• Clinical and Experimental Reproductive Medicine
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• v.24 no.2
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• pp.217-223
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• 1997

This study was performed to determine if women with day 3 serum inhibin-B concentrations <45pg/ml (conversion factor to SI unit, 1.00) demonstrate a poor response to ovulation induction and assisted reproductive technology outcome to women with inhibin-B${\ge}45pg$/ml, independant of day 3 FSH, E2 and patient age. From Jan 1996 to Dec 1996, 16 volunteers patients who underwent 25 IVF cycles with luteal phase GnRH agonist suppression and HMG stimulation were allocated to the study group. We evaluated day 3 serum inhibin-B, FSH, E2, peak E2, cancellation rate per initiated cycle (%) and clinical pregnancy rate per initiated cycle (%) according to the above two groups and independent of patient age, day 3 FSH, day 3 E2 and all of above combined. Women with day 3 serum inhibin-B${\ge}45pg$/ml demonstrated higher average day 3 inhibin-B level, clinical pregnancy rate per initiated cycle ($20.3{\pm}2.5$ pg/ml vs $80.9{\pm}5.0$ pg/ml, p<0.05; 24.8% vs 8.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($6.9{\pm}0.3$ mIU/ml vs $8.5{\pm}0.5$ mIU/ml, p<0.05; 1.5% vs 9.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and age<40 year demonstrated higher pregnancy rate per initiated cycle (28.2% vs 7.4%, p<0.05) and lows. day 3 FSH level, cancellation rate per initiated cycle ($6.9{\pm}0.5$ mIU/ml vs $8.2{\pm}0.7$ mIU/ml, p<0.05; 1.0% vs 9.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and day 3 FSH<15mIU/ml demonstrated higher pregnancy rate per initiated cycle (33.5% vs 9.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($7.7{\pm}0.2$ mIU/ml vs $8.5{\pm}0.5$ mIU/ml, p<0.05; 1.5% vs 10.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and day 3 E2<50pg/ml demonstrated higher pregnancy rate per initiated cycle (30.0% vs 9.5%, p<0.05) and lower cancellation rate per initiated cycle (1.5% vs 9.5%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml, age<40 year, day 3 FSH<15mIU/ml and day 3 E2<50pg/ml demonstrated higher pregnancy rate per initiated cycle (30.0% vs 10.8%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($6.8{\pm}0.6$ mIU/ml vs $8.4{\pm}0.9$ mIU/ml, p<0.05; 1.5% vs 7.8%, p<0.05). Therefore women with low day 3 serum inhibin-B concentrations demonstrate a poorer response to ovulation induction and are less likely to conceive a clinical pregnancy though ART relative to women with high day 3 inhibin-B and day 3 serum inhibin-B, in addition to a day 3 FSH, E2 and patient age, appears helpful in prediction in IVF-ET outcome.

• Clinical and Experimental Reproductive Medicine
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• v.16 no.2
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• pp.211-220
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• 1989

The aim of this study was to compare the response and their outcome of superovulation induction protocol in IVF-ET program. One hundued seventy seven infertile women were stimulated by FSH/hMG(group I, N=128), clomiphene citrate/hMG(group II, N=51), and hMG(group III, N=18) for the purpose of ovulation induction. The results were as follows; 1. The mean ages of patients were $31.9{\pm}3.8$ in group I, $30.6{\pm}3.3$ in group II, and $29.3{\pm}2.5$ in group III. 2. The day of hCG administration was $11.1{\pm}1.8$ in group I, $12.1{\pm}2.0$ in group II, and $13.7{\pm}6.8$ in group III. The hCG administration day of group III was significantly delayed compared with that of group I (p<0.001). 3. The terminal E2 pattern in group II was different from those of group I and III, but there was no significant difference. 4. The mean numbers of mature eggs aspirated were $5.5{\pm}3.8$ in group I, $5.0{\pm}3.3$ in group II, and $5.6{\pm}5.4$ in group III. There was no significant differences in the mean numbers of mature eggs retrieved among the three groups. 5. The fertilization rate of eggs was significantly higher in group II (67.9%) than that of group I (52.2%)(p<0.001). 6. The cleavage rate of group I (67.0%) was significantly lower than those of group II (93.2%) and group III (95.8%) (p<0.0001). 7. The mean numbers of embryos transfered were $3.3{\pm}1.4$ in group I, $3.1{\pm}1.3$ in group II, and $3.2{\pm}1.6$ in group III and the ET rate was 69.0% in group I, 77.3% in group II, and 100% in group III. There was significant difference in ET rate between group I and group III (p<0.005). 8. The pregnancy rates per OPU cycle or ET cycle were not significantly different among the three groups, but delivered and ongoing pregnancy rates were significantly different between group I (36.8%) and group II (p<88.8%) (p<0.05).

