A high response to controlled ovarian stimulation induces premature luteinization with a negative impact on pregnancy outcomes in a gonadotropin-releasing hormone antagonist cycle / 대한생식의학회지

OBJECTIVE: The goal of this study was to investigate the relationship between serum progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration and the pregnancy rate among women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) using a flexible antagonist protocol. METHODS: This prospective study included 200 IVF and ICSI-ET cycles in which a flexible antagonist protocol was used. The patients were divided into five distinct groups according to their serum P4 levels at the time of hCG administration (0.80, 0.85, 0.90, 0.95, and 1.00 ng/mL). The clinical pregnancy rate (CPR) was calculated for each P4 interval. Statistically significant differences were observed at a serum P4 level of 0.9 ng/mL. These data suggest that a serum P4 concentration of 0.9 ng/mL may represent the optimal threshold level for defining premature luteinization (PL) based on the presence of a significant negative impact on the CPR. RESULTS: The CPR for each round of ET was significantly lower in the PL group defined using this threshold (25.8% vs. 41.8%; p=0.019), and the number of oocytes retrieved was significantly higher than in the non-PL group (17.3+/-7.2 vs. 11.0+/-7.2; p=0.001). Elevated serum P4 levels on the day of hCG administration were associated with a reduced CPR, despite the retrieval of many oocytes. CONCLUSION: Measuring serum P4 values at the time of hCG administration is necessary in order to determine the optimal strategy for embryo transfer.

Correlation between the Serum Luteinizing Hormone to Folliclestimulating Hormone Ratio and the Anti-Mullerian Hormone Levels in Normo-ovulatory Women

Serum anti-Mullerian hormone (AMH) levels are regarded as an age-specific marker for predicting the ovarian reserve in women of reproductive age. Some studies have shown that the luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio can be used as a predictor of ovarian reserve. The purpose of this study was to assess the variation of LH/FSH ratio with aging and to evaluate the correlation between serum LH/FSH ratio and AMH levels as a predictor of the ovarian reserve in normo-ovulatory women. We retrospectively analyzed the day 3 serum hormone levels in 1,251 patients (age range: 20-50 yr) between January 2010 and January 2011. We divided the patients into 6 groups according to their age. Relation between serum AMH level and LH/FSH ratio was analyzed statistically. The serum AMH level was inversely correlated with age (r = -0.400, P < 0.001). A significant negative correlation was found between serum LH/FSH ratio and age (r = -0.213, P < 0.001). There was a significant partial correlation between serum LH/FSH ratio and AMH level when adjusted by age (r = 0.348, P < 0.001). The LH/FSH ratio could be considered as a useful marker for the ovarian reserve and could be applied to the clinical evaluation with AMH.

Correlation between the Serum Luteinizing Hormone to Folliclestimulating Hormone Ratio and the Anti-Mullerian Hormone Levels in Normo-ovulatory Women

Serum anti-Mullerian hormone (AMH) levels are regarded as an age-specific marker for predicting the ovarian reserve in women of reproductive age. Some studies have shown that the luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio can be used as a predictor of ovarian reserve. The purpose of this study was to assess the variation of LH/FSH ratio with aging and to evaluate the correlation between serum LH/FSH ratio and AMH levels as a predictor of the ovarian reserve in normo-ovulatory women. We retrospectively analyzed the day 3 serum hormone levels in 1,251 patients (age range: 20-50 yr) between January 2010 and January 2011. We divided the patients into 6 groups according to their age. Relation between serum AMH level and LH/FSH ratio was analyzed statistically. The serum AMH level was inversely correlated with age (r = -0.400, P < 0.001). A significant negative correlation was found between serum LH/FSH ratio and age (r = -0.213, P < 0.001). There was a significant partial correlation between serum LH/FSH ratio and AMH level when adjusted by age (r = 0.348, P < 0.001). The LH/FSH ratio could be considered as a useful marker for the ovarian reserve and could be applied to the clinical evaluation with AMH.

Current status of assisted reproductive technology in Korea, 2009

Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical pregnancy rate per cycle with embryo transfer. When comparing with international registry data, clinical pregnancy rate per transfer from fresh IVF cycles including ICSI (34.1%,) was comparable to clinical pregnancy rate per transfer in European Society for Human Reproduction and Embryology report was 32.5% though lower than 45.0% for USA data. There was no remarkable difference in status of assisted reproductive technology in Korea between the current report and the data reported in 2008. The age of women trying to get pregnant was reconfirmed to be the most important factor that may have impact on success of ART treatment.

