Altered first-trimester screening markers after IVF/ICSI: no relationship with small-for-gestational-age and number of embryos transferred

Abstract

First-trimester serum markers in 110 in-vitro fertilization (IVF) and 331 intracytoplasmatic sperm injection (ICSI) pregnancies were compared with 1431 pregnancies with spontaneous conception. Alterations of serum markers were evaluated with respect to small-for-gestational-age (SGA) growth and number of embryos transferred. For pregnancy-associated plasma protein A (PAPP-A), significantly lower concentrations were observed in IVF and ICSI pregnancies compared with controls (0.86 and 0.9 versus 1.06; P<0.001). Free beta-human chorionic gonadotrophin (betaHCG) values were significantly higher in the IVF/ICSI groups than in controls (1.1 and 1.1 versus 0.94; P<0.005). IVF and ICSI pregnancies showed higher rates of SGA (10.0% and 8.2%) compared with natural conception (4.6%), but differences in PAPP-A concentrations remained significant (P<0.005) after the exclusion of SGA pregnancies. No relationship between serum values and the transfer of one, two or three embryos was observed. Centre-specific corrections may be needed to adjust screening parameters for assisted reproductive technology.

First‐trimester maternal serum ADAM12‐s and PAPP‐A levels are altered in pregnancies conceived after assisted reproduction techniques (ART)

“…4,[29][30][31][32][33] Some previous studies have also found decreased levels of PAPP-A in the subgroup of IVF pregnancies. 4,[30][31][32]34,35 In FET pregnancies, PAPP-A concentrations were unaffected when compared with those in the natural conception in several previous studies. 29,30,32,36 However, two previous studies showed that PAPP-A levels were decreased in FET pregnancies, but only in FET cycles accompanied by any hormonal treatment.…”

“…35 However, Bender et al found no correlation between altered serum marker levels of PAPP-A and fβ-hCG and transfer of one, two, or three embryos in ART pregnancies. 31 Infertility itself and its severity may also be the reason for altered PAPP-A levels. In fact, one previous study found that in pregnancies conceived naturally after a time greater than 2 years, PAPP-A levels were decreased similarly than in IVF pregnancies.…”

“…4,30,33,35,36,47,48 However, some previous studies have reported the MoM levels of fβ-hCG to be significantly increased in ART pregnancies that in spontaneous conception. 31,34,37,[49][50][51] One study even has reported slightly decreased MoM levels of fβ-hCG in ART pregnancies. 32 Gjerris et al suggested in the review article that one reason for contradictory results might be that in those studies finding increased fβ-hCG levels, blood samples were taken at gestational age 11-13 weeks, in contrast to studies with similar fβ-hCG levels between IVF and spontaneous pregnancies, where blood samples were taken earlier, in gestational week 8.…”

Validation of Correction Factors for Serum Markers for First-Trimester Down Syndrome Screening in Singleton Pregnancies Conceived with Assisted Reproduction

“…Most studies showed decreased PAPP-A levels in ART pregnancies combined with unaltered levels of fβ-hCG [9,13,14,16,17,20,21] increased fβ-HCG levels [12,22,23,24] or even decreased fβ-hCG levels [15,25]. Two studies reported only an increase in fβ-hCG levels [10,26], and some studies reported no changes in maternal serum values in ART pregnancies [11,18,19].…”

“…In ART pregnancies maternal serum marker levels change during the first trimester affecting the risk assessment for DS [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Counseling for prenatal screening of women carrying an ART pregnancy is complicated due to contradictory reports in FTS performance in ART pregnancies.…”