혈액에서 생물학적 활성을 나타내는 (bioavailable) steroid hormone은 주로 비결합형(free form)과 알부민 결합형(albumin-bound form)으로 구성된다. 특히 Testosterone (T)과 5 alpha-Dihydrotestosterone (DHT)의 활성적 분획이 전체의 T, DHT 양에 비해 생리적 현상과 보다 잘 일치하는 것으로 알려지고 있다. 본 연구는 섬광면역측정법(Luminescence immunoassay, LIA)으로 혈청내 활성적 T 및 DHT의 농도의 측정에 이용하고져 하였다. 항체는 T- 또는 DHT-3-CMO-BSA를 항원으로 토끼에 면역주사하여 얻었다. 추적자는 T-3-CMO, DHT-3-CMO에 aminobutylethylisoluminol(ABEI)를 부착시켜 사용하였다. 항체중 IgG분획을 Protein-A-Sepharose CL-4B로 분리한 후 Immunobead(Bio-Rad)에 부착시켜 Solid-phase LIA를 실시하였다. 본 연구에서 LIA는 정확도(accuracy), 정밀도(precision), 감도(sensitivity), 교차반응도(specificity)등을 조사하고, 기존의 방사면역측정법(RIA)과 비교하여 만족할만한 결과를 얻었다. 혈청내 T및 DHT의 활성적 분획의 농도를 측정한 결과는 다음과 같았다. T의 경우는 남성에서 T의 전체량의 33% 이상으로 $7.1{\pm}1.5nmol/l$, 여성에서는 26% 이상으로 $0.28{\pm}0.05nmol/l$이었다. DHT의 활성적 분획은 남성의 경우 $601.7{\pm}85.8pmol/l$, 여성의경우 $52.4{\pm}19.9\;pmol/l$이었다. 이상의 결과를 보아 본 연구에서 이용된 LIA는 혈청내 활성적 농도를 측정하기에 충분하다고 사료된다. 또한 이 방법을 이용하여 여성의 Androgenicity 및 남성 정소기능등의 제어방법에 응용될 수 있을 것으로 판단된다.

These studies were undertaken to examine the relationship between tamoxifen and sex steroid hormones in rat uterine morphology and the effect of tamoxifen on sex steroid hormone levels, implantation and myometrial contraction. The results obtained were as follows : 1) The increase in height of the luminal epithelium caused by tamoxifen treatment was blocked by progesterone. The increase in height of luminal epithelium caused by $estradiol-17{\beta}$ treatment was blocked by tamoxifen. 2) When a single dose of tamoxifen(10, 20, $40{\mu}g$) was given on Day 2 of pregnancy, implantation was prevented. Plasma $estradiol-17{\beta}$ level fell in a dose-dependent manner but plasma progesterone level was constant. 3) In vitro, tamoxifen decreased rat uterine contractility in a dose-dependent manner.