A case of clear cell carcinoma of uterine cervix not related to intrauterine dietylstilbesterol exposure / 대한산부인과학회지

Clear cell carcinoma of the uterine cervix is rare cancer that accounts for 4 to 9% of the adenocarcinoma of uterine cervix. Although intrauterine exposure to diethylstilbestrol (DES) during early pregnancy is one of the established risk factors, DES exposure may not be confirmed in all patients. We experienced a case of clear cell carcinoma in the uterine cervix of 67-year-old woman who was not exposed to DES. She was initially diagnosed as endometrial clear cell carcinoma because of the normal colposcopic finding and histologically proven clear cell carcinoma from endometrial aspiration biopsy and endocervical curettage. We performed a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and lymphadnectomy including both pelvic and para-aortic regions. On the final pathologic diagnosis of clear cell carcinoma confined to endocervix, the patient was received adjuvant concurrent chemoradiation with weekly cisplatin. We present the case with a brief review of related literature.

A case of small bowel obstruction with elevated aspartate transaminase/alanine transaminase (AST/ALT) in the third trimester of pregnancy / 대한산부인과학회지

The intestinal obstruction during pregnancy is rare but early diagnosis and treatment is essential. This disease can be diagnosed very late because the presenting symptoms such as nausea, vomiting and abdominal pain are often seen in normal pregnancies and most pregnant women avoid radiologic examinations. Moreover, this disease can be accompanied by high aspartate transaminase/alanine transaminase (AST/ALT) which can be also found in acute fatty liver of pregnancy or preeclampsia, and it makes diagnosis to be much delayed. If the diagnosis were delayed much, maternal and perinatal mortality would be increased highly. Therefore, the previous record of abdominal surgery or above mentioned symptom should be considered as the intestinal obstruction, and simple abdominal x-ray for early diagnosis and prompt operation step are critical. We present a case of small bowel obstruction accompanied with high AST/ALT during pregnancy which had the history of previous cesarean section with a brief review of the literature.

The polycystic ovary syndrome / 대한산부인과학회지

The polycystic ovary syndrome (PCOS) is a heterogeneous disorder that is characterized principally by oligomenorrhea or amenorrhea with clinical or laboratory evidence of hyperandrogenemia. Furthermore, it is now recognized that a significant proportion of overweight women with PCOS have hyperinsulinemia. Three features are generally recognized to compose this syndrome, including androgen excess, ovulatory dysfunction, and polycystic ovaries. Because its etiology and natural history are poorly understood, there is controversy about the diagnostic criteria and clinical evaluation of the syndrome. But the diagnosis of PCOS entails two principal steps: (a) to determine whether features suggestive of PCOS are present and (b) to exclude related androgen excess or ovulatory disorders. The PCOS results in a number of immediate and long-term morbidities that are associated with a significant impact on quality of life and on economic costs. Immediate morbidities include menstrual dysfunction and abnormal uterine bleeding, subfertility and infertility, and androgen excess-related dermatologic abnormalities including hirsutism, acne, and androgenic alopecia, and an increased risk of obstetrical complications such as pregnancy-induced hypertension and gestational diabetes. However, PCOS is also associated with an increased risk of various other long-term complications or morbidities including cancer, type 2 diabetes mellitus, the metabolic syndrome, and possibly cardiovascular disease. For the management of PCOS, we should consider not only immediate but also the long-term morbidities.

Clinical factors affecting the outcomes of oocyte donation cycles / 대한산부인과학회지

OBJECTIVE: Oocyte donation cycle has been a useful model for the assessment of potential factors affecting human pregnancy, such as uterine receptivity or oocyte quality. The purpose of this study was to investigate variable clinical factors affecting the outcomes of oocyte donation cycles. METHODS: This study reviewed 109 cycles of 85 women who underwent oocyte donation in SNUH infertility clinic from March 1992 to February 2004. Variable clinical characteristics were compared between pregnant and non-pregnant group. Data was evaluated by student's t-test, oneway ANOVA, and Chi-square test. RESULTS: Clinical pregnancy rate was 38.5% per cycle and 48.2% per recipient. When pregnant and non-pregnant groups were compared, there was a significant difference in donor age between both groups. (30.2+/-3.6 vs. 32.1+/-4.3, P=0.017). On the other hand, there were no significant differences in mean age, BMI, gravidity of recipient, and peak estradiol level of donor. The number of oocytes retrieved, embryos transferred, fertilization rate, and cumulative embryo score were not different between pregnant and non-pregnant group. Among the various donor age groups, clinical pregnancy rate was significantly higher in or =35 years (50.0% vs 18.2%, P=0.015). There were no significant differences for both endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycles by ovum donation. CONCLUSION: The most reliable predictive factor for pregnancy in oocyte donation cycles is the age of oocyte donor. The mid-cycle endometrial thickness and trilaminar patterns are insignificant predictors. The age of recipient and cumulative embryo score are also insignificant factors.

