ENDOMETRIAL AND PLACENTAL PROTEIN MARKERS AND OVARIAN-STEROIDS IN SERUM DURING IN-VITRO FERTILIZATION CYCLES

The objective of this study was to find the earliest time at which it was possible to detect clinical pregnancy in an invitro fertilization (IVF) treatment cycle supported with human chorionic gonadotrophin (HC G), and also retrospectively to diagnose abnormal ovarian- or endometr ium-related situations in failure cycles, Serum samples were taken in 41 IVF cycles at frequent intervals from the beginning of ovarian stim ulation until menstrual bleeding occurred or a pregnancy was establish ed, Concentrations of oestradiol, progesterone, placental protein 14 ( PP14), pregnancy-specific beta 1-glycoprotein (SP1), and pregnancy-ass ociated plasma protein A (PAPP-A) were determined in the serum samples using commercially available (steroid) or purpose-developed (protein) immunoassays. The cycles were retrospectively distributed into four o utcome groups: (i) fertilization failure (FF, n = 8); (ii) implantatio n failure (IF, n = 10); (iii) 'interaction' (embryo-endometriun) cycle (IC, n = 14), and (iv) clinical pregnancy (CP, n = 9). The embryo-end ometrium interaction was detected by a rise in SP1 in 23 cycles (70% o f embryo transfers) at a time when endogenous HCG was still masked by external support, Early ('false') positive SP1 concentrations were obs erved in two out of eight and five out of 14 cases in groups FF and IC respectively, but never amongst the ongoing pregnancies (CP). PAPP-A did not distinguish pregnancy from the other outcomes, The PP14/proges terone ratio was lower, later in the cycle, in CP than in the other gr oups. We conclude that, while it is not possible to predict the outcom e of a given IVF cycle earlier than 2 weeks after embryo transfer, the hormonal patterns can be used to detect abnormalities (e.g. endometri al asynchrony) which may be useful for subsequent treatment cycles in the same patient.