ABSTRACT
OBJECTIVES: To evaluate the effect of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) on total hCG, free ss-hCG, AFP and unconjugated estriol (uE3) used as markers for second-trimester Down syndrome maternal serum screening. METHODS: Second-trimester maternal sera from 1515 singleton pregnancies (970 by IVF, 545 by ICSI) were compared with control sera (21 014 cases). Free ss-hCG, total hCG, AFP and uE3 were compared between the control group and the medically assisted reproduction groups. The percentages of at-risk patients (>/=1/250) were also compared. RESULTS: No differences in values of the maternal serum markers were observed between the medically assisted and control groups. When maternal age was taken into account, the screen-positive rate for Down syndrome screening did not differ between the two groups. CONCLUSION: Patients undergoing assisted reproduction techniques can be counseled for maternal serum Down syndrome screening with the same efficacy as patients with naturally conceived pregnancies.
Subject(s)
Down Syndrome/blood , Down Syndrome/diagnosis , Fertilization in Vitro , Prenatal Diagnosis , Sperm Injections, Intracytoplasmic , Adult , Biomarkers , Case-Control Studies , Chorionic Gonadotropin, beta Subunit, Human/blood , Counseling , Estriol/blood , Female , France , Humans , Laboratories/statistics & numerical data , Medical Records , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, Second , Retrospective Studies , alpha-Fetoproteins/metabolismABSTRACT
BACKGROUND: Using fluorescence imaging, an a posteriori multiparametric analysis was performed of human oocytes which failed to give pronucleated zygotes after IVF in cases of very low rates of fertilization or complete fertilization failure. METHODS: The analysis included: (i) the state of the maternal and paternal chromatin; (ii) quality of the metaphase II oocytes; and (iii) cortical granule (CG) distribution. RESULTS: Most oocytes were arrested in metaphase II, but they were abnormal in 50% of cases. The incidence of spindle and chromosome aberrations was strongly influenced by maternal age (69% for 40- to 45-year-old women versus 35% for 26- to 33-year-olds), and sperm chromatin was always condensed in immature oocytes, and fully decondensed only in normal metaphase II. The migration of CGs appeared to be associated with achievement of nuclear maturation at the time of puncture. CONCLUSIONS: These factors, when analysed on a complete set of oocytes from the same patient, provided information about potential causes of IVF failure, and also represented part of an 'oocyte quality evaluation' to select the assisted fertilization technique most suitable for each patient. For example, when the majority of oocytes were judged non-fertilizable at a first attempt, no pregnancy was registered at any subsequent attempt.