Diagnosis of factor VIII gene inversion by PCR in Korean patients with hemophilia A and its application to carrier detection / 대한산부인과학회지

OBJECTIVE: To establish PCR (polymerase chain reaction) method for detecting factor VIII gene inversion (intron 22) causing hemophilia A, and to apply it to carrier detection of hemophilia A. DESIGN: A laboratory analysis MATERIALS AND METHODS: An inversion pattern of the factor VIII gene was analyzed in 130 unrelated Korean patients with hemophilia A and 26 female subjects using PCR. RESULTS: PCR analysis of the factor VIII gene for intron 22 inversion revealed that 91 patients (70%) were negative for the inversion, yielding 12 kb band by PQ primer. And all the other 39 (30%) patients who showed no amplification by PQ primer were positive for the inversion, yielding 11kb band by AQ primer. Among 113 patients with severe hemophilia A, 39 (35%) patients were positive for the inversion. Carrier detection for intron 22 inversion in 26 female subjects was performed, and revealed that 22 cases were carriers and 4 cases were normal female. CONCLUSION: This result suggests that PCR analysis of the inversion within the factor VIII gene is useful in the carrier detection of hemophilia A as well as in identifying hemophilia A patients with intron 22 inversion, in the Korean population.

A Case of a Family with a High Frequency of cis-AB / 대한수혈학회지

The cis-AB phenotype is relatively common in the Japanese and Korean populations. Phenotypes of cis-AB include variables such as A2B3, A2B and A1B3. A few cases of cis-AB with phenotype A1 have been reported. Recently, we experienced a case with one family member identified with phenotype A1, genotype cis-AB/A and a high frequency of cis-AB. A 34-year-old woman visited the hospital for prenatal testing. The ABO phenotype of the patient was A2B3. To confirm the presence of cis-AB, ABO typing and genotyping of the patient's family were performed. The patient's mother and father were typed as normal group O and A, respectively. The ABO genotype of the mother was identified as cis-AB/A. The four sisters and brothers were typed as cis-AB. The normal incidence of cis-AB in a family is 50%. Interestingly, ABO typing revealed that all five members of the family had cis-AB in this case.

Comparative study between natural cycles and programmed cycles using exogenous steroid hormones for endometrial preparation in cryopreserved-thawed blastocyst transfer / 대한산부인과학회지

OBJECTIVE: The objective of this study was to compare the outcomes of cryopreserved-thawed blastocyst transfer (CT-BT) in natural or programmed cycles using exogenous steroid hormones. METHODS: A total of 221 CT-BT cycles were included and divided into two groups according to endometrial preparation protocols. In natural cycle group (n=116), monitoring was performed by transvaginal ultrasonography to detect ovulation. In programmed cycle group (n=105), oral estradiol valerate, 6 mg/day, was started on the third day of the menstrual cycle and administered continuously, and progesterone in oil 100 mg i.m. daily injection was started on cycle day 15. CT-BTs were performed on five days after ovulation in natural cycles and five days after the initiation of progesterone administration in programmed cycles. Pregnancy rates, implantation rates, and other clinical characteristics of the two groups were compared. RESULTS: Clinical characteristics of study subjects did not differ between the two groups. Post-thaw survival rates, number of transferred blastocysts, and number of good-quality blastocysts were not different. There were no statistically significant differences in implantation rates (21.1% vs. 19.4%), clinical pregnancy rates (36.2% vs. 36.2%), and ongoing pregnancy rates (28.4% vs. 27.6%) between the two groups. CONCLUSIONS: No statistically significant differences were found in pregnancy rates and implantation rates between the two protocols. Our results suggest that both protocols are equally effective for endometrial preparation in CT-BT cycles.

Clinical efficacy of transabdominal ultrasound-guided embryo transfer for in vitro fertilization and embryo transfer according to age of women / 대한산부인과학회지