Ovulation induction was done with 3 different regimens as clomid combined with HMG, HMG only, and FSH combined with HMG in 28 menstrual cycles for IVF-ET and GIFT program. The appearance of endogenous LH surge, estradiol plateau, atypical LH surge, and time from initiation to peak of LH surge in serum and urine were observed and compared in 3 groups. 1. The estradiol concentration of serum LH surge day was similar in three groups but 1st group (Clomiphene Citrate+Sequential HMG) was slightly higher at $1924.0{\pm}865.1\;pg/ml$. In regards to the existence of serum estradiol plateau, 3rd group (FSH+Sequential HMG) was highest at 60%, and 1st group and 2nd group (HMG only) were similar at 33% and 44% respectively. 2. The number of ovarian of ovarian follicle which was more than 18mm in diameter was $4.1{\pm}2.0$, $4.2{\pm}2.1$ respectibely for 2nd group and 3rd group. Although the numbers were slightly higher thean 1st group for each ovarian follicle, serum estradiol value per follicle was higher for 1st group at $583.0{\pm}261.2pg/ml$. 3. When measuring the urine LH surge according to Hi-Gonavi and according to the standard set by three different types of surge, simultameous satisfaction for 1st group, 2nd group, 3rd group was two cases, five cases, four cases respectively at 40%, and the remained cases were composed of numorous type combination which satisfied the two definition, simultaneously in this study, the LH surge starting time was determined only in the cases tow combination were satisfied simultaneously at first, but there are something to study more. In one case of the 3rd group. 4. The concentration of LH surge start in urine and serum of 2nd group was highest at306. $0{\pm}287.2IU/l$ and $34.0{\pm}9.9mIU/ml$ and 1st group was low at $116.6{\pm}66.1IU/l$ and 7.4mIU/ml. The urine and serum value of LH was highest at $1644.4{\pm}988.8IU/l$, $65.9{\pm}15.0mIU/ml$ for 2nd group, 1st group was low at urine, and 3rd group was low of serum. With pregnancy established, the LH concentration of urine was relatively high but on the contrary the LH concentration of serum was low compared to urine concentration. 5. Time from LH surge start to the maximun of urine and serum value was highest at 15. $7{\pm}9.1$ hrs and $10.8{\pm}4.9$ hrs for 1st group and 3rd group. With pregnancy established, time was shortened for urine but on the contrary serum showed an increase in time. 6. The concentration of LH which increases with time on urine was highest at 2nd group ($194.6{\pm}76.8\;IU/hour$). The lowest increase for serum was at 3rd group (2.1mIU/hour). With pregnancy established, urine showed more increase than control group ($266.5{\pm}47.4\;IU/hour$) and for serum there was similar increase ($3.4{\pm}0.8\;mIU/hour$). 7. There were two examples of non-typical surge from 1st group and 3rd group each. Among these three cases showed a reestablishment of LH surge after 10-24 hours. 8. Endogenous spontaneous Lh surge occurs once for each 2nd group and 3rd group.

It has been suggested that the presence of periovarian adhesions might impair the ovarian response to gonadotropins. Total 136 patients who underwent IVF-ET from February to June 1988(88-1 and 88-2 series) at SNUH were classified into three groups according to total ovarian access score, sum of each ovarian availability, estimated by diagnostic laparoscopy : group I(N=43,0%-50%), group II(N=49, 50%-150%) and group III(N=44, 150%-200%). To evaluate the effects of periovarian adhesions on follicular development in controlled ovarian yperstimulation for IVF-ET, serum E2 levels on the day of hCG dministration (Day 0) and the day after hCG administration (Day+1), the number of ovarian follicles with mean diameter${\geqq}$12mm on Day 0, and the number of oocytes retrieved by transvaginal aspiration were measured and compared among groups. There were no significant differences in age of patients, cancellation rate due to inadequate ovarian response, serum E2 levels, the number of ovarian follicles, the number of oocytes retrieved, and oocytes retrieval rate per follicle. In the same patients(N=31) in group II in whom the difference in ovarian availability between two ovaries is more than 50%, there was also no significant difference in the number of ovarian follicles between them. These data suggest that pelvic adhesions including periovarian adhesions have no adverse effects on the ovarian response to gonadotropins stimulation and the outcome of IVF-ET.

Combined (intra and extrauterine) pregnancy refers to impregnations of two different ova at intrauterine and extrauterine sites simultaneously or within a short time interval each other. It is a rare clinical entity and freqently missed in early diagnosis in most instances. Its incidence rate is about 1 in 30,000 pregnancies and the incidence was rised in cases of using ovulation induced agents. The diagnostic rate is less than 10% at early process of the disease. We experienced a case of intrauterine and left tubal pregnancy as combined pregnaney in ovulation cycle which had been induced by clomiphene citrate and now present it with brief review of related leteratures.

