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Gestational Trophoblastic Neoplasia
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Risk for CHM does not rise with increasing gravidity. However, the risk of a subsequent pregnancy being a CHM rises from 1 in 1000 to about 1 in 70–100 with one previous CHM and to 1 in 4–6.5 with two previous CHMs.32,65,66 Interestingly, the risk of a further molar pregnancy after a PHM is only very slightly increased, so most of the risk for repeat moles resides with CHM rather than PHM.66 Tiny nests of residual molar disease may persist and can rarely reactivate in or after subsequent pregnancies. We therefore used to recommend that a serum hCG was assessed at 6 and 10 weeks after the end of any subsequent pregnancy following a previous CHM or PHM. However, a recent analysis has shown that these risks are so small that hCG testing in this situation is no longer required.67
Regulation of the Pituitary Gland by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
Beyond the events of the mid-cycle surge, the main function of LH is to increase the production of androgens by ovarian theca cells. The androgens, androstendione and testosterone, diffuse into the granulosa cells, where they are converted to E2 and estrone by aromatase (CYP19). Aromatase action, and therefore estrogen production, is controlled by FSH. Hence, the function of theca cells and granulosa cells are controlled by LH and FSH, respectively, according to the “two cell–two hormone” paradigm. In humans, LH stimulates the production of progesterone by the corpus luteum, while in rodents, this is done by PRL. In male mammals, LH stimulates androgen production by the testicular Leydig cells. Clinically, LH is used to support FSH therapy in the treatment of some fertility disorders. The longer-acting hCG is used to induce ovulation in women, to increase sperm count in men, and to treat boys with undescended testes.
Use of Luteal Phase Support
Published in Botros Rizk, Yakoub Khalaf, Controversies in Assisted Reproduction, 2020
Laura Melado, Barbara Lawrenz, Human Fatemi
Derived from the knowledge gathered by providing luteal phase support with low-dose hCG administration after GnRH-agonist trigger, Andersen et al. (59) designed a mathematical model to calculate the daily applied hCG dosage required to maintain sufficient hCG concentrations and, therefore, adequate progesterone levels in the luteal phase. Preliminary results indicate that a daily applied dosage of 100 IU hCG without additional exogenous progesterone seems to be sufficient to maintain the corpora lutea function until endogenous hCG from the developing embryo takes over. This approach may present a means of further individualizing luteal phase support. Unfortunately, the aforementioned small doses of hCG are not commercially available, rendering it difficult to implement this as a clinical routine.
Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy
Published in Journal of Obstetrics and Gynaecology, 2022
Semra Yuksel, Fatma Ketenci Gencer
Demographic properties are shown in Table 1. There were no differences between groups statistically in terms of age, gestational age, gravity, parity and haemoglobin level. Kisspeptin and human chorionic gonadotropin (β-hCG) levels of the groups are shown in Table 2. Serum kisspeptin levels were found as 0.30 (0.22–0.39), 0.11 (0.08–0.16), 1.48 (1.29–1.80) and 0.03 (0.001–0.04) ng/mL in ectopic pregnancy, miscarriage, early first trimester and non-pregnant group, respectively (p < .001). Pairwise comparisons are shown in Table 3. A serum kisspeptin cut-off of 0.84 was found 100% sensitive and 100% specific to discriminate early pregnancy from ectopic pregnancy or miscarriage. Comparison of serum kisspeptin levels among the groups was shown with box plots (Figure 1). hCG levels were found as 6151 mIU/mL (576–19,941) in women with early first trimester of pregnancy. Median hCG levels were found to be higher in women with miscarriage than women with ectopic pregnancy, 1771 mIU/mL (98–11,890) vs. 1333 mIU/mL (94–11,600), respectively, p < .005). Moderate correlation was found between serum kisspeptin levels and hCG (r = 0.51, p < .001).
Prevalence and aetiology of thyrotoxicosis in patients with hyperemesis gravidarum presenting to a tertiary hospital in Cape Town, South Africa
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021
T van der Made, M van de Vyver, M Conradie-Smit, Magda Conradie
Human chorionic gonadotropin (hCG) is produced by placental trophoblasts and part of the glycoprotein hormone family, together with luteinising hormone (LH), follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH). These hormones are heterodimers that share a common alpha-subunit and varying degrees of homology in their beta-subunits. There is considerable homology between the beta-subunits of hCG and TSH. As a result, hCG has weak thyroid-stimulating activity and may cause thyrotoxicosis during the period of highest serum hCG concentrations (peaks at 10–12 weeks’ gestation). The range of hCG at peak is wide with values between 20 000–150 000 mIU/ml noted at the end of the first trimester. The thyroid stimulating effect of 1 mIU/ml of hCG is equivalent to 0.0013 mIU/l of TSH. Prolonged and significant elevation of hCG (usually more than 200 000 mIU/ml) is thus required to increase thyroid hormone production and cause clinical effects.5
A moderately extended time interval between hCG administration and oocyte retrieval is good for most patients with oocyte retrieval scheduled on the same day: a retrospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2020
Mingfen Deng, Yulian Liang, Hua Qin, Yanling Tan, Qingyun Mai, Xi Yuan, Yuan Yuan
Only patients in their first or second ICSI treatment cycles were included. For patients underwent two cycles during this time period, only the first cycle was selected. All patients underwent a long protocol using depot (triptorelin 1.0 mg) or daily (triptorelin 0.1 mg) injection of GnRH agonist from mid-luteal phase of the previous menstrual cycle. After downregulation confirmation by serum FSH/LH/E2 levels and pelvic ultrasound performed 14 days later, individualised urinary or recombined gonadotropins were then administered for ovarian stimulation according to patient’s age and ovarian reserve. When at least three follicles reached 18 mm, urinary or recombinant hCG was administered at approximately 9:00 pm to trigger final oocyte maturation and ovulation. The exact time of hCG administration was documented in minutes. Oocyte retrieval was performed in the morning of day 3. The order of the OPU procedures on the same day was scheduled following: priority will be the advance aged patients (≥40 years), followed by patients with decreased ovarian reservation (basal FSH ≥12 mIU/mL and/or AMH ≤1.0 ng/mL), then patients of suboptimal ovarian response (number of growing follicles ≤3), and lastly will be patients with normal ovarian reservation and/or response. The exact time of first puncture was also documented in minutes. All accessible follicles above 10 mm were aspirated guided by transvaginal ultrasound.