OBJECTIVE: To evaluate the clinical efficacy of transabdominal ultrasound-guided embryo transfer for in vitro fertilization and embryo transfer (IVF-ET) according to age of women. METHODS: A total of 211 cycles of IVF?ET were included in this study. The pregnancy outcomes were compared between transabdominal ultrasound?guided embryo transfer (USG-guided group, n=108) and clinical touch technique (Clinical touch group, n=103) groups. Then, comparative analysis was performed in women aged or =38 years. RESULTS: Clinical characteristics of study subjects did not differ between the two groups. There was no difference between the two groups in terms of duration of controlled ovarian hyperstimulation, dose of gonadotropins used, numbers of oocytes retrieved and embryos transferred. Clinical pregnancy rate was significantly higher in USG-guided group than Clinical touch group (27.8% vs. 16.5%, p<0.05). This difference was also found in women 35~37 years (27.6% vs. 8.6%, p<0.05), but not in those <35 years. USG-guided group showed a significantly higher implantation rate in women 35~37 years (10.5% vs. 3.4%, p<0.05), but not in those <35 years. In women at 38 years or older, USG-guided group showed higher clinical pregnancy and implantation rates than Clinical touch group (15.0% vs. 7.6%; 4.8% vs. 2.5%, respectively), however the differences were not statistically significant. CONCLUSION: Transabdominal ultrasound-guided embryo transfer may improve the pregnancy outcomes in IVF-ET cycles, especially in women at age 35 years or older.

Cytotoxicity of Paecilomyces tenuipes Against Human Carcinoma Cells, HepG2 and MCF-7 In Vitro

The methanolic extract of fruiting body of Paecilomyces tenuipes DGUM 32001 showed significant cytotoxicity against human cancer cells: HepG2 and MCF-7. The methanolic extract was further fractionated with organic solvents such as chloroform and ethyl acetate in that order. Among the fractions tested, the ethyl acetate fraction showed the highest cytotoxicity against the carcinoma tested. The IC50 values of ethyl acetate fraction against HepG and MCF-7 were 40 and 9.6 microg/ml, respectively.

Rapid detection of aneuploidy in uncultured fetal cord blood cells by FISH ( Fluorescence In Situ Hybridization ) / 대한산부인과학회잡지

OBJECTIVE: To determine the fetal aneuploidy in fetal blood cells from cordocentesis. METHODS: We analyzed their karyotype and performed fluorescence in situ hybridization(FISH) for chromosome 18, 21, X, and Y in 14 cases of fetal blood cells from cordocentesis at Department of Obstetrics & Gynecology, College of Medicine, Seoul National University and Hamchoon Women's Clinic. RESULTS: In all cases we obtained the consistent results in both methods and were able to rapidly detect aneuploidy in uncultured fetal blood cells using FISH before karyotyping with culture for 48 hr. The averages for accuracy of FISH were from 84.6 % to 93.9%. CONCLUSION: In this study we suggest that the rapid detection in uncultured fetal blood using FISH is possible and that this diagnostic method will be clinically useful when rapid result would be demanded.

Detection of Down Syndrome & Edward Syndrome in uncultured amniocytes using FISH ( Fluorescence In Situ Hybridization / 대한산부인과학회잡지

FISH is suggested as a possible method to detect the numerical and structural abnormalities of chromosomes in interphase nucleus. We performed this study to discuss the clinical usefulness of FISH in uncultured amniocytes and to set up the cut-off value for further study. We collected amniotic fluid samples from patients whose chromosome studies were recommended due to screen positive for Down and Edword syndrome in triple marker test using maternal serum. The centromeric probe for chromosome 18 and the locus-specific probe for chromosome 21 were used and the results were compared to their karyotypes. We could find 2 cases of trisony 21 and 2 cases of trisony 18 and the other cases represented normal karyotypes. The accuracies were 91% for disomy 18, 89% for trisomy 18, 92% for disomy 21 and 88% for trisomy 21. Therefore FISH technique is a possible method to detect the chromosomal abnormalities in uncultured amniocytes and the use of locus-specific probe for chromosome 21 would be more useful for detecting the aneuploidy of chromosome 21 than 13/21 centromeric probe.

In Situ Culture and Harvest of Amniocytes using coverslip processing method

Genetic amniocenteses were performed in a series of 127 patients as a routine study. Samples from the patients were cultured by in situ method, flask method or both according to the state of amniotic fluid. The overall success rate of culture was 97.6% and no culture failure was observed in the flask method. It took 5 days first of all and 8.15 days average from set-up to harvest and there were 7.2 colonies per dish in in situ method. Therefore, it is suggested that in situ method which decreased the mean culture days and made clonal analyses possible, is a clinically available and even more reliable method in parallel with flask method in prenatal diagnosis.

Selective termination in multiple pregnancy guided by transvaginal sonography / 대한산부인과학회잡지

No abstract available.

Heterotopic pregnancies after IVF-ET / 대한산부인과학회잡지

No abstract available.

Heterotopic pregnancies after IVF-ET / 대한산부인과학회잡지

No abstract available.

Comparison of cryopreservation protocol in human spermatozoa / 대한산부인과학회잡지

No abstract available.