G.M. Masson

Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy

Summary. Serum concentrations of human chorioni gonadotrophin (hCG). schwangerschaftsprotein l(SPl), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out‐patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.

The relation between immunoglobulin G antibodies to Chlamydia trachomatis and poor ovarian response to gonadotropin stimulation before in vitro fertilization

OBJECTIVE To determine whether a relation exists between previous exposure to Chlamydia trachomatis and impaired ovarian response to gonadotropin stimulation. DESIGN Controlled clinical study. SETTING Two university IVF centers. PATIENT(S) Two hundred forty-two patients receiving IVF treatment and 81 control patients. Ninety-four patients with a poor response to IVF, defined by cycle cancellation in response to a daily stimulation dose of 300 IU of FSH, and 148 patients with a good response were matched for age. Twenty-eight pregnant controls and 53 controls of proven fertility also were included. INTERVENTION(S) Serum samples were obtained from patients and controls. Serum levels of immunoglobulin (Ig) G antibodies to C. trachomatis were determined by ELISA. MAIN OUTCOME MEASURE(S) The prevalence of serum IgG antibodies to C. trachomatis in critically defined poor responders was compared with that of age-matched good responders. RESULT(S) A significantly higher proportion of poor responders had serum IgG antibodies to C. trachomatis compared with good responders (44.7% and 30.4%, respectively). Patients undergoing IVF had a significantly higher prevalence of IgG antibodies to C. trachomatis (36%) than did either pregnant or nonpregnant controls (12%). CONCLUSION(S) A significantly higher prevalence of serum IgG antibodies to C. trachomatis was observed in critically defined poor responders, suggesting a possible detrimental effect of C. trachomatis on subsequent ovarian function.

Simultaneous intrauterine and cervical pregnancies after in vitro fertilization and embryo transfer in a patient with a history of a previous cervical pregnancy. Case report

\Ye report simultaneous intrauterine and cervical pregnancies occurring after in virro fertilization and embryo transfer (IVF-ET) in a 30-year-old woman with a history of a natural ccrvical pregnancy. She was initially seen at St Marys Hospital. Newport, Isle of Wight in March 1983, complaining of post-coital bleeding. There was a cervical ectropion, with normal ccrvical cytology. Treatment by cervical dilatation, curettage of the utcrinc cavity and cautery to the cervix was undertaken. No other abnormality was found and at follow-up the cervix appeared healthy. The next admission was as an emergency in November 1984. with acute lower abdominal pain. At laparoscopy the patient was found to havc a hacmoperitoneurn resulting from a ruptured right ampullary ectopic pregnancy. A right salpingectomy was performed. The left fallopian tube and ovary were noted to be normal. The patient was seen again in March, 1985, at the request of her general practitioner. Following a very light period she had further slight vaginal bleeding 2 weeks later. In addition her

Value of Schwangerschaftsprotein 1 (SP1) and pregnancy-associated plasma protein-A (PAPP-A) in the clinical management of threatened abortion

Summary. Pregnancy‐associated plasma protein‐A (PAPP‐A) and Schwangerschaftsprotein 1 (SP1) levels were measured in single serum samples from 60 patients admitted with vaginal bleeding in the first 14 weeks of pregnancy. When based on ultrasound diagnoses the prediction of non‐viability (the predictive value) was 97% for SP1 and 84% for PAPP‐A. Whereas the prediction of viability (above –2SD of the normal range) with SP1 was 88% the value with PAPP‐A was only 57%; the poorer result obtained with PAPP‐A probably reflects its longer half‐life. Pregnancy outcome is not related to the duration of bleeding.

Early conceptual loss in subfertile patients.

Summary. The incidence of early conceptual loss was studied in 27 subfertile women by measuring their serum and urine hCG levels in the luteal phase. Eleven patients eventually had clinically confirmed pregnancies, nine of whom had had significant hCG elevations in previous menstrual cycles. In the remaining 16 patients, who have so far failed to achieve a clinical pregnancy, only three had had elevated hCG results. Thus ‘apparent’ early conceptual loss in non‐pregnancy cycles was found to be more often associated with the fertile group of patients.

