• Clinical and Experimental Reproductive Medicine
• /
• 제29권4호
• /
• pp.251-258
• /
• 2002

Objective : The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrotide) minimal stimulation protocol comparing with GnRH agonist combined long step down stimulation protocol in PCOS patients. Materials and Method: From Apr 2001 to May 2002, 22 patients (22 cycles) were performed in controlled ovarian hyperstimulation using by GnRH antagonist and GnRH agonist for PCOS patients. GnRH antagonist (Cetrotide) combined minimal stimulation protocol was administered in 10 patients (10 cycles, Study Group) and GnRH agonist long step down stimulation protocol was administered in 12 patients (12 cycles, Control Group). We compared the pregnancy rate/cycle, total FSH (A)/cycle, Retrieved oocyte/cycle, the incidence of ovarian hyperstimulation syndrome, multiple pregnancy rate between the two groups. Student-t test were used to determine statistical significance. Statistical significance was defined as p<0.05. Results: Group of GnRH antagonist (Cetrorelix) minimal stimulation protocol produced fewer oocytes (6.4 versus 16.3 oocytes/cycle) using a lower dose of FSH (22.2 versus 36.1 Ample/cycle) and none developed OHSS and multiple pregnancy. Although the trends were in favour of the GnRH antagonist (Cetrorelix) protocol, the differences did not reach statistical significance. This was probably due to small sample size. Conclusion: The use of GnRH antagonist reduce the risk of ovarian hyperstimulation and multiple pregnancy. We suggest that GnRH antagonist might be alternative controlled ovarian hyperstimulation method, especially in PCOS patients who will be ovarian high response.

• Clinical and Experimental Reproductive Medicine
• /
• 제37권4호
• /
• pp.267-291
• /
• 2010

최근 동결기술이 발달하면서 다양한 목적에 따라 초기 발생단계, 특히 수정 전후의 난자나 수정란의 생명을 연장하는 것이 가능해졌다. 이러한 난자나 수정란의 보존기술은 인간의 수정능력을 배가시키거나 임신조절에서 응용되고 있으며, 동물에서는 우수한 유전자원의 보존과 운영, 저렴한 국제간 운송수단, 그리고 생식보조기술과 유전공학 등의 연구에 필요한 생식세포의 공급하는 데서도 중요하게 활용되고 있다. 최근 개발된 완만동결과 유리화 동결방법은 난자와 수정란을 장기간 동결하여 보존하는데 활용하는 주요 기술이다. 이러한 방법들은 각각 장점과 단점을 가지고 있지만, 상당한 수준의 효율성이 입증되어 실용화되어 있는 실정이다. 무엇보다도 유리화 방법은 완만동결 방법보다 13년이나 늦게 개발되었으나 보다 우수한 기술로 인정을 받고 있다. 비록 유리화 동결은 아직 대한 상반된 의견과 오염문제가 있지만 인간과 동물의 생식보조기술로 활용되는 빈도가 점차 많아지고 있는 실정이다. 따라서 본 원고에서는 먼저 난자와 수정란의 동결보존에 대한 기초적인 기술에 대해서 고찰한 다음, 유리화 동결에 관 한 최근의 연구동향에 대해서 종합적으로 검토하고자 한다.

• Clinical and Experimental Reproductive Medicine
• /
• 제26권1호
• /
• pp.117-121
• /
• 1999

Although anejaculation is a relatively uncommon occurrence in the general population, over 12,000 new cases are reported annually. Anejaculation may result from spinal cord injury, retroperitoneal lymph node dissection, diabetes mellitus, transverse myelitis, multiple sclerosis, or psychogenic disorders. At least 30% of men with this problem are or will be married and many will seek help to remedy their infertile state. The evolution of technique and instrumentation over the last 30 years has made electroejaculation an accessible and acceptable form of therapy. Recent successes in inducing ejaculation by means of rectal probe electrostimulation or vibratory stimulation combined with assisted reproductive techniques, such as zygote intrafallopian transfer (ZIFT), gamete intrafallopian transfer (GIFT), and in vitro fertilization (IVF), have provided these men means of producing their own biologic offspring. We have experienced a successful pregnancy with electroejaculation and in vitro fertilization in a infertile patient whose husband had an ejaculatory disturbance due to a spinal cord injury. So we report this case with a brief review of literatures.

