: An autopsy-based case report

Background: Ectopic pregnancy complications, particularly when they cause rupture, can lead to a sudden and critical situation. In cases of sudden death, it is important to approach it as an unnatural death until proven otherwise through scientific means. Autopsy, conducted by a forensic and medicolegal pathologist, is a key method for establishing the cause of death. Case presentation: We have reported a suspected case of unnatural death being investigated by the police. A young, unmarried woman living alone was found dead in her room, with no clear medical history. The forensic autopsy was performed to establish the cause of death in this case. The findings revealed an enlarged uterus, a tear in the right fallopian tube, and a blood β-hCG level of 5,224.07 mIU/mL. Supported by histopathological findings in the form of an overview that supports the existence of tubal ectopic pregnancy. There is severe internal bleeding in the abdominal cavity due to a tear in the right fallopian tube, leading to hemorrhagic shock because of a loss of 1,946.7 ml of blood. As a result, the patient experiences Multiple Organ Failure (MOF), indicated by lung edema and kidney and stomach necrosis observed in the histopathological examination. Conclusions: The victim's sudden death was a result of a natural cause. The cause of death is determined after eliminating other possibilities.

Retroperitoneal ectopic pregnancy from a tertiary obstetrics hospital in Vietnam: A case series and literature review.

Retroperitoneal ectopic pregnancy is an uncommon condition in clinical practice, often associated with misdiagnosis and unconventional treatment. Delayed interventions can lead to poor prognosis and sometimes catastrophic situations. Due to the limited number of reported cases in the literature, an established treatment protocol has yet to be introduced. This case series presents three instances at a tertiary women's hospital in Vietnam. In cases 1 and 2, a single approach-either surgery or a chemo-regimen-was applied. However, the third patient was treated with a combination of both therapies. This series highlights an evolution in management, progressing from incomplete removal of the gestation to a comprehensive combination of surgery and chemotherapy. Additionally, high serum beta-human chorionic gonadotropin (β-hCG) levels and suspicious ultrasound and magnetic resonance imaging (MRI) findings are crucial for establishing the diagnosis.

Risk factors associated with the failure of local methotrexate combined with minimally invasive surgery for late cesarean scar pregnancy

BackgroundThis study aimed to investigate the risk factors related to the failure of initial combined local methotrexate (MTX) treatment and minimally invasive surgery for late cesarean scar pregnancy (CSP).MethodsThis retrospective case-control study was conducted between January 2016 and December 2023, involving patients with late CSP (≥ 8 weeks) who received local MTX injection combined with either hysteroscopic or laparoscopic surgery. Cesarean scar pregnancy was classified as type I, II, or III based on the direction of growth of the gestational sac and the residual myometrial thickness as assessed by ultrasound. Binary logistic regression analysis was utilized to identify the risk factors associated with the failure of the initial combined treatment.ResultsOverall, 574 patients with late CSP were included in our study. Among them, 29 patients (5.1%) experienced treatment failure with the initial local MTX combined with minimally invasive surgery, while 545 patients (94.9%) achieved successful treatment outcomes. In the univariate analysis, several potential risk factors associated with the initial combined treatment failure were identified, including baseline serum β-human chorionic gonadotropin (β-hCG) levels, type of CSP, time interval between MTX and surgery, and positive fetal heart activity before surgery. Subsequent binary logistic regression analysis revealed the following independent risk factors linked to the failure of the initial combined treatment: baseline serum β-hCG levels exceeding 94,000 IU/L [odds ratio (OR) 3.060, 95% confidence interval (CI) 1.387–6.749, P = 0.006], type III CSP (OR 3.574, 95% CI 1.147–11.135, P = 0.028), a time interval greater than seven days between MTX and surgery (OR 3.847, 95% CI 1.725–8.581, P = 0.001), and the presence of a fetal heartbeat before surgery (OR 4.405, 95% CI 1.014–19.128, P = 0.048).ConclusionThe findings indicate that higher baseline serum β-hCG levels, an extended time interval between MTX and surgery, type III CSP and a positive preoperative fetal heartbeat are significant risk factors for the failure of initial local MTX combined with minimally invasive surgery in patients with late CSP. Individualized treatment strategies are recommended for these high-risk patients with late CSP.

