First- and second-trimester Down syndrome screening markers in pregnancies achieved through assisted reproductive technologies (ART): a FASTER trial study.
OBJECTIVE
To determine whether first- and second-trimester Down syndrome screening markers and screen-positive rates are altered in pregnancies conceived using assisted reproductive technologies (ARTs).


METHODS
ART pregnancies in the multicenter FASTER trial were identified. Marker levels were evaluated for five types of ART: in vitro fertilization with ovulation induction (IVF-OI), IVF with OI and egg donation (IVF-OI-ED), IVF with ED (IVF-ED), and intrauterine insemination with OI (IUI-OI) or without OI (IUI). Each group was compared to non-ART controls using Mann-Whitney U analysis.


RESULTS
First-trimester marker levels were not significantly different between ART and control pregnancies, with the exception of reduced PAPP-A levels in the IUI-OI group. In contrast, second-trimester inhibin A levels were increased in all ART pregnancies, estriol was reduced and human chorionic gonadotropin (hCG) was increased in IVF and IUI pregnancies without ED, and alpha-fetoprotein (AFP) was increased in ED pregnancies. Second-trimester screen-positive rates were significantly higher than expected for ART pregnancies, except when ED was used.


CONCLUSIONS
These data show that ART significantly impacts second-, but not first-, trimester markers and screen-positive rates. The type of adjustment needed in second-trimester screening depends on the particular type of ART used.
Lambert-Messerlian
G
G
Women and Infants Hospital and Brown Medical School, Providence, RI 02903, USA. gmesserl@wihri.org
Dugoff
L
L
Vidaver
J
J
Canick
J A
JA
Malone
F D
FD
Ball
R H
RH
Comstock
C H
CH
Nyberg
D A
DA
Saade
G
G
Eddleman
K
K
Klugman
S
S
Craigo
S D
SD
Timor-Tritsch
I E
IE
Carr
S R
SR
Wolfe
H M
HM
D'Alton
M E
ME
D000328:Adult; D015415:Biomarkers / Q000032:analysis; D016208:Databases, Factual; D004314:Down Syndrome / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010062:Ovulation Induction; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second
D015415:Biomarkers