Regarding the effect of infertility on the test results, a record-linkage study showed that PAPP-A levels were reduced when the infertility was reported to be of female-only etiology (0.82 MoM), male-only etiology (0.85 MoM), and when a combination of male and female etiologies were present in the couple (0.82 MoM) (3). This evidence concerns the gene PAPPA and Infertility.