• Journal of Embryo Transfer
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• v.27 no.3
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• pp.141-147
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• 2012

This study was operated to establish induction using ultrasonography by estimating the relation of follicle size and estrus manifestation. Clinical estrus symptoms were observed 97.4% in cows and 87.5% in heifers when overall 55 cows were induced to estrus in a single dose of $PGF_{2{\alpha}}$ after verifying CL through ultrasonography, which means estrus hours among those 52 cows showing the clinical estrus symptoms were estimated 2.39 days on cows and for 2.37 days on heifers which showed no differences (p>0.05). The estrus manifestation hours according to the follicle size in cows didn't have any significance each other (p>0.05), though estrus hours was 54 hours (the shortest) with follicle size bigger than 10 mm and were made up within 69 hours. The estrus manifestation hours according to the follicle size in heifers didn't have any significance each other (p>0.05) and took around 42 hours (the shortest) with follicle size of 5mm (the smallest) and were made up within 66 hours. Follicles after $PGF_{2{\alpha}}$ injection were ovulated and assigned to many phases as follows; Group 1 (growing phase) - continuously growing into ovulation, Group 2 (growing and static phase) - delaying in growth after the growth of follicles, Group 3 (static and growing phase) - growing after growth delay, Group 4 (regressing and new growing phase) - the follicle is closed and a new follicle grows. In addition, the process of follicle development and estrus hours had no significance each other (p>0.05), though estrus manifestation hours in Group 1 and 2 was relatively short, and in Group 3 and 4 for a relatively long time. In the result of all above, the estrus manifestation hours after $PGF_{2{\alpha}}$ injection has no differences accoring to the follicle size in cows and heifers. Therefore, High pregnancy rate is obtained when practicing artificial insemination within 3 days in estrus or TAI in 72 to 80 hours after adminitrating $PGF_{2{\alpha}}$.

• Clinical and Experimental Reproductive Medicine
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• v.27 no.4
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• pp.345-351
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• 2000

Objective: Hatching of the blastocyst from the zona pellucida (ZP) is a key event in mammalian implantation. In vivo, two factors have been identified as possible mediators of hatching: lysis of the ZP by substances elaborated either from the embryo or female reproductive tract and pressure exerted on the zona by expansion of the blastocyst. Two methods of zona manipulation were already in use to enhance the ability of embryos to hatch: mechanical PZD and chemical ZD by acidic Tyrode's solution. But several controversies of each method have been reported. The purpose of this study was to investigate the effect of pronase for mouse embryo hatching. Methods: Mouse embryos were obtained following ovulation induction of $F_1$ animals. Fresh and cryo-thawed morula embryos were exposed to 0.5, 1.0, 2.0, 5.0 ${\mu}g/ml$ pronase in Ham's F10 for 72 hrs. Main outcome measures were the rates of partial hatching and completely hatched blastocysts, and cell number of it. Results: In fresh and cryo-thawed group, the rates of completely hatched blastocyst were significantly higher in 5 ${\mu}g/ml$ pronase treatment group than control group. There was no difference in completely hatched blastocyst total cell number between pronase treatment group and control group. This suggest that pronase treatment did not harmful in mouse embryo development. In pronase treatment group, zona pellucida were thinner than control group. Conclusion: The addition of pronase to culture media may accelerate the hatching of embryo. So, enzymatic treatment of the zona may provide a valuable and effective assisted hatching technique for human in-vitro fertilization-embryo transfer.

• Clinical and Experimental Reproductive Medicine
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• v.38 no.1
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• pp.37-41
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• 2011

Objective: To compare the effectiveness and convenience of a pen device for the self-administration of follitropin ${\beta}$ with a conventional syringe delivering follitropin ${\beta}$ solution in patients undergoing IVF-ET. Methods: GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). Results: There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin ${\beta}$. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. Conclusion: The pen device for self-administration of follitropin ${\beta}$ is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin ${\beta}$ when compared with the conventional syringe.

• Clinical and Experimental Reproductive Medicine
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• v.25 no.2
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• pp.141-151
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• 1998

Objectives: To determine whether the body weight, body mass index (BMI), and basal serum level of LH, FSH, testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) are related to the ovarian response to clomiphene citrate (CC) in patients with polycystic ovarian syndrome (PCOS). Materials and Method: From January 1996 to June 1997, total 57 patients with PCOS were enrolled in the present study. Women who had other infertility factors were excluded from our study. The ovulation induction using CC was used in all patients. The patients were grouped into 50 mg group, 100 mg group, and 150 mg group according to their daily CC dose. The patients were also grouped to ovulatory and non-ovulatory group. The body weight, BMI, and basal serum level of LH, FSH, T, DHEA-S were measured in all patients on the 2nd or 3rd day of the menstrual cycle. Results were analysed with Student's t-test and Fisher's exact test. Results: The body weight and BMI of the nonovulating group were significantly higher than those of the ovulating group in all groups (50, 100, 150 mg of CC). However, there were no significant differences of the level of LH and FSH between ovulating and nonovulating groups in all CC groups (50, 100, 150 mg). The level of T of nonovulating group was significantly higher in 50 and 100 mg of CC groups, but not in 150 mg group. The level of DHEA-S of the non-ovulating group is significantly higher in 50 mg group, but not in 100 and 150 mg groups. Conclusion: The body weight and BMI could be useful predictors of ovarian response to CC in patients with PCOS, and basal T and DHEA-S also might be useful in cases of low-dose CC treatment.