Association of First-Trimester Low PAPP-A Levels (<0.2 MoM) with Maternal and Fetal Outcomes

Background and Aim: First-trimester screening is routinely performed globally to detect chromosomal abnormalities using non-invasive methods such as nuchal translucency (NT) measurements, pregnancy-associated plasma protein A (PAPP-A), and β-human chorionic gonadotropin (β-hCG). Recent studies have highlighted that low PAPP-A levels may be associated with adverse pregnancy outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), and pre-term delivery. Generally, low PAPP-A is defined as below 0.4 multiples of the median (MoM) or under the 5th percentile. However, extremely low PAPP-A, defined as levels below 0.2 MoM or under the 1st percentile, significantly increases the risk of adverse outcomes. This category has received less attention in research. Our study aims to investigate the correlation between PAPP-A levels below 0.2 MoM and adverse pregnancy outcomes. Materials and Methods: A retrospective cross-sectional study was conducted on 10,256 pregnant women who underwent first-trimester screening at Imam Khomeini Hospital in Ahvaz between January 2010 and April 2024. PAPP-A and β-hCG levels were measured, and factors such as maternal age, weight, parity, and abortion history were assessed. Data were obtained using the Fetal Medicine Foundation (FMF) software and medical records. Statistical analysis was performed using SPSS version 26. Results: Out of 10,256 pregnancies, 6,040 (6.4%) had PAPP-A levels below the 5th percentile, while 45 women had PAPP-A levels below 0.2 MoM. The average age of these women was 30.4 ± 4.812 years. Among those with PAPP-A < 0.2 MoM, 2.2% had trisomy 21, 6.7% had IUGR, 26.7% experienced gestational hypertension, and 15.6% developed pre-eclampsia. Trisomies 13 and 18 were not observed in the study population. Conclusions: Pregnant women with PAPP-A levels below 0.2 MoM showed increased incidences of trisomy 21, pre-eclampsia, gestational hypertension, and IUGR. Although low PAPP-A appears to contribute to both maternal and fetal complications, it cannot be used independently to predict adverse pregnancy outcomes. Further large-scale studies are required to better understand the implications of extremely low PAPP-A on pregnancy outcomes.

Risk factors for methotrexate treatment failure in tubal ectopic pregnancy: a retrospective cohort study

BackgroundEctopic pregnancy (EP) accounts for approximately 2% of all pregnancies, with tubal ectopic pregnancies (TEPs) being the most common type. Methotrexate (MTX) is a noninvasive and effective medical management option for TEP, but failure rates range from 10 to 36%, posing challenges in clinical practice. Identifying risk factors for MTX treatment failure is crucial to improve patient outcomes and guide clinical decision-making. This study aimed to determine the risk factors associated with MTX failure in TEP patients and support personalized treatment strategies.MethodsThis retrospective study included female patients who were diagnosed with TEP at Peking Union Medical College Hospital (PUMCH) between January 2016 and December 2022. Patients received MTX treatment initially, with dosing intervals and protocols varying according to clinical practice. MTX treatment failure was defined as the need for surgery after MTX administration. The study included two groups: patients who failed MTX treatment (n = 91) and those who succeeded in treatment (n = 268). Univariate and multivariate logistic regression analyses were performed to identify significant predictors of MTX treatment failure. A nomogram was developed to visualize the predictive factors.ResultsA total of 359 patients were included, with 268 (74.7%) succeeding with MTX and 91 (25.3%) required surgery. Specifically, 282 patients (78.6%) received 1-dose MTX, whereas 77 (21.4%) received 2-dose MTX. Univariate analysis revealed that gravidity, previous EP, gestational age, pretreatment β-human chorionic gonadotropin (β-hCG) level, number of MTX treatments, and presence of a visible yolk sac in ultrasound were significant predictors (all P < 0.05). Multivariate analysis confirmed that higher gravidity (odds ratio (OR) = 1.2487, 95% confidence interval (CI): 1.0103 – 1.5433, P = 0.040) and elevated pretreatment β-hCG levels (OR = 1.0006, 95% CI: 1.0004 – 1.0008, P < 0.001) were independent risk factors. Number of MTX treatments was a significant protective factor (OR = 0.4409, 95% CI: 0.2153 – 0.9025, P = 0.025). The nomogram incorporating these six risk factors was developed.ConclusionHigher gravidity and elevated β-hCG levels were significant predictors of MTX failure, while more MTX doses provided a protective effect. These findings underscore the importance of personalized MTX treatment strategies to improve outcomes in TEP. However, the limitations of this study, including its retrospective and single-center design, suggest that further prospective multicenter studies are needed to validate these results.Trial registrationThe trial is registered at http://www.chictr.org.cn. [registration number: ChiCTR2400081314; registration date: 2024–02-28 (prospectively registered)].

