Maternal serum levels of placental proteins after in vitro fertilisation and their implications for prenatal screening

Abstract

Reduced PAPP-A with increased hCG yields an increased risk in screening for foetal trisomy 21. We confirm recently published observations but do not recommend the establishment of normal medians for IVF pregnancies since the extent of the deviations is varying according to the different stimulation protocols and dosages of gonadotrophins used.

In combined first-trimester Down syndrome screening, the false-positive rate is not higher in pregnancies conceived after assisted reproduction compared with spontaneous pregnancies

“…This is in agreement with most previous studies (6,10,11,14,(17)(18)(19)(20). Some studies have reported the fb-hCG to be increased (13,15,(21)(22)(23). In the largest study to date, Kagan et al (12) found the median fb-hCG was 9% higher in the IVF pregnancies.…”

“…Also, a functional delay in fetal and placental development and the higher risk of obstetric complications associated with ART can lead to changes in marker concentrations (15,19). Several studies have suggested that exogenous hormone treatment is the main reason for reduced PAPP-A levels (11,15,16,21). In our study, we found that PAPP-A levels were reduced in hormonally stimulated IVF/ICSI pregnancies, but we also found that PAPP-A levels were decreased in nonstimulated FET cycles.…”

“…The odds ratios (OR) and 95% confidence intervals (CI) for the elevated risk for trisomy21 were calculated using logistic regression analysis. ART ¼ assisted reproduction technology; CRL ¼ crown-rump length; fb-hCG ¼ maternal serum free b subunit human chorionic gonadotropin; FET ¼ frozen embryo transfer; FPR ¼ false-positive rate (proportion of women with a 21-trisomy risk R1:250); HRT ¼ hormone replacement therapy; ICSI ¼ intracytoplasmic sperm injection; IVF ¼ in vitro fertilization; MoM ¼ multiples of medians; NT ¼ nuchal translucency thickness; PAPP-A ¼ pregnancy-associated plasma protein-A.…”

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.…”