Human Reproduction, Vol. 17, No. 4, 1081-1085,
April 2002
© 2002 European Society of Human Reproduction and Embryology
Serial first- and second-trimester Down's syndrome screening tests among IVF-versus naturally-conceived singletons
1 Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin and 2 Sheba Medical Center, Tel Hashomer, both affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
BACKGROUND: It has been reported that second-trimester serum markers may be affected by assisted reproduction, leading to a higher false-positive rate. METHODS: A total of 285 naturally and 71 IVF-conceived singletons which underwent a serial disclosure Down's syndrome screening programme were compared. The study protocol included first-trimester combined [nuchal translucency (NT), free ß-HCG and pregnancy-associated plasma protein-A (PAPP-A)] testing. The second-trimester triple serum screening included 
-fetoprotein (AFP), intact HCG and unconjugated estriol (uE3). After excluding aneuploidies, miscarriages, anatomical anomalies and cases with incomplete follow-up, the serum samples of normal cases were assessed and correlated. RESULTS: NT measurement was not significantly changed in either group. However, the IVF group had lower PAPP-A [0.96 versus 1.05 multiples of normal median (MoM)] and higher AFP (1.13 versus 1.07 median MoM). Both groups had similar rates of first-trimester false-positive results (FPR; 7 and 9% respectively), but the IVF group had a significantly higher mid-gestation FPR rate (10 versus 5%; Pearson 
2, P = 0.029). This has contributed to amniocentesis uptake rates of 15 and 13% for the IVF and natural conception pregnancies respectively. CONCLUSIONS: The IVF group tended to have a significantly higher second-trimester FPR rate. To counterbalance this phenomenon, integrated first- and second-trimester screening tests or the use of NT alone might be a reasonable option that deserves further investigation.
Key words: assisted reproduction/combined test/Down's syndrome/triple test
3 To whom correspondence should be addressed. E-mail: intposgr{at}post.tau.ac.il
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