Beta-human chorionic gonadotropin, carbohydrate antigen 19-9, cancer antigen 125, and carcinoembryonic antigen as prognostic and predictive biological markers in bladder cancer

IntroductionWe evaluated the prognostic potential of the Beta-human chorionic gonadotropin (β-hCG), Carbohydrate Antigen 19-9 (CA19-9), Cancer Antigen 125 (CA125), and Carcinoembryonic Antigen (CEA) tumor markers for bladder cancer.MethodsWe analyzed the records of 369 patients who underwent radical cystectomy for urothelial cancer (UC) between October 2012 until December 2019. Levels of CA19-9, CA125, CEA, and β-hCG before radical cystectomy were measured in all patient samples, and serum biomarker cutoff values were used as normal and elevated values.Results and discussionThe proportion of abnormal β-hCG (P&amp;lt;0.001), CA19-9 (P&amp;lt;0.001), and CA125 (P=0.033) was significantly higher in locally advanced bladder UC than in organ-confined bladder UC. In patients with preoperative β-hCG and CA125 abnormality, there was poor prognosis of recurrence-free survival (RFS)(P=0.003, P=0.042) and overall survival (OS) (P=0.003, P=0.002). Using the Cox multivariate regression analysis, both β-hCG (HR: 3.88, 95% CI: 1.43–10.25) and CA125 (HR: 6.21, 95% CI: 1.34–32.16) were found to be significant independent factors for predicting OS and RFS. In addition, patients with a high number of increased tumor markers showed significantly worse OS ((P&amp;lt;0.001) and RFS (P=0.002) than patients with a low number of increased tumor markers. In conclusion, serum β-hCG and CA125 levels could potentially be used for UC prognosis in patients undergoing radical cystectomy. To assess their usefulness in evaluating long-term recurrence and survival, further treatment responses and large-scale additional studies are needed.

Evaluating single-dose methotrexate alone versus methotrexate with letrozole for treating ectopic pregnancy: a comparative study.

Ectopic pregnancy (EP) constitutes 1-2% of all pregnancies. Methotrexate (MTX) is commonly used in treating EP, but it has some limitations and potential side effects. Clinical studies have shown that letrozole, an aromatase inhibitor, may potentially be used in conjunction with MTX therapy. In our study, we explored the efficacy of adding letrozole to MTX in managing EP. Between June 2021 and September 2022, a total of 60 patients diagnosed with EP at the Faculty of Medicine, Yüzüncü Yıl University, were randomly divided into two groups. Group 1 received MTX alone, while Group 2 received a combination of MTX and letrozole. The primary outcome measure was the change in serum β-hCG levels. Secondary outcomes included the need for surgical intervention and the occurrence of side effects. Both groups demonstrated similar success rates in treatment, and there was no significant difference between the MTX and MTX + letrozole groups regarding the need for surgical intervention. Although β-hCG levels declined more rapidly in the MTX + letrozole group, these decreases were not statistically significant. The combination of MTX and letrozole in the treatment of ectopic pregnancy has shown similar efficacy to single-dose MTX. Letrozole may offer a potential contribution to MTX therapy by providing a more pronounced reduction in β-hCG levels, but further research with larger sample sizes and longer follow-up periods is needed to confirm these findings.

