MyMedR

Normalisation of human chorionic gonadotrophin (hCG) levels in a patient with partial molar pregnancy with a uterine mass without chemotherapy: impact of using herbal remedies

Ismail N, Zainudin AM, Hua GS

J Complement Integr Med, 2021 Apr 02;18(4):859-863.

PMID: 33818024 DOI: 10.1515/jcim-2019-0091

OBJECTIVES: Level of βhCG and the presence of any uterine mass of hydatidiform mole need a careful review or monitoring in order to prevent metastasis, provide an early treatment and avoid unnecessary chemotherapy.

CASE PRESENTATION: A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an "at own risk" (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound.

CONCLUSIONS: Brucea javanica fruits, Pereskia bleo and Annona muricata leaves can potentially be useful alternatives to chemotherapy and need further studies.

Matched MeSH terms: Chorionic Gonadotropin

Fulltext Peritoneal trophoblastic implant

Rachagan SP, Kutty K, Govindan KS

Med J Malaysia, 1997 Sep;52(3):293-4.

PMID: 10968101

A case of persistent trophoblastic tissue on the pelvic peritoneum is presented. While most cases are secondary to conservative surgery for tubal ectopic pregnancy, primary implantation can also occur as highlighted by this case. A brief pathophysiology of the condition is presented. The importance of monitoring the serum for beta subunit human chorionic gonadotrophin (HCG) is emphasised.

Matched MeSH terms: Chorionic Gonadotropin, beta Subunit, Human/blood

Fulltext Reproductive hormonal levels in Malay women with superovulatory cycles

Nwe HH, Abdul Wadood H, Abdullah RB, Arshad H

Med J Malaysia, 1990 Sep;45(3):244-50.

PMID: 2152087

This paper presents a study of cycles with spontaneous luteinizing hormone (LH) surge in superovulatory Malay women during in vitro fertilization and gamete intrafallopian transfer programmes. Sixteen Malay women underwent ovarian stimulation for ovum pick up at the National Population and Family Development Board, Malaysia. Two cycles showed spontaneous LH surge, and comparisons were made between these two cycles and the cycles without surge. Further observations were made in their characteristics and differences in these two cycles as well as the relationship between progesterone and LH at the time and before the surge.

Matched MeSH terms: Chorionic Gonadotropin/administration & dosage

Immunoassay of gonadotropins using a fully-automated benchtop analyser

Kamariah K, Lopez JB, Satgunasingam N

Br J Biomed Sci, 1994 Sep;51(3):296-8.

PMID: 7881328

We assessed the analytical performance of the Abbott IMxTM immunoassay analyser for total beta human chorionic gonadotropin (Beta hCG), follicle-stimulating hormone (FSH) and luteinising hormone (LH). The within-run CVs for various analyte concentrations were 2% to 6% while those for between-run imprecision in routine assay ranged from 4% to 10%. IMxTM values correlated well with radioimmunoassay for beta hCG, and immunoradiometric assay for FSH and LH; the correlation coefficients (r) were 0.97, 0.99 and 0.98 for total beta hCG, FSH and LH respectively. The average sensitivities were approximately 3.1, 0.2 and 0.5 iu/l for beta hCG, FSH and LH, respectively. Sample carry-over was not detected and there was negligible cross-reaction between LH and beta hCG in the respective assays. The automatic sample dilution protocol for beta hCG was superior to the manual procedure. The IMxTM is easy to operate and is able to process 24 samples in 40-45 minutes.

Matched MeSH terms: Chorionic Gonadotropin/blood

Fulltext Parathyroid carcinoma with steroid-suppressible plasma immunoreactive parathyroid hormone and human chorionic gonadotrophin

Chng SL, Krishnan MM, Ramachandran, Chan CH, Zain Z

Singapore Med J, 1990 Feb;31(1):83-4.

