PLACENTA-ASSOCIATED PLASMA PROTEIN AND FREE HUMAN CHORIONIC GONADOTROPIN LEVELS IN DAY 3 VERSUS DAY 5 TRANSFER

Öz

Amaç: Bu çalışma blastokist evresi embriyo transferi ile klivaj evresi embriyo transferinde plasenta ilişkili plasma protein A (PAPP-A) ile serbest insan koryonik gonadotropin B (B-hCG) arasında farklılık olup olmadığını araştırmak amacıyla yürütülmüştür. Gereç ve yöntemler: Bu retrospektif çalışmaya toplam 449 kadın dahil edilerek iki çalışma grubu oluşturuldu. Grup 1: İntrasitoplazmik sperm enjeksiyonu yapılarak klivaj evresi (2. veya 3. gün) taze embriyo transferi sonrası gebe kalan ve 11-14. gebelik haftasında birinci trimester fetal anöploidi biyokimyasal markerlarına bakılan 275 kadından oluşmaktadır. Grup 2: İntrasitoplazmik sperm enjeksiyonu yapılarak blastokist evresi (5. gün) taze embriyo transferi sonrası gebe kalan ve 11-14. gebelik haftasında birinci trimester fetal anöploidi biyokimyasal markerlarına bakılan 174 kadın çalışma kapsamına alınmıştır. Kadınların demografik özellikleri, infertilite sebebi, infertilite süresi, protokol rejimi, total gonadotropin dozu, follikül ve toplanılan oosit sayısı, endometrial kalınlık, funsus embriyo arası mesafe kaydedildi ve PAPP-A ile serbest B-hCG düzeyleri ölçüldü. Bulgular: PAPP-A ve serbest B-hCG düzeyleri, protokol rejimi, endometrial kalınlık ve fundus-embryo arası mesafe de istatistiksel olarak anlamlı fark bulunamamıştır. Azalmış over reservi ve total gonadotropin dozu grup 1 de (p < 0.05) ve follikül sayısı, toplanan oosit sayısı ve MII sayısı anlamlı olarak grup 2 de yüksek bulunmuştur (p < 0.05). Sonuç: 3. gün ve 5. gün taze embriyo transferi arasında PAPP-A ve serbest B-hCG düzeylerinde fark gözlenmemiştir.

Anahtar Kelimeler

• PAPP-A
• serbest B- hCG
• 3. gün ve 5. gün taze embriyo transferi

PLACENTA-ASSOCIATED PLASMA PROTEIN AND FREE HUMAN CHORIONIC GONADOTROPIN LEVELS IN DAY 3 VERSUS DAY 5 TRANSFER

Öz

Aim: This study was conducted to investigate placenta-associated plasma protein (PAPP-A) and free human chorionic gonadotropin (B-hCG) levels after blastocyst transfer versus cleavage-stage embryo transfer. Materials and method: A total of 449 women were included in this rerospective sudy. The study consisted of two groups: Group 1: pregnant women conceived by intracytoplasmic sperm injection (ICSI) procedures after fresh embryo transfer at the cleavage stage (day 2 or day 3) and had first trimester fetal aneuploidy biochemical markers performed at 11-14th gestational week (n: 275). Group 2: pregnant women conceived by ICSI procedures after fresh embryo transfer at the blastocyst stage (day 5) and had first trimester fetal aneuploidy biochemical markers performed at 11-14th gestational week (n:174). Demographic characteristics, causes of infertility, duration of infertility, stimulation protocol regimens, total gonadotropin doses, number of follicles and oocytes retrieval, endometrial thickness, fundus –embryo distance were recorded and placenta-associated plasma protein (PAPP-A) and free human chorionic gonadotropin (B-hCG) levels were measured. Results: We found no significant differences in PAPP-A and free B-hCG levels, stimulation protocols regimens and endometrial thickness and fundus-embryo distance. Diminished ovarian reserve and total gonadotropin doses were significiantly higher in group 1 (p < 0.05). Number of follicles, number of oocytes retrieval and MII oocytes were significiantly higher in group 2 (p < 0.05). Conclusion: No difference was observed in PAPP-A and free B-hCG levels between the 3rd and the 5th day fresh transfer.