Enhancing decision-making in tubal ectopic pregnancy using a machine learning approach to expectant management: a clinical article

ObjectiveTo refine decision-making regarding expectant management for ectopic pregnancy (EP) using machine learning.MethodsThis retrospective study addressed expectant management in stable patients with ampullar EP, 2014–2022. Electronic medical record data included demographics, medical history, admission data, sonographic findings, and laboratory results. Follow-up data on βhCG levels and success rates were collected. Statistical analysis incorporated a Decision Tree Classifier, a decision tree-based machine learning model. The cohort was divided into training and testing groups for the machine learning model. This model was evaluated for accuracy, precision, recall, and F1 score to predict success of expectant management.ResultsAmong 878 cases of EP, the expectant management cohort, comprising 221 cases, exhibited a success rate of 79.6%, with 20.4% requiring subsequent intervention. Mean βhCG levels on admission were 1056.8 ± 1323.5 mIU. The Decision Tree Classifier demonstrated an accuracy of 89%, with precision, recall, and F1 scores of 92%, 95%, and 94%, respectively. Factors for predicting success included clinical symptoms such as pain, the percentage decrease in βhCG levels, gestational age and βhCG level at decision day. Moderate impactful features were white blood cell count, gravidity and maximum tubal dimensions. Smoking status, duration (hours) from time of EP diagnosis to second βhCG test and marital status were minimal significant predictors of success.ConclusionThe Decision Tree-Based classifier model, with 92% precision and 95% recall, may be a valuable tool for predicting treatment success in hemodynamically stable patients with EP, particularly within the initial 24 h of βhCG follow-up.

The role of inflammatory markers and βhCG levels in predicting the success of single-dose methotrexate treatment in tubal ectopic pregnancy.

To evaluate the predictive ability of serum beta human chorionic gonadotropin (βhCG) levels and inflammatory markers derived from hemogram parameters in the success of methotrexate (MTX) treatment for tubal ectopic pregnancy. This retrospective study involved the examination of patients diagnosed with tubal ectopic pregnancy and treated with a single dose of MTX at our clinic between 2018 and 2023. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated from blood samples taken at the time of presentation. βhCG levels were recorded on days 1, 4, and 7 of treatment. The patients were categorized into successful and unsuccessful treatment groups based on their response to MTX. No statistically significant differences were found between the two groups regarding MLR, NLR, PLR, or SII values (P = 0.284, P = 0.097, P = 0.455, and P = 0.061, respectively). In the receiver operating characteristic analysis of serum βhCG from day 1 to day 4, the area under the curve value was calculated as 0.832. The cutoff value for the serum βhCG change from days 1 to 4 was -0.093 (-9.3%), with a sensitivity of 85.53% and specificity of 74.14%, and a positive predictive value (PPV) of 87.5%. There were no significant differences in inflammatory markers (MLR, NLR, PLR, and SII) between the successful and unsuccessful MTX treatment groups. The change in serum βhCG levels between days 1 and 4 can be used as an early predictor of MTX treatment success in tubal ectopic pregnancy.

Correlation of Post-Evacuation Serum β-hCG Levels with Persistent Gestational Trophoblastic Neoplasia: A Tertiary Care Experience

Background: Gestational trophoblastic disease (GTD) includes various abnormal cell growths from the placental trophoblast, such as hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT). This study aimed to determine if post-evacuation serum hCG levels and their ratio during the first two weeks could predict persistent gestational trophoblastic neoplasia (GTN) in complete molar pregnancies. Aim of the study: The aim of the study was to evaluate the relationship between post-evacuation serum β-hCG levels and the occurrence of persistent gestational trophoblastic neoplasia in patients at a tertiary care center. Methods: This cross-sectional study was conducted at the Outpatient Department of Gynecological Oncology, BSMMU, Dhaka, in 2021, involving 50 patients with histopathologically confirmed molar pregnancy. Post-evacuation β-hCG levels were monitored to assess the risk of persistent gestational trophoblastic neoplasia (PGTN). Data were analyzed using SPSS version 20 with t-tests, chi-square tests, ROC curves, and logistic regression, setting p&lt;0.05 as significant. Results: GTN-positive patients were younger, had lower incomes, and were underweight. They showed a higher prevalence of grape-like vesicle expulsion, thyrotoxic symptoms, prior molar pregnancies, and family history of molar pregnancy. β-hCG levels &gt;100,000 mIU/mL were found in all GTN-positive cases. Log-transformed β-hCG levels from weeks 5 to 8 were higher in GTN-positive cases, with week 8 β-hCG providing 97.7% sensitivity, 100% specificity, and an AUC of 0.997 for GTN prediction. Conclusion: Elevated post-evacuation β-hCG levels and specific clinical factors are strong predictors of persistent gestational trophoblastic neoplasia in hydatidiform mole, highlighting the importance of early detection.