PMID: 2333552

A 31-year old male presented with bone pain, polyuria and a palpable nodule in the neck. Radiological examination showed generalised osteopenia, subperiosteal erosion and presence of bilateral renal stones. The essential chemical pathological changes were increased plasma calcium, mid-molecule immuno-reactive parathyroid hormone (iPTH), human chorionic gonadotrophin (hCG) levels. Surgical excision of the nodule revealed a parathyroid carcinoma. The uniqueness of this case is the steroid-suppressible plasma calcium, iPTH, and hCG levels. The diagnostic implications of the findings are discussed.

Matched MeSH terms: Chorionic Gonadotropin/analysis*

SDS-PAGE electrophoretic property of human chorionic gonadotropin (hCG) and its beta-subunit

Gam LH, Latiff A

Int J Biol Sci, 2005;1(3):103-9.

PMID: 16094462

The microheterogeneity property of hCG with regards to its sialic acid contents resulted in variable mobility of the glycoprotein in SDS-PAGE. The intact hCG molecule is composed of two dissimilar subunits, namely alpha- and beta-subunits. The identification of hCG bands in SDS-PAGE was accomplished by the immunoblotting experiment, whereby the antibody directed toward the specific region of beta-subunit of hCG was used. The data shows that the different mobility of intact hCG was attributed to the different degree of desialylation of the glycoprotein. Nevertheless, unlike the intact hCG, the mobility of its beta-subunit was not affected by its variety sialic acid content. This characteristic of beta-hCG is beneficial when semi-quantification of total hCG is required. Quantification of hCG using the HPLC-reversed phase C18 analytical column is not possible as the glycoprotein was eluted in multiple fractions at different retention times. The identification of denatured hCG (HPLC eluted fractions) was carried out by immunoblotting experiment whilst immunoassay technique failed to detect its presence in any fraction.

Matched MeSH terms: Chorionic Gonadotropin/isolation & purification*

A Narrow Escape From Methotrexate: The Importance of Correlating Ultrasound Findings With Discriminatory Level of β-hCG and the β-hCG Ratio

Lim JA, Sheng KL, Chong SE

J Ultrasound Med, 2019 08;38(8):2237-2238.

PMID: 30536687 DOI: 10.1002/jum.14899

Matched MeSH terms: Chorionic Gonadotropin, beta Subunit, Human

Immunoaffinity extraction and tandem mass spectrometric analysis of human chorionic gonadotropin in doping analysis

Gam LH, Tham SY, Latiff A

J Chromatogr B Analyt Technol Biomed Life Sci, 2003 Jul 25;792(2):187-96.

PMID: 12860026

A confirmatory and quantitative HPLC-tandem mass spectrometry (MS-MS) method for human chorionic gonadotropin hormone (hCG) at concentrations as low as 5 IU/l following immunoaffinity extraction of the glycoprotein from urine was developed. The extraction method involved retention of urinary hCG in the immunoaffinity column via specific antigen-antibody interaction. A variety of eluents were then used to quantitatively elute hCG from the immunoaffinity column. Qualitative and quantitative analysis of hCG were undertaken using MS-MS by identifying the amino acid sequence of the marker peptide betaT5 obtained from hCG by tryptic digestion and the peak areas of three product ions b(6)(+), b(9)(+) and y(11)(+), respectively.

Matched MeSH terms: Chorionic Gonadotropin/urine*; Chorionic Gonadotropin/chemistry

Fulltext The impact of luteal supplement on pregnancy outcome following stimulated IVF cycles

Tay PYS, Lenton EA

Med J Malaysia, 2005 Jun;60(2):151-7.

PMID: 16114155

This is a prospeve randomised study designed to clarify the impact of various luteal support regimes (HCG and progesterone) on progesterone profiles and pregnancy outcomes. This study involved subjects undergone down regulated. stimulated IVF cycles using various types of luteal support, namely: Cyclogest (n=35). Crinone gel (n=36), various doses of Utrogestan (n=55) and HCG (n=35). Various doses of Utrogestan (administered vaginally), Crinone gel (progesterone administered vaginally) and Cyclogest (progesterone administered rectally) supplementation induced similar end plasma progesterone concentrations ranging from 26 to 32 mmnl/l. These progesterone regimes produced no significant differences. Hence, the impact of exogenous proge,terone supplement was relatively trivial and did not 'stabilise' the sub-optimal luteal phase. In contrast, two small HCG injections during the early and mid-luteal phase possessed a much greater ability to 'stabilise' progesterone profiles. Despite this additional advantage, implantation and pregnancy rates with either HCG or progesterone supplements were similar. Although none of these forms of luteal support adequately 'normalised' luteal progesterone profiles, this did not appear to be detrimental to the process of implantation.

