Abstract
Purpose: To evaluate whether achieving a singleton pregnancy by IUI affects the results of first-trimester screening for Down syndrome compared to naturally conceived pregnancy.
Methods: Forty-nine IUI and 3059 naturally conceived singleton pregnancies were included in the study. Ovulation in IUI pregnancies was induced by clomiphene and human menopausal gonadotropin. Progesterone was given after insemination for 2 weeks. Down syndrome screening was performed using a combination of maternal age, fetal nuchal translucency, and maternal serum concentrations of free β-hCG and PAPP-A during the period of 10–14 weeks' gestation.
Results: In IUI pregnancies, nuchal translucency thickness and the levels of PAPP-A were significantly higher. The values of free β -hCG were not statistically different between the two groups. The screen-positive rate in IUI pregnancies was significantly higher (14.3% vs. 7.1%).
Conclusions: Singleton pregnancies achieved by IUI have a higher screen-positive rate. Not only elder maternal age but also exogenous hormones given during the process of ovulation induction and after conception may play an important factor influencing positive screening results.
Keywords: Down syndrome, intrauterine insemination, ovulation induction, screening
Full Text
The Full Text of this article is available as a PDF (588.1 KB).
References
- 1.Nicolaides KH, Azar G, Byrne D, Mansur C, Marks K. Fetal nuchal translucency: Ultrasound screening for chromosomal defects in first trimester of pregnancy. Br Med J. 1992;304:867–869. doi: 10.1136/bmj.304.6831.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Snijders RJ, Noble P, Sebire N, Souka A, Nicolaides KH. UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal translucency thickness at 10–14 weeks of gestation. Lancet. 1998;352:343–346. doi: 10.1016/s0140-6736(97)11280-6. [DOI] [PubMed] [Google Scholar]
- 3.Spencer K, Souter V, Tul N, Snijders R, Nicolaides KH. A screening program for trisomy 21 at 10–14 weeks using fetal nuchal translucency, maternal serum free beta-hCG and PAPP-A. Ultrasound Obstet Gynecol. 1999;13:231–237. doi: 10.1046/j.1469-0705.1999.13040231.x. [DOI] [PubMed] [Google Scholar]
- 4.Spencer K, Liao AW, Skentou H, Cicero S, Nicolaides KH. Screening for triploidy by fetal nuchal translucency and maternal serum free beta-hCG and PAPP-A at 10–14 weeks of gestation. Prenat Diagn. 2000;20:495–499. doi: 10.1002/1097-0223(200006)20:6<495::aid-pd846>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- 5.Spencer K, Spencer CE, Power M, Moakes A, Nicolaides KH. One stop clinic for assessment of risk for fetal anomalies: A report of the first year of prospective screening for chromosomal anomalies in the first trimester. Br J Obstet Gynecol. 2000;107:1271–1275. doi: 10.1111/j.1471-0528.2000.tb11619.x. [DOI] [PubMed] [Google Scholar]
- 6.Maymon R, Dreazen E, Weinraub Z, Bukovsky I, Herman A. Antenatal screening for Down's syndrome in assisted reproductive pregnancies. Hum Reprod Update. 1999;5:530–534. doi: 10.1093/humupd/5.5.530. [DOI] [PubMed] [Google Scholar]
- 7.Heinone S, Ryynanen M, Kirkinen P, Hippelainen M, Saarikoski S. Effect of in vitro fertilization on human chorionic gonadotropin serum concentrations and Down's syndrome screening. Fertil Steril. 1996;66:398–403. doi: 10.1016/s0015-0282(16)58508-2. [DOI] [PubMed] [Google Scholar]
- 8.Ribbert LS, Kornman LH, De Wolf BT, Simons AH, Jansen CA, Beekhuis JR, Mantingh A. Maternal serum screening for fetal down syndrome in IVF pregnancies. Prenat Diagn. 1996;16:35–38. doi: 10.1002/(SICI)1097-0223(199601)16:1<35::AID-PD805>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
- 9.Wald NJ, White N, Morris JK, Huttly WJ, Canick JA. Serum markers for Down's syndrome in women who have had in vitro fertilization: Implications for antenatal screening. Br J Obstet Gynecol. 1999;106:1304–1306. doi: 10.1111/j.1471-0528.1999.tb08186.x. [DOI] [PubMed] [Google Scholar]
- 10.Barkai G, Goldman B, Ries L, Chaki R, Dor J, Cuckle H. Down's syndrome screening marker levels following assisted reproduction. Prenat Diagn. 1996;16:1111–1114. doi: 10.1002/(SICI)1097-0223(199612)16:12<1111::AID-PD998>3.0.CO;2-X. [DOI] [PubMed] [Google Scholar]
- 11.Frishman GN, Canick JA, Hackett RJ, Kellner LH, Saller DN., Jr Serum triple marker screening in vitro fertilization and naturally conceived pregnancies. Obstet Gynecol. 1997;90:98–101. doi: 10.1016/S0029-7844(97)00139-7. [DOI] [PubMed] [Google Scholar]
- 12.Nicolaides KH, Brizot ML, Snijders RJ. Fetal nuchal translucency: Ultrasound screening for fetal trisomy in the first trimester of pregnancy. Br J Obstet Gynaecol. 1994;101:782–786. doi: 10.1111/j.1471-0528.1994.tb11946.x. [DOI] [PubMed] [Google Scholar]
- 13.Wald NJ, HackshawAK K. Combining ultrasound and biochemistry in first-trimester screening for Down's syndrome. Prenat Diagn. 1997;17:821–829. [PubMed] [Google Scholar]
- 14.Liao AW, Heath V, Kametas N, Spencer K, Nicolaides KH. First-trimester screening for trisomy 21 in singleton pregnancies achieved by assisted reproduction. Hum Reprod. 2001;16:1501–1504. doi: 10.1093/humrep/16.7.1501. [DOI] [PubMed] [Google Scholar]
- 15.Maymon R, Dreazen E, Rozinsky S, Bukovsky I, Weinraub Z, Herman A. Comparison of nuchal translucency measurement and mid-gestation serum screening in assisted reproduction versus naturally conceived singleton pregnancies. Prenat Diagn. 1999;19:1007–1011. [PubMed] [Google Scholar]
- 16.Haddow JE, Palomaki GE, Knight GJ, Cunningham GC, Lustig LS. In: Maternal age-related Down syndrome detection and screening positive rate using the multiple marker screening test. Obstetrics W., Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Hauth JC, Wenstrom KD, editors. New York: Mcgraw-Hill; 2001. pp. 984–985. [Google Scholar]
- 17.Wojdemann KR, Larsen SO, Shalmi A, Sundberg K, Christiansen M, Tabor A. First trimester screening for Down syndrome and assisted reproduction: No basis for concern. Prenat Diagn. 2001;21:563–565. doi: 10.1002/pd.124. [DOI] [PubMed] [Google Scholar]
- 18.Hsu TY, Ou CY, Hsu JJ, Kung FT, Chang SY, Soong YK. Maternal serum screening for Down syndrome in pregnancies conceived by intra-uterine insemination. Prenat Diagn. 1999;19:1012–1014. doi: 10.1002/(sici)1097-0223(199911)19:11<1012::aid-pd688>3.0.co;2-0. [DOI] [PubMed] [Google Scholar]