The Role of GnRH Agonist Therapy and Hysterosalpingography (HSG) in Diagnosing and Treating Tubal Factor Infertility

ABSTRACT The paper describes the treatment of a 27-year-old woman with a history of infertility, heavy menstrual periods, and severe endometriosis with bilateral hydrosalpinx. The patient received hormonal treatment with triptorelin acetate, a GnRH agonist, to treat her endometriosis and regulate her menstruation. Hysterosalpingography confirmed the presence of bilateral hydrosalpinx, thus suggesting IVF as the most suitable method to conceive. The patient went through a long protocol using GnRH agonist and 14 oocytes were retrieved from her with 10 being fertilized. To avoid ovarian hyperstimulation syndrome (OHSS), all the embryos were frozen and thawed after six months of hormone replacement therapy for the preparation of the endometrium, and a single blastocyst was transferred. The patient conceived, and a subsequent β-hCG level of 256 mIU/mL proved good pregnancy status 14 days after the embryo transfer. This case demonstrates how a personalized and holistic treatment approach to the management of infertility, especially in patients with such conditions as endometriosis and hydrosalpinx, can be very fruitful.

Optimizing Assisted Reproductive Techniques: The Role of L-Carnitine, Acetyl-L-Carnitine, and IMSI in Managing High-Sperm DNA Fragmentation

ABSTRACT This case reports a couple with infertility due to male factor asthenozoospermia and increased sperm DNA fragmentation along with a slightly thin endometrial lining of the female partner. The male partner received 1 g/day of acetyl-L-carnitine and 2 g/day of L-carnitine for 3 months, following which sperm motility was improved, and DFI was reduced from 45% to 20%. Intracytoplasmic morphologically selected sperm injection (IMSI) was utilized during the in vitro fertilization (IVF) cycle to utilize sperms with optimal morphological characteristics for fertilization selectively. To improve endometrial receptivity, the female partner underwent estrogen and platelet-rich plasma (PRP) treatment and the endometrial thickness increased from 6.5 mm to 8 mm, improving endometrial receptivity. A frozen embryo transfer was then carried out after 1 month of the initial cycle. Two weeks after the transfer, a subsequent serum β-hCG level measured 302 mIU/mL, indicating a pregnancy. This case demonstrates the importance of the combined management of acetyl-L-carnitine and L-carnitine supplementation alongside IMSI and PRP in treating the complex etiology of both male and female infertility and leading to successful IVF pregnancy. The systematic approach to focus on aspects that included improving sperm quality as well as the endometrium was therefore important in yielding the result.

Cell-free pregnancy-associated microRNAs in blood plasma as potential biomarker in early diagnosis of ectopic pregnancy.

Ectopic pregnancy (EP) is one of the life-threatening disorders in early pregnancy and current strategies are inadequate in its clinical management. There is a need to identify more accurate biomarkers for early diagnosis of ectopic pregnancy. This case-control study was conducted in a group of 35 women diagnosed with ectopic pregnancy and 31 women with a normal singleton pregnancy. Patients' characteristics including the level of β-hCG, age, body mass index (BMI), and gestational age have been recorded. The plasma levels of cell-free hsa-miR-411, hsa-miR-433, and hsa-miR-524 were examined by qRT-PCR using specific primers. There was no statistically significant difference in maternal age, gestational age, and BMI between the two groups. β-hCG concentrations in EP were significantly lower than normal pregnancy group. Cell-free hsa-miR-411 and hsa-miR-433 had statistically significant differences in concentrations in women with EP and normal pregnancy. hsa-miR-411 and hsa-miR-433 had better diagnostic values for discriminating EP from normal pregnancy. Moreover, hsa-miR-411 and hsa-miR-433 showed a specificity of 61% and 53%, and a sensitivity of 72% and 79%, respectively. hsa-miR-411 and hsa-miR-433 microRNAs concentrations in plasma have potential as a predicting biomarker for early diagnosis of EP. However, further research is needed before using miRNAs in clinical practice for both diagnostic and therapeutic goals.