Matched MeSH terms: Chorionic Gonadotropin/administration & dosage; Chorionic Gonadotropin/therapeutic use*

Fulltext Hydatidiform mole and post-evacuation regression patterns of serum beta human chorionic gonadotrophin

Kamariah K, Satgunasingam N, Nasri NM, Ng KY

Med J Malaysia, 1993 Mar;48(1):40-5.

PMID: 7688063

Eighty-nine patients who had hydatidiform moles evacuated at the General Hospital, Kuala Lumpur, were followed with serum beta hCG determinations from October 1988 to June 1991. A regression curve for serum beta hCG, as measured by RIA, was derived from the results of 47 of the patients who demonstrated spontaneous regression of serum beta hCG titres. All 47 patients had normal serum titres at 135 days after evacuation. The mean time taken to reach normal level was 82.6 days, while the range was 39 to 135 days (5 to 19 weeks).

Matched MeSH terms: Chorionic Gonadotropin/blood*; Chorionic Gonadotropin, beta Subunit, Human

Complete mole with a coexistent normal fetus: a case report

Rahman RA, Ahmad S, Ismail NA, Mahdy ZA

J Reprod Med, 2012 Sep-Oct;57(9-10):456-8.

PMID: 23091998

The incidence of a coexistent normal fetus is quoted in literature as 1 in 22,000 to 100,000 pregnancies and may be associated with multiple complications including persistent trophoblastic neoplasia.

Matched MeSH terms: Chorionic Gonadotropin, beta Subunit, Human/blood

Fulltext Ovulation induction and ovarian cancer: is there a link?

Rupinder KR, Pratap K

Med J Malaysia, 2006 Mar;61(1):132-6; quiz 137.

PMID: 16708754

Introduction : Ovarian cancer accounts for approximately 4% of all cancers occurring in women and ranks the fourth most frequent cause of cancer-related death in women. Despite aggressive treatment modalities the 5 year survival rate remains less than 30%'. Almost 2.5% of all live births/ year result from assisted reproductive techniques (ARD2. Concern has been expressed that exposure to fertility drugs (FD) might be associated with a risk of ovarian tumors. Given the grave prognosis of ovarian cancer and the increasing use of ART, for the past several years this has been a subject of much scientific debate. The likely magnitude of risk may be 2 - 3 times that of the general population, which is at most 4-5% in a woman's lifetime. Several case control and cohort epidemiological studies have attempted to address this issue but failed to specifically look at drug treatment as risk factor and research to date demonstrates conflicting results.
Review of literature : Ovulation induction (Ol) agents are commonly used in the treatment of infertility in patients with or without ovulatory disturbances. These agents include clomiphene citrate (CC), bromocryptine, gonadotropins (Gn), Gonadotropin releasing hormone (GnRH) and its analogues. In in vitro fertilization (IVF), combinations and different drug dosages of FD are given to stimulate production of multiple oocytes. Fertility drugs were first marketed since the 1960's. The first to hit the market was CC in 1967 followed 2 years later by human Menopausal Gonadotropin (hMG) & human Chorionic Gonadotropin (hCG)'. Until 1987, most IVF cycles used CC in combination with HMG followed by hCG. From 1987, GnRH agonists were introduced to replace Cc. From 1990, the main drug regimen was GnRH agonist in combination with HMG or Follicular Stimulating Hormone (FSH) followed by hCG.

Matched MeSH terms: Chorionic Gonadotropin/adverse effects

Fulltext A Point-of-Care Immunosensor for Human Chorionic Gonadotropin in Clinical Urine Samples Using a Cuneated Polysilicon Nanogap Lab-on-Chip

Balakrishnan SR, Hashim U, Gopinath SC, Poopalan P, Ramayya HR, Iqbal Omar M, et al.