• Clinical and Experimental Reproductive Medicine
• /
• 제50권4호
• /
• pp.270-276
• /
• 2023

Objective: This study investigated the clinical and laboratory factors associated with the presence of dysmorphic oocytes in intracytoplasmic sperm injection (ICSI) cycles. Methods: The study involved 200 ICSI cycles, performed from 2020 to 2021, that yielded at least one mature oocyte. Clinical characteristics and ovarian stimulation methods were compared between 68 cycles with at least one dysmorphic oocyte (the dysmorphic group) and 132 cycles with normal-form oocytes only (the non-dysmorphic group). Dysmorphic oocytes were characterized by dark cytoplasm, cytoplasmic granularity, cytoplasmic vacuoles, refractile bodies in the cytoplasm, smooth endoplasmic reticulum in the cytoplasm, an oval shape, an abnormal zona pellucida, a large perivitelline space, debris in the perivitelline space, or an abnormal polar body. Results: The ages of the women, indications for in vitro fertilization, serum anti-Müllerian hormone levels, and rates of current ovarian endometrioma were similar between the dysmorphic and non-dysmorphic groups. In both groups, the three ovarian stimulation regimens, two types of pituitary suppression, and total gonadotropin dose were employed similarly. However, the dual-trigger method was used more frequently in the dysmorphic group (67.6% vs. 50%, p=0.024). The dysmorphic group contained significantly more immature oocytes and exhibited significantly lower oocyte maturity (50% vs. 66.7%, p=0.001) than the non-dysmorphic cycles. Within the dysmorphic group, significantly lower oocyte maturity was found in the cycles using a dual-trigger, but not in those with a human chorionic gonadotropin trigger. Conclusion: ICSI cycles with dysmorphic oocytes are closely associated with reduced oocyte maturity. This association was observed exclusively in dual-trigger cycles.

• Clinical and Experimental Reproductive Medicine
• /
• 제36권1호
• /
• pp.45-53
• /
• 2009

목 적: 본 연구는 정상 정액을 배양액으로 세척한 후 $4^{\circ}C$, $22^{\circ}C$, $37^{\circ}C$에서 5일 동안 보존하면서 정자의 운동성, 생존성을 관찰하여 정자의 운동성과 수명 유지를 위한 적정 배양 환경을 분석하고자 하였다. 연구방법: 정액검사 시 정상으로 판정된 남성의 정자를 HTALP 배양액으로 세척하여 정자의 최종 농도 $1{\times}10^6/ml$로 각 5 ml을 배양온도 $4^{\circ}C$, $22^{\circ}C$, $37^{\circ}C$에서 5일 동안 배양하였다. 1일, 3일 5일째에 CASA에 의해 운동성을 측정하였고, HOST로 정자막의 온전성을 분석하였으며, CTC pattern으로 수정능획득 상태 분석하여 최적의 배양 환경을 분석하였다. 결 과: 정자의 운동성, 생존성 및 수정능획득이 야기되지 않은 정자는 배양일에 따라 유의하게 감소하였다 (p<0.05). 또한 정자 배양 후 1일에는 정자의 운동성, 생존성 및 정자막의 온전성과 CTC pattern은 온도에 따라 차이가 없었으나, 배양 후 3일과 5일에서는 $22^{\circ}C$에서 배양된 정자가 다른 배양온도에 비해 가장 잘 보존되었다 (p<0.05). 결 론: HTALP로 세척된 정자를 $22^{\circ}C$에서 보존 시 5일까지 정자의 운동성과 수명을 보조생식술에 적합한 수준으로 유지시킬 수 있는 최적 배양 환경으로 제시할 수 있다.