The role of single-dose prophylactic methotrexate in the prevention of post-molar gestational trophoblastic neoplasia in patients with high-risk molar pregnancy

IntroductionProphylactic chemotherapy (PC) has been suggested to be effective in prevention of post molar gestational trophoblastic neoplasia (PGTN) in patients with high-risk molar pregnancies. The goal of this study is to assess the efficacy of single dose methotrexate as PC in terms of spontaneous remission, time to remission, and progression to PGTN.Materials and methodsPatients with molar pregnancy were recruited to the study and underwent cervical dilation and suction curettage. Patients who had pathologically proven complete hydatidiform mole were evaluated with abdominal ultrasonography to confirm complete evacuation and absence of remnants. These patients were allocated to two groups: group one received Methotrexate 50 mg/m2 via intramuscular injection, while group two did not. PGTN was defined according to the 2018 FIGO criteria. For patients with confirmed PGTN, the following variables were recorded: occurrence of metastasis, resistance to first-line chemotherapy and time to βHCG level normalization.ResultsEighty patients were enrolled to the study, of which 22 cases (27.5%) received PC. It was found that PC with MTX did not significantly influence spontaneous remission (18 (81.8%) Vs 37 (63.7%), p value: 0.12) or time to remission (57 ± 22.5 Vs 61.24 ± 21.78 days, p value: 0.46) in high-risk molar pregnancies. Moreover, among patients in PC group and control group, 4 cases (18.2%) and 21 patients (36.3%) progressed to PGNT, respectively (p value: 0.12). Although patients in PC group tended to be diagnosed in lower stages compared to patients in control group, this difference was insignificance (p value: 0.95). Among patients who developed to PGTN, PC did not reduce the frequency of metastatic disease, resistance to first-line chemotherapy, or the time interval to serum βHCG level normalization (all p values > 0.05).ConclusionThis study suggests that a single-dose MTX as PC may not be an effective therapeutic option for preventing PGTN in patients with high-risk molar pregnancy.

Diagnostic value of colour Doppler ultrasound, serum β-hCG concentration, and progesterone concentration in ectopic pregnancy

Background The rising incidence of ectopic pregnancy (EP) in China underscores the critical need for early and accurate diagnosis to achieve optimal patient outcomes. Colour Doppler ultrasound, β-hCG, and progesterone testing are essential tools in the detection of EP, with transvaginal ultrasound offering precise visualization of EP lesions. Lower levels of β-hCG and progesterone in EP cases compared to normal pregnancies serve as key diagnostic markers. Awareness of atypical symptoms is crucial to prevent missed or misdiagnosed cases, underscoring the importance of timely intervention to mitigate severe complications. Objective To investigate the differences in colour Doppler ultrasound findings, serum β-hCG levels, and progesterone levels between normal and ectopic pregnancies, in order to provide insights into the clinical diagnosis and treatment of EP. Methods Sixty patients who showed no gestational sac in the uterus during early pregnancy and were either highly suspected or pathologically confirmed to have EP were selected for this study. As controls, fifty women with normal pregnancies during the same period were also included. Colour Doppler ultrasound findings (endometrial thickness, pelvic effusion, uterine effusion, and adnexal mass), serum β-hCG levels, and progesterone levels were recorded and compared between the two groups. Results Colour Doppler ultrasound showed that the EP group had significantly greater incidences of pelvic effusion, uterine effusion, and an adnexal mass than did the control group. Moreover, the EP patients had significantly thinner endometria (8.3 ± 3.37 mm vs. 16.12 ± 3.09 mm; P &lt; 0.05), lower serum β-hCG levels (846.18-1444.09 vs. 2429.24–3020.56; P &lt; 0.05), and lower progesterone levels (9.1 ± 7.19 vs. 17.66 ± 5.63; P &lt; 0.05) than did the controls. Receiver operating characteristic (ROC) analysis revealed that endometrial thickness, serum β-hCG concentration, and progesterone concentration had considerably high area under the curve (AUC), sensitivity, and specificity for the diagnosis of EP. Conclusion Colour Doppler ultrasound, serum β-hCG concentration, and progesterone concentration have high diagnostic value for EP.