PLoS One, 2015;10(9):e0137891.

PMID: 26368287 DOI: 10.1371/journal.pone.0137891

Human chorionic gonadotropin (hCG), a glycoprotein hormone secreted from the placenta, is a key molecule that indicates pregnancy. Here, we have designed a cost-effective, label-free, in situ point-of-care (POC) immunosensor to estimate hCG using a cuneated 25 nm polysilicon nanogap electrode. A tiny chip with the dimensions of 20.5 × 12.5 mm was fabricated using conventional lithography and size expansion techniques. Furthermore, the sensing surface was functionalized by (3-aminopropyl)triethoxysilane and quantitatively measured the variations in hCG levels from clinically obtained human urine samples. The dielectric properties of the present sensor are shown with a capacitance above 40 nF for samples from pregnant women; it was lower with samples from non-pregnant women. Furthermore, it has been proven that our sensor has a wide linear range of detection, as a sensitivity of 835.88 μA mIU(-1) ml(-2) cm(-2) was attained, and the detection limit was 0.28 mIU/ml (27.78 pg/ml). The dissociation constant Kd of the specific antigen binding to the anti-hCG was calculated as 2.23 ± 0.66 mIU, and the maximum number of binding sites per antigen was Bmax = 22.54 ± 1.46 mIU. The sensing system shown here, with a narrow nanogap, is suitable for high-throughput POC diagnosis, and a single injection can obtain triplicate data or parallel analyses of different targets.

Matched MeSH terms: Chorionic Gonadotropin/urine*

Fulltext Recurrent vomiting in a woman due to miscarriage: think out of the box

Khalid S, Aris MS

BMJ Case Rep, 2016 Mar 30;2016.

PMID: 27030452 DOI: 10.1136/bcr-2015-213165

A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.

Matched MeSH terms: Chorionic Gonadotropin, beta Subunit, Human/blood

Fulltext The role of maternal serum alpha-fetoprotein, human chorionic gonadotrophin and oestriol in the antenatal screening of Down's syndrome

Chang TC, Cheng HH

Med J Malaysia, 1994 Dec;49(4):351-4.

PMID: 7545778

The use of maternal age alone to identify pregnant mothers at risk of a fetus with Down's syndrome has recently been supplemented by maternal serum screening using biochemical markers such as alpha-protein, human chorionic gonadotrophin and oestriol. These tests have been reported to increase the sensitivity of antenatal detection of such fetuses from 35% to 67% with a false positive rate of 5%. However, these maternal serum markers may be affected by maternal weight, the smoking history of mothers and diabetes mellitus. Furthermore, such sensitivities are achieved only when gestational age is assessed accurately by ultrasound. Many further studies need to be carried out before the introduction of maternal serum screening into routine obstetric practice in Singapore. These include studies on the incidence of Down's syndrome in the local population, studies on the distribution of these serum markers in the second trimester of pregnancy, sensitivities and positive predictive values of such a test in the local population as well as the socio-economic implications of implementing such a screening test in the local obstetric population.

Matched MeSH terms: Chorionic Gonadotropin/blood*

Fulltext Delayed haemorrhage in conservative surgery for ectopic pregnancy

Rachagan SP, Neoh HS

Med J Malaysia, 1990 Mar;45(1):84-6.

PMID: 2152077

A case of delayed haemorrhage after conservative surgery for ectopic pregnancy is presented. Brief pathophysiology of the condition is presented. The importance of beta-subunit human chorionic gonadotrophin monitoring of the serum in this patient is highlighted. Surgical procedures to prevent this complication are also discussed.

Matched MeSH terms: Chorionic Gonadotropin/blood

Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum

Tan PC, Tan NC, Omar SZ

Clin Chem Lab Med, 2009;47(2):165-71.

PMID: 19191722 DOI: 10.1515/CCLM.2009.041

Serum human chorionic gonadotropin (hCG) and estradiol levels are higher in women with hyperemesis gravidarum (HG) than in unaffected pregnant controls. We postulated that higher levels of these hormones may be associated with clinically more severe HG. The aim of this study was to evaluate the effect of maternal hCG and estradiol levels on the severity of HG.

