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Down's syndrome screening marker levels following assisted reproduction
Prenatal Diagnosis
|December 1, 1996
Summary
Assisted reproduction techniques like ovulation induction and in vitro fertilization can alter maternal serum marker levels. These changes are generally small and do not necessitate routine adjustments for Down
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Biochemistry
Background:
- Maternal serum screening for alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), and unconjugated oestriol (uE3) is crucial for prenatal diagnosis.
- Assisted reproductive technologies (ART) such as ovulation induction and in vitro fertilization (IVF) are increasingly common.
- The potential impact of ART on maternal serum marker levels requires careful evaluation to avoid misinterpretation of screening results.
Purpose of the Study:
- To investigate the effects of ovulation induction and in vitro fertilization on maternal serum AFP, hCG, and uE3 levels.
- To determine if these changes warrant routine adjustments in screening protocols for women undergoing ART.
- To provide reassurance to women with positive Down's syndrome screening results undergoing ART.
Main Methods:
- Analysis of maternal serum AFP, hCG, and uE3 levels in 1632 women undergoing ovulation induction and 327 undergoing IVF.
- Comparison of marker levels (expressed as multiples of the normal gestation-specific median - MOM) with a large control group (34582 women).
- Statistical analysis to assess the significance of observed differences, accounting for gravidity.
Main Results:
- Ovulation induction showed a significant increase in hCG (median 1.09 MOM) and a decrease in uE3 (median 0.92 MOM).
- Ovulation induction with Clomiphene increased AFP (1.05 MOM), while Pergonal decreased it (0.93 MOM).
- IVF resulted in a significant reduction in uE3 (median 0.92 MOM); donor egg use led to higher AFP and uE3.
- Despite statistical significance, the observed effects were not substantial enough for routine marker level adjustments.
Conclusions:
- Assisted reproduction techniques can alter maternal serum screening marker levels, but the effects are generally minor.
- Positive Down's syndrome screening results in women undergoing ART are unlikely to be solely due to the ART procedure.
- No routine adjustment of marker levels is recommended for women undergoing ovulation induction or IVF.