• 한국발생생물학회:학술대회논문집
• /
• 한국발생생물학회 1998년도 제4차 학술발표대회 및 정기총회
• /
• pp.12-18
• /
• 1998

Tremendous progress has been made over the past quarter-century studying the genetics of gametogenesis and the resulting gametes and embryos. Studies merging molecular techniques and conventional cytogenetics are now beginning to bridge the gap between what we have learned about the meiotic process in males and females and what we know of the mitotic chromosomes of zygotes. Numerical abnormalities in sperm, oocytes and embryo can now diagnosed by fluorescence in situ hybridization (FISH). "At risk" couples can, therefore, have only unaffected embryos replaced in the sterus and avoid the possibility of terminating a pregnancy that might only be diagnosed as affected later gestation. Single-cell genetic analysis has also provided powerful tools for studying genetic defects arising during early human development. Recent studies of sperms, oocytes and cleavage-stage human embryos have revealed an unexpectedly high incidence. These genetic abnormalities are likely to contribute to early pregnancy loss and have important implications for improving pregnancy rates in infertile couples by assisted reproduction. The widespread use of preimplantation genetic diagnosis (PGD) awaits further documentatio of safety and accuracy. Other issues also must be addressed. First, the ethical issues regarding germ cell and embryo screening must be addressed including what diseases are serious enough to warrant the procedure. Another concern is the use of this technology for non-genetic disorders such as gender selection. Finally, the experimental nature of these procedure must continually be discussed with patients, and long-term follow-up studies must be undertaken. Development of more accurate and less expensive assays coupled with improved assisted reproductive technology success rates may make PGD a more widely use clinical tool. The future awaits these development.velopment.

• 한국수정란이식학회지
• /
• 제25권4호
• /
• pp.291-295
• /
• 2010

Four estrus-induced Himalayan tahrs (Hemitragus jemlahicus) were inseminated with frozen-thawed semen by laparoscopic or transcervical insemination techniques with no regard to the site of ovulation in non-breeding season. In June and July, 2009, estrus was synchronized by Eazi-Breed $CIDR^{(R)}$ (Controlled internal drug release; Pfizer Animal Health, New Zealand) insertion for 16 days and PG 600 (PMSG 400IU, hCG 200 IU; Intervet, Netherlands) injection (IM) a day before removing $CIDR^{(R)}$. Forty eight hours later, laparoscopic or transcervical insemination was done to each of two tahrs under anesthetic condition inducted by ketamine (1.5 mg/kg) and medetomidine (0.09 mg/kg). For examination of estradiol and progesterone, blood was collected right before $CIDR^{(R)}$ insertion, PG 600 injection, $CIDR^{(R)}$ removal and insemination. Estradiol levels of four tahrs (No. 1, 2, 3, 4) before $CIDR^{(R)}$ insertion and insemination were 13.3, 8.8, 14.3, 12 pg/ml and 23.5, 25.5, 21.1, 11.5 pg/ml, respectively. Progesterone levels of four tahrs (No. 1, 2, 3, 4) before $CIDR^{(R)}$ insertion and insemination were 1.8, 0.05, 0.63, 0.61 ng/ml and 1.03, 0.37, 1.48, 2.12 ng/ml. Except for No. 4 tahr, cervices showed cervical mucus and opened enough to penetrate with embryo transfer gun sheet usually used for cows. Therefore, No.4 was laparoscopically inseminated together with No. 1. In conclusion, none of four Himalayan tahrs was pregnant. However, we proved that estrus could be induced by CIDR and PG 600 injection in non-breeding season, and laparoscopic or transcervical insemination with frozen-thawed semen could be one of assisted reproductive techniques in Himalayan Tahr.

• Clinical and Experimental Reproductive Medicine
• /
• 제35권1호
• /
• pp.83-88
• /
• 2008