Reverse transcription with nested polymerase chain reaction shows expression of basic fibroblast growth factor transcripts in human granulosa and cumulus cells from in vitro fertilisation patients

Basic fibroblast growth factor (bFGF) is a potent angiogenic factor that has also been implicated in granulosa cell and oocyte maturation. We now report the expression of messenger ribonucleic acid (mRNA) encoding bFGF in human granulosa and cumulus cells obtained at oocyte recovery in in vitro fertilisation patients. It was necessary to use the sensitive technique of a nested polymerase chain reaction (PCR) after reverse transcription (RT) to detect transcripts. This finding in conjunction with a recent report showing the presence of transcripts for transforming growth factor beta (TGF beta) in the same type of cells by PCR indicates that mechanisms are in place for controlling extracellular proteolysis and cell differentiation.

Progestogen therapy and prevention of functional ovarian cysts during pituitary desensitisation with GnRH agonists

Henshaw R. C., Cooper K., El-Refaey H., Smith N. C. & Templeton A.A. (1993) Medical management of miscarriage: non surgical uterine evacuation of incomplete and inevitable spontaneous abortion. Br Med J 306,894-895. Peyron R., Aubeny E., Targosz V. et al. (1993) Early termination of pregnancy with mifepristone (RU486) and the orally active prostaglandin misoprostol. N Engl J Med 21, 1501-1513. Wilcox A. J., Weinberg C. R., OConnor J. F. et al. (1988) Incidence of early pregnancy loss. N Engl J Med 319, 189-194.

Persistent elevation of serum oestradiol levels by functional ovarian cysts despite effective pituitary desensitization with GnRH agonists

OBJECTIVE This study assessed whether functional ovarian cysts may prevent suppression of serum oestradiol levels even after pituitary desensitization had been achieved with buserelin.

Placental protein 14 secretion during in vitro fertilization cycles with and without human chorionic gonadotropin for luteal support

OBJECTIVE To investigate levels of placental protein 14 (PP14) in in vitro fertilization (IVF) patients with and without exogenous human chorionic gonadotropin (hCG) for luteal support. DESIGN, PATIENTS Thirty-one women undergoing IVF were studied. For 18 women, hCG was administered in the luteal phase, and 12 became pregnant. Five pregnancies occurred in 13 women not receiving exogenous hCG. SETTING All the patients attended the University of Southampton/Chalybeate Hospital IVF program. RESULTS There was no change in PP14 levels 2 days after embryo transfer (ET), but small significant rises were noted by day 8 in all patients. Thereafter, levels rose further in pregnant subjects but showed no change in nonpregnant patients. The highest level of PP14 was seen in the group of women on hCG support, but there was no overall statistical difference between those on support and those not. In the nonpregnant group, there was no significant correlation between progesterone (P) and PP14 8 days from ET, whereas a highly significant correlation was noted in the pregnant group. CONCLUSIONS Neither hCG nor P are primary factors in the control of endometrial PP14 secretion, but PP14 and P may have common underlying control mechanisms.

THE RADIOIMMUNOASSAY OF A PREGNANCY SPECIFIC‐β1‐GLYCOPROTEIN IN PLASMA AS A PREGNANCY TEST FOR SUBFERTILE WOMEN

We used a pregnancy specific‐β‐glycoprotein (SP1) radioimmunoassay to monitor 72 menstrual cycles of 38 apparently subfertile women who were trying to become pregnant. Blood samples were taken up to day 42 from the start of the previous menstrual cycle. Using serum SP1 levels greater than 6μg/1 as indicative of pregnancy, we obtained 16 positive results of which 11 were later confirmed by a human chorionic gonadotrophin haemagglutination pregnancy test. Three of the five women whose pregnancies were not confirmed had a subsequent history of spontaneous abortion.