Matched MeSH terms: Chorionic Gonadotropin/blood*

Fulltext Comparison between hCG and GnRH Agonist for Ovulation Trigger in GnRH Antagonist In-Vitro Fertilization Cycles in a Tertiary Hospital in Malaysia: An observational study

Aziz NA, Ibrahim A, Ramli R, Yaacob N, Rahman SNA, Ismail EHE, et al.

JBRA Assist Reprod, 2024 Feb 26;28(1):21-26.

PMID: 38224580 DOI: 10.5935/1518-0557.20230066

OBJECTIVE: hCG is commonly used as an ovulation trigger in IVF. Its usage is associated with OHSS. GnRH agonist is an alternative to hCG and is associated with reduced incidence of OHSS. This study compared the cycle outcomes of GnRH agonists with hCG as an ovulation trigger in IVF cycles.

METHODS: The medical notes of 209 IVF cycles receiving GnRH agonist and hCG as ovulation trigger over 18 months were reviewed in this retrospective study. The number and quality of mature oocytes, the number and quality of embryos, pregnancy rates, and outcomes were compared using Independent T-test or One-way ANOVA for normal distribution. The Mann-Whitney test or Kruskal-Wallis test was used for not normally distributed. p<0.05 was considered statistically significant.

RESULTS: The cycle outcomes of 107 GnRH agonist-trigger and 102 hCG-trigger were compared. The MII oocytes retrieved and 2PN count was significantly higher in the GnRH agonist trigger group (p<0.001). Clinical pregnancy rate and ongoing pregnancy were higher in the GnRH agonist trigger group but were not statistically significant. The GnRH agonist trigger group was associated with low OHSS than the hCG trigger group (n=2(1.9%) and n=12(11.8%) respectively, p=0.004).

CONCLUSION: GnRH agonist trigger is an option as a final maturation trigger in high-responder women undergoing IVF or ICSI cycles.

Matched MeSH terms: Chorionic Gonadotropin/therapeutic use

Successful treatment of anabolic steroid-induced azoospermia with human chorionic gonadotropin and human menopausal gonadotropin

Menon DK

Fertil Steril, 2003 Jun;79 Suppl 3:1659-61.

PMID: 12801577

OBJECTIVE: To document for the first time the successful treatment using human chorionic gonadotropin (hCG) and human menopausal gonadotropins (hMG) of anabolic steroid-induced azoospermia that was persistent despite 1 year of cessation from steroid use.

DESIGN: Clinical case report.

SETTINGS: Tertiary referral center for infertility.

PATIENT(S): A married couple with primary subfertility secondary to azoospermia and male hypogonadotropic hypogonadism. The husband was a bodybuilder who admitted to have used the anabolic steroids testosterone cypionate, methandrostenolone, oxandrolone, testosterone propionate, oxymetholone, nandrolone decanoate, and methenolone enanthate.

INTERVENTION(S): Twice-weekly injections of 10,000 IU of hCG (Profasi; Serono) and daily injections of 75 IU of hMG (Humegon; Organon) for 3 months.

MAIN OUTCOME MEASURE(S): Semen analyses, pregnancy.

RESULT(S): Semen analyses returned to normal after 3 months of treatment. The couple conceived spontaneously 7 months later.

CONCLUSION(S): Steroid-induced azoospermia that is persistent after cessation of steroid use can be treated successfully with hCG and hMG.

Matched MeSH terms: Chorionic Gonadotropin/therapeutic use*

Normal pregnancy after successful treatment of choriocarcinoma with cerebral metastases. A case report

Sivanesaratnam V, Sen DK

J Reprod Med, 1988 Apr;33(4):402-3.

PMID: 2452881

Pregnancy after treatment of choriocarcinoma with cerebral metastases is uncommon. We treated a patient successfully with less-toxic chemotherapeutic agents than those advocated by others together with whole brain irradiation. She subsequently had two uneventful pregnancies.

Matched MeSH terms: Chorionic Gonadotropin/blood; Chorionic Gonadotropin, beta Subunit, Human

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