보조생식술 시행 후 혈전색전증의 발생은 매우 드물기는 하나 치명적인 합병증이다. 과배란 유도시 중증 난소 과자극 증후군은 $0.1{\sim}0.5%$에서 발생하며, 중증 난소 과자극증후군 환자의 128명 중 한 명에서 혈전색전증이 발생하는 것으로 알려져 있다. 발병기전으로는 과배란 유도에 따른 고에스트로젠 혈증에 의한 혈액응고인자의 변화, 혈관 투과성의 증가에 따른 혈액농축 및 순환혈액의 감소 등을 원인으로 추정하고 있으나 그 정확한 기전은 알려진 바가 없다. 또한 thrombophilia나, 혈전색전증의 과거력 및 가족력이 있는 경우 발병율이 증가한다. 혈전증의 발생 부위는 정맥이 67%이나, 33%는 동맥에 발병하며 주로 뇌동맥에 발생된다고 보고되었다. 본 예는 3년간의 이차성 불임을 주소로 내원하여 시험관 아기시술을 시행하였으며 hCG 투여 8일 후 난소 과자극증후군이 중등도로 발생하였다. hCG 투여 후 11일째 갑작스런 의식 소실 및 우측 상지의 운동장애가 발생하여 시행한 MRI상 뇌바닥동맥 (basilar a.) 혈전증으로 진단되었으며, 혈관내 혈전 용해술 및 풍선 확장술 시행후 재관류에 성공하였다. 시술 2일 후 의식 및 운동장애는 완전히 회복되었으며 시술 7일 후 말더듬증 역시 회복되어 후유장애 없이 건강한 상태이다. Thrombophilic study상 Protein S결핍 소견을 보였고, 또한 vWF-associated Ag.이 증가된 양상을 보였다. 지금까지 국내에서 난소 과자극증후군 이후에 발생한 뇌경색은 5예가 보고되었으며, 이중 4예에서 protein S deficiency 소견을 보였으므로 선별 검사로 유용할 것으로 사료된다. 저자 등은 3년간의 이차성 불임을 주소로 내원한 33세 환자에서 시험관 아기시술시 hCG 투여 11일째에 발생한 뇌바닥동맥 혈전증을 간단한 문헌 고찰과 함께 보고하는 바이다.

• Clinical and Experimental Reproductive Medicine
• /
• 제20권2호
• /
• pp.107-115
• /
• 1993

Procedures to separate motile. normal & motile and acrosome-reacted sperm with high efficiency have clinical application in Assisted Reproductive Technology in terms of increasing the probability of fertilization by a normal sperm and subsequent normal embryonic development. This study evaluated the effects of 10 sperm preparation techniques [Swim-up from a washed pellet (SU). Swim-up from semen (SO). Continuous Percoll Gradients I (PIC). Discontinuous Percoll Gradients I (PID). Continuous Percoll Gradients II(P II C). Discontinuous Percoll Gradients II(P II D), SpermPrep (SFC). Wang's tube (WT). Albumin Gradients (AG), Low temperature capacitation (LTC)] on motility (%), normal morphology (%), motile sperm recovery rate(%). morphologically normal & motile sperm recovery rate (%), true acrosome reaction (%) and fertilizing ability. A P II D proved to be an effective means of separating morphologically normal & motile sperm. Our results indicated the P II D has advantages as compared with other methods in terms of recovery rate. enhancement of motility and normal morphology. And a LTC seems to be an effective means of enhancing the true acrosome reaction and fertilizing ability. These results suggest that the combined method of LTC and P II D for separation of morphologically normal & motile sperm and acrosome reacted sperm may be a useful procedure for intrauterine insemination and in vitro fertilization in the management of male factor infertility as well as for isolation of subpopulation of sperm for basic research.

• Journal of Genetic Medicine
• /
• 제6권2호
• /
• pp.131-145
• /
• 2009

착상전 유전진단은 유전질환이 이환될 가능성이 있는 부부들을 대상으로 산전진단을 통한 임신중절의 위험성 없이 정상적인 아이를 가질 수 있게 도와주는 보조생식술의 한 방법으로 확립되었다. 단일 할구를 대상으로 하는 분자생물학 및 분자생물학적 기술의 발전은 착상전 유전진단의 정확성을 높은 수준에 이르게 하였고 whole genome amplification 방법을 이용함으로써 단일세포로부터 여러 가지 다양한 진단을 동시에 수행 가능케 하였으며 단일 유전자 질환에 대한 착상전 유전진단에서의 오진을 감소시킬 수 있었다. 따라서 PCR을 이용한 단일 유전자 질환에 대한 착상전 유전진단의 적용가능 유전질환은 더욱 확대될 것이며 건강한 아이의 출산을 원하는 더 많은 부부들에게 기회를 제공해 줄 것이다. 본 종설에서는 현재 단일유전자 질환에 대한 착상전 유전진단을 시행하는 대부분의 센터에서 시행하고 있는 생검 방법과 multiplex PCR, PCR 후 진단 방법, 그리고 multiple displacement amplification 등의 분자생물학적 방법과 단일 세포 분석에서의 문제점 등을 포함한 단일 유전자 질환에 대한 착상전 유전진단 전반에 관하여 논의할 것이다.