The Predictive Value of a Single Serum Beta Human Chorionic Gonadotropin Level in Pregnancies Achieved by Intrauterine Insemination and In Vitro Fertilization-Embryo Transfer Program / 대한산부인과학회잡지

OBJECTIVE: To clarify specific serum beta-human chorionic gonadotropin (beta-hCG) levels on 11 days after intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET) that could predict live birth. METHODS: Three hundred ninety-two pregnancies resulting from IUI and IVF-ET procedures between January 1, 1997 and December 31, 2000 were evaluated. Serum quantitative beta-hCG levels were measured 11 days after IUI or ET using standard immunoradiometric assays. Pregnancy outcomes were categorized as spontaneous abortion, biochemical pregnancy, ectopic pregnancy, singleton live birth, or multiple live birth. Statistical analyses were performed by analysis of variances, and Student's t-test. The sensitivity and specificity of serum beta-hCG level for predicting live birth were plotted using receiver-operator-characteristic (ROC) curve. RESULTS: The multiple live birth group has significantly higher serum beta-hCG level among the different pregnancy outcome groups. The beta-hCG level on the eleventh day after IUI and IVF-ET was significantly higher in the live birth group than the non viable pregnancy group. At a threshold level of 65 mIU/ml, the serum beta-hCG level on the eleventh day after IUI had a positive predictive value of 78.9% in predicting live birth with 95% specificity. At a threshold level of 115 mIU/ml, the serum beta human chorionic gonadotropin level on the eleventh day after ET had a positive predictive value of 92.1% with 95% specificity. CONCLUSION: These data suggest that serum beta-hCG level on 11 days after IVF-ET could be a reliable indicator predicting pregnancy outcome.

Panhypopituitarism in a Pregnant Woman with Ovarian Hyperstimulation Syndrome and Residual Pituitary Adenoma / 대한산부인과학회잡지

Ovarian hyperstimulation syndrome (OHSS) is one of the most serious complication of controlled ovarian hyperstimulation (COH) and ovulation induction. High serum estradiol concentration can induce the increase of capillary permeability and fluid shift, and it can results in hypovolemia, hemoconcetration, thromboembolism, oliguria, ascites and even death. This physiologic changes of OHSS and/or pregnancy might induce the deterioration of pituitary function in patients with abnormal pituitary conditions such as low pituitary reserve or tumor. However, all this while, panhypopituitarism or pituitary apoplexy in a pregnant woman with OHSS and/or pituitary adenoma has not been reported. We have experienced a case of panhypopituitarism developed in a pregnant woman with severe OHSS and residual pituitary adenoma. She had residual prolactinoma, despite a transsphenoidal adenoidectomy, and had suffered from uncontrolled hyperprolactinemia (HPRL) and chronic anovulation. Therefore, she had taken ovulation induction for getting a pregnancy and conceived, but, in the conception cycle, she was hospitalized for management of severe OHSS and hyperemesis gravidarum. During the period of hospitalization, abrupt panhypopituitarism was developed unexpectedly. Therefore, we present this case with the brief review of literature.