Are the first trimester serum and US markers altered in pregnancies after ART?

Amaç

Today, first-trimester screening, which combines maternal age, NT and maternal serum free b-hCG, and pregnancy-associated plasma-protein-A (PAPP-A), can achieve a detection rate 90% with a FPR of 5%. The pregnancies achieved after ART, has been shown to be associated with changes in biochemical serum screening second-trimester markers, but for the first-trimester screening there is a controversial issue. Some trials report altered serum markers and some others are unable to confirm it.

Yöntem

To evaluate distribution of US and biochemical first-trimester screening markers in ART pregnancies and to compare the results with the values of US and biochemical screening markers in spontaneous pregnancies. Material and Method: Prospective cohort study from January 2010 to September 2013. Blood sampling & NT thickness measurement in 478 singleton pregnant women. Study group: 187 pregnancies conceived after ART. Control group: 291 pregnancies conceived spontaneously. Screening performed between 11w.g - 13w+6d. Included only singleton pregnancies conceived after ICSI or FER (frozen embryo replacement) as well as in the control group.

Bulgular

No difference in age between two groups. We found no difference in NT measurements in ART pregnancies compared with spontaneous conceptions and no influence on the screening performance and the FPR rate by combining maternal age and NT for Down syndrome risk assessment. We found a significant reduction in the PAPP-A concentration level in entire ART group when compared with controls, but no statistically significant differences in pregnancies conceived after spontaneous FET or HRT-FET, compared with the control group. We found no difference in the median free b-hCG MoM concentrations in between the ART and control groups. The FPR in ART pregnancy group compared with controls was higher.

Sonuç

Further studies are needed to establish standard values of biochemical markers for first trimester prenatal screening of ART pregnancies. Low PAP-A levels accompanied with normal free β-hCG levels and NT thickness may be primary associated with trophoblast invasion features and mother-placenta-fetus system problems but not fetus chromosomal abnormalities. 

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