To compare the stimulation effect of the ratio in follicle stimulating hormone and luteinizing hormone in induction of multiple follicular growth, the serum $E_2$ level, the diameter of follicle, number of aspirated follicles and cleavage rate of in vitro fertilized preovulatory oocytes as well as the pregnancy rate were evaluated. Forty one patients with irreparable tubal disease were stimulated by hMG(n=24) or FSH/hMG(n=17) for the purpose of in vitro fertilization and embryo transfer. The following results were obtained. 1. Serum estradiol($E_2$) levels on the day of hCG administration were $921.0{\pm}353.3\;pg/ml$ in hMG group and $1272.9{\pm}1060.6\;pg/ml$ in FSH/hMG group. The serum $E_2$ value of hMG group was significantly lower than that of FSH/hMG group. 2. The diameter of leading follicle by ultrasonogram on the day of hCG administration were $16.2{\pm}2.0\;mm$ in hMG group and $16.2{\pm}2.6\;mm$ in FSH/hMG group. No significant difference of follicle diameter between two groups was demonstrated. 3. The number of follicles with diameter above 10 mm by sonogram on the day of hCG injection were $3.91{\pm}2.32$ in hMG group and $6.52{\pm}3.86$ in FSH/hMG group. There was significant difference of number of follicles between two groups, (p< 0.01). 4. The number of oocytes found per patient at aspiration were $2.59{\pm}1.00$ in hMG group and 3. $76{\pm}2.31$ in FSH/hMG group. There was significant difference of number of aspirated oocytes between two groups. (p< 0.05). 5. The detection rate of preovulatory oocyte at aspiration were 68.4%(39/57) in hMG group (n=22) and 77.6%(38/49) in FSH/hMG group (n=13). 6. The cleavage rate of preovulatory oocyte at 44 hours after insemination were 74.4%(29/39) in hMG group(n=22) and 81.6%(31/38) in FSH/hMG group (n=13). When only hMG was used, one pregnancy was established in 15 patients to whom 29 zygotes were transferred. And a full term normal female baby was delivered by elective cesarean section. In the FSH/hMG group, five pregnancies out of 9 transferred patients were confirmed by serum ${\beta}-hCG$. Two pregnancies were spontaneously aborted before the 6th week of pregnancy. One patient aborted her baby at the 18th week of pregnancy because of incompetent internal os of the cervix. Two patients delivered two full term babies by elective cesarean section. From the above findings, paralell with the increase in the ratio of exogenous follicle stimulating hormone to luteinizing hormone, an increase in oocyte recovery was observed as well as an improvements in pregnancy rate. It was concluded that FSH enrichment early in the follicular phase had a beneficial effect in the controlled ovarian hyperstimulation.

To increase fertilization rate in vitro, separation of viable spermatozoa from the seminal plasma and its other components may be a useful procedure. Ejaculates from healthy men, whose semen analysis findings were normal in 19, and abnormal in 10, were filtered using the glass-wool filtration technique to yield a concentrated, viable sperm samples for IVF, and the usefulness and safety of this method were evaluated. The recovery rate of motile sperm in abnormal groups was 46.2% and 54.5% in normal group. The % motility was increased significantly compared with original sample after filtration, and the grade motility was improved, too. The sperm population with normal morphology was also increased significantly in both group. Using transmission electron microscopy, the ultrastructural integrity of acrosomal segment was examined in order to evaluate the potentially hazardous effect of glass-wool filtration to sperm head, however, sperm population with normal ultrastructure was increased compared with that of original ejaculate after separation. The filtered sperm was then processed for IVF, as the fertilizing capacity is the ultimate parameter of the sperm function. In abnormal group, the fertilization rate(41.5 %) and the ET rate per stimulated cycle were much lower than that of mormal group(69.6%). However, the cleavage rate and the number of embryos transfered per ET cycle were comparable with those of nomal group. The results suggest that the glass-wool filtration of sperm, particularly in oligo-asthenozoospsrmia, may be useful and safe method in the preparation of sperm for IVF.

We found reports of only about 20 cases of well documented ejaculatory duct obstruction presenting with infertility and treated by TUR. While infertility caused by ejaculatory duct obstruction is rare accurate diagnosis by vasoseminal vesiculography is important, since these obstructions may be treatable. In our 29 patients undergoing vasoseminal vesiculography for 1 year to demonstrate obstruction site in seminal tract the ejaculatory duct obstruction was found in 6 patients. The intial methods of treament were TUR of the ejaculatory duct in 2 patients, forceful lavage of ejaculatory duct through the vas deferens in 4 patients. One patient's wife who had undergone TUR of the ejaculatory duct delivered a normal female baby 15 months postoperatively. In one patient who had undergone forceful lavage of ejaculatory duct semen analysis returns to normal level except the motility. When initial methods of treatment fail to get the normal semen we have the plan to perform TUR of the ejaculatory duct or aspiration of seminal fluid in the seminal vesicle under the control of the ultrasonography for AIH according to the level of ejaculatory duct obstruction. Our report suggests that ejaculatory obstruction has been underdiagnosed and should receive more attention by urologist.