Anahtar Kelimeler

• PAPP-A
• free B- hCG
• 3rd -5th day fresh embryo transfer

Kaynakça

1. 1. Hook EB. Ultrasound and fetal chromosome abnormalities. Lancet (London, England). 1992;340(8827):1109.
2. 2. Gjerris AC, Loft A, Pinborg A, Christiansen M, Tabor A. First-trimester screening markers are altered in pregnancies conceived after IVF/ICSI. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2009;33(1):8-17.
3. 3. Spencer K, Nicolaides KH. Screening for trisomy 21 in twins using first trimester ultrasound and maternal serum biochemistry in a one-stop clinic: a review of three years experience. BJOG : an international journal of obstetrics and gynaecology. 2003;110(3):276-80.
4. 4. Kagan KO, Wright D, Spencer K, Molina FS, Nicolaides KH. First-trimester screening for trisomy 21 by free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A: impact of maternal and pregnancy characteristics. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2008;31(5):493-502.
5. 5. Orlandi F, Rossi C, Allegra A, Krantz D, Hallahan T, Orlandi E, et al. First trimester screening with free beta-hCG, PAPP-A and nuchal translucency in pregnancies conceived with assisted reproduction. Prenatal diagnosis. 2002;22(8):718-21.
6. 6. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. The Cochrane database of systematic reviews. 2016(6):Cd002118.
7. 7. Martins WP, Nastri CO, Rienzi L, van der Poel SZ, Gracia CR, Racowsky C. Obstetrical and perinatal outcomes following blastocyst transfer compared to cleavage transfer: a systematic review and meta-analysis. Human reproduction (Oxford, England). 2016;31(11):2561-9.
8. 8. Brown J, Daya S, Matson P. Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection. The Cochrane database of systematic reviews. 2016;12(12):Cd004378.

9. 9. Maheshwari A, Kalampokas T, Davidson J, Bhattacharya S. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertility and sterility. 2013;100(6):1615-21.e1-10.
10. 10. Chambers GM, Chughtai AA, Farquhar CM, Wang YA. Risk of preterm birth after blastocyst embryo transfer: a large population study using contemporary registry data from Australia and New Zealand. Fertility and sterility. 2015;104(4):997-1003.
11. 11. Amor DJ, Xu JX, Halliday JL, Francis I, Healy DL, Breheny S, et al. Pregnancies conceived using assisted reproductive technologies (ART) have low levels of pregnancy-associated plasma protein-A (PAPP-A) leading to a high rate of false-positive results in first trimester screening for Down syndrome. Human reproduction (Oxford, England). 2009;24(6):1330-8.
12. 12. Liao AW, Heath V, Kametas N, Spencer K, Nicolaides KH. First-trimester screening for trisomy 21 in singleton pregnancies achieved by assisted reproduction. Human reproduction (Oxford, England). 2001;16(7):1501-4.
13. 13. Maymon R, Shulman A. Serial first- and second-trimester Down's syndrome screening tests among IVF-versus naturally-conceived singletons. Human reproduction (Oxford, England). 2002;17(4):1081-5.
14. 14. Niemimaa M, Heinonen S, Seppälä M, Hippeläinen M, Martikainen H, Ryynänen M. First-trimester screening for Down's syndrome in in vitro fertilization pregnancies. Fertility and sterility. 2001;76(6):1282-3.
15. 15. Ghisoni L, Ferrazzi E, Castagna C, Levi Setti PE, Masini AC, Pigni A. Prenatal diagnosis after ART success: the role of early combined screening tests in counselling pregnant patients. Placenta. 2003;24 Suppl B:S99-s103.
16. 16. Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Human reproduction (Oxford, England). 1992;7(10):1342-6.
17. 17. Seifer DB, Baker VL, Leader B. Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertility and sterility. 2011;95(2):747-50.
18. 18. Hofmann GE, Toner JP, Muasher SJ, Jones GS. High-dose follicle-stimulating hormone (FSH) ovarian stimulation in low-responder patients for in vitro fertilization. Journal of in vitro fertilization and embryo transfer : IVF. 1989;6(5):285-9.
19. 19. Crosignani PG, Ragni G, Lombroso GC, Scarduelli C, de Lauretis L, Caccamo A, et al. IVF: induction of ovulation in poor responders. Journal of steroid biochemistry. 1989;32(1b):171-3.
20. 20. Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Human reproduction (Oxford, England). 2007;22(4):980-8.
21. 21. Handyside AH, Montag M, Magli MC, Repping S, Harper J, Schmutzler A, et al. Multiple meiotic errors caused by predivision of chromatids in women of advanced maternal age undergoing in vitro fertilisation. European journal of human genetics : EJHG. 2012;20(7):742-7.