Hyperthyroidism induced by paraneoplastic human chorionic gonadotropin (hCG) production from testicular tumours: a retrospective clinical and histopathological study.

Human chorionic gonadotropin (hCG) has structural similarities with thyroid-stimulating hormone (TSH) and may stimulate TSH receptors at higher concentrations. During pregnancy, placental hCG causes TSH suppression, contributing to hyperemesis. However, in males, clinical manifestations caused by excess hCG are rare. Herein, we describe complications of life-threatening thyroid storm caused by paraneoplastic hCG secretion from testicular germ cell tumours (GCTs) and aim to identify high-risk groups through retrospective analysis in n = 20 males (aged 17-55 years) with testicular hCG-positive GCTs. Seven hCG-positive testicular GCTs were classified as seminoma, and 13 were classified as non-seminomatous GCTs (NSGCTs). In 3/7 males with seminomas (43%), serum β-hCG concentrations were mildly elevated (median: 0.3 U/L; range: 0.3-82.1 U/L). In contrast, β-hCG was increased in 12/13 (92%) males with a NSGCT (median: 71.1 U/L; range: 0.3-1,600,000 U/L). In 10/13 males with NSGCT (77%), we detected components of embryonal cell carcinoma (EC), and in 7/13 (54%), we detected components of a choriocarcinoma (ChC). TSH was suppressed with high free thyroxine levels in two cases with NSGCT and excessively elevated β-hCG concentrations, but there was no TSH suppression in a further case with high β-hCG. One patient with NSGCT and high β-hCG levels presented with thyroid storm and imminent decompensation refractory to anti-thyroid treatment, requiring a total thyroidectomy. In the second patient, anti-thyroid treatment was initiated shortly after the diagnosis, successfully normalizing hyperthyroxinaemia. In conclusion, paraneoplastic β-hCG production, occurring in NSGCTs with components of ECs or ChCs, is a rare cause of thyrotoxicosis. Early recognition and treatment are critical to prevent a life-threatening thyroid storm.

. Predictive Value of Pre-delivery Serum β-human Chorionic Gonadotropin, Fibrinogen, and Homocysteine for Hypertensive Disorders of Pregnancy

Introduction: it was to investigate the relationship between pre-delivery serumβ-human chorionic gonadotropin (β-HCG), fibrinogen (FIB), and homocysteine (HCY) with hypertensive disorder complicating pregnancy (HDCP). Materials and Methods: 200 HDCP patients and 150 normal pregnant women were selected as study subjects. Fasting cubital venous blood samples were collected to measure serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL), as well as β-HCG, FIB, and HCY levels. Pearson correlation analysis examined relationship between β-HCG, FIB, HCY, and HDCP. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of these indicators for HDCP. Multiple logistic regression analysis identified risk factors (RFs) for HDCP.Results: serum TG, TC, HDL, LDL, FIB,β-HCG, and HCY were greatly elevated in the HDCP group versus control group (CG) (P&lt;0.05). Serumβ-HCG, FIB, and HCY showed notable positive correlations with HDCP (r = 0.935, 0.547, 0.811; P&lt;0.05), and the areas under the ROC curve (AUC) for predicting HDCP based on serum β-HCG, FIB, HCY, and their combination were 0.743, 0.659, 0.801, and 0.886, respectively (P&lt;0.05). Lipid indicators and serum levels of FIB, β-HCG, and HCY were RFs for HDCP.Conclusion:pregnant women with HDCP exhibited markedly elevated serum lipid levels and FIB, β-HCG, and HCY levels before delivery, which can serve as predictive indicators for HDCP.