• Clinical and Experimental Reproductive Medicine
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• v.23 no.1
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• pp.11-24
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• 1996

The number of multifetal pregnancies has increased dramatically as a result of the widespread clinical use of ovulation induction and assisted reproductive technology(ART) in infertile patients. In multifetal pregnancies, the adverse outcome is directly proportional to the number of fetuses within the uterus, primarily because of an increased predisposition to premature delivery. It is extremely difficult to counsel patients about the expected outcome of pregnancies involving three or more fetuses. To increase the chances of delivering infants mature enough to survive without being irreversibly damaged by the sequelae of marked prematurity, selective fetal reduction(SFR) to the smaller number of fetuses should be considered in multifetal pregnancies. From January, 1991 to December, 1992, transabdominal SFR in multifetal pregnancies was performed in 22 patients including 13 triplet, 7 quadruplet, 1 quintuplet and 1 heptuplet pregnancies. Transabdominal SFR using intracardiac KCI injection and aspiration of amniotic fluid was carried out in 8-13 weeks of gestation. After procedure, 20 patients were remained as twin pregnancies, and 2 patients as triplet pregnancies. There have been 11 sets of twin delivery including 2 stillbirths, 2 sets of triplet delivery including 1 stillbirth, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 4 cases in 33 - 37 weeks, and 1 case in 30 weeks. Unfortunately, 3 stillbirths occurred in 20-24 weeks of gestation, and 4 cases were aborted. As 7 losses of pregnanancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 38.9%(7/18) in transabdominal SFR. All babies born after 30 weeks of gestation were healthy, and no fetal anomaly directly related to the procedure was encountered. From July, 1993 to February, 1995, transvaginal SFR was performed in 20 patients including 15 triplet, 4 quadruplet and 1 quintuplet pregnancies. Transvaginal SFR using the same method as transabdominal SFR was carried out in 8-11 weeks of gestation. After procedure, 19 patients were remained as twin pregnancies, and 1 patient as singleton pregnancy. There have been 13 sets of twin delivery including 2 stillbirths, and 1 singleton delivery. Six cases were delivered after 37 weeks of gestation, 5 cases in 36-37 weeks, and 1 case in 30 weeks. Unfortunately, 2 still-births occurred in 20 weeks and 21 weeks of gestation, respectively, and 2 cases were aborted. As 4 losses of pregnancy including 1 case of septic abortion occurred, the delayed fetal loss rate was 25.0%(4/16) in transvaginal SFR. No fetal anomaly directly related to the procedure was encountered. It is suggested that transvaginal SFR could be performed more easily and earlier with the lower fetal loss rate as compared with transabdominal SFR. In conclusion, SFR is a rather safe and ethically justified procedure that may improve the outcome of multifetal pregnancies.

• The Journal of Korean Obstetrics and Gynecology
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• v.18 no.1
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• pp.218-233
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• 2005

Purpose : To investigate clinical-epidemologic aspect of infertility patients in Conmaul Oriental Hospital. Methods : From 2003, 5 to 2004, 4, a total 1223(female 943, male 280) patients was recruited, and their medical records were reviewed retrospectively. Results : The mean age of female was $31.83{\pm}3.63$ yesrs, and $34.08{\pm}3.66$ years in male. The mean BMI of female was $20.83{\pm}2.74$, and $24.36{\pm}3.03$ in male. The most common occupation of female was profession, administration, management.The primary infertility was 52.9% and the secondary infertility 47.1%. The most common past history in female was laparotomy. The mean duration of infertility was $3.32{\pm}2.5$ years and $3.9{\pm}2.63$ years in female and male. 83.6% of secondary infertility women experienced abortion. The incidence of patients with both combinded infertility factors of female and male was the most highest, and the most common single factor was ovulatory. 92.4% of female patients took sterility tests, 71.0% of male patients took semen analysis. 50.8% female took ovulation induction, IUI, IVF before coming. 8.91% of female and 72.14% of male were accompanied by their spouse. 61.2% of female took sterility test with their spouse. Female's duration of treatment was longer than man's. The most reliable source of choices was encouragement of family members, acquaintance. Conclusion : In this study, we presented staus concerend with infertility and the characteristics of patients went to oriental hospital. Furthermore, the study about oriental treatments and the results of that treatments is required.

• Journal of Embryo Transfer
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• v.22 no.1
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• pp.53-61
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• 2007

This study was investigated factors affecting the pregnancy rates after transfer of pronuclear microinjected embryos for the production of transgenic Korean black goats. Embryo transfer was carried out in 343 recipient Korean black goats from September 1999 to June 2000. Estrus was induced by the insertion of intravaginal progesterone devices $CIDR^(R)$ for 2 weeks. A single injection of 400 IU equine chorionic gonadotropin was administered at 48h before $CIDR^(R)$ removal to increase the proportion of does cycling and ovulation rate. Good quality embryos were prepared by microinjection of DNA into the pronuclei of fertilized goat oocyte and cultured in vitro. Pronuclear microinjected $1{\sim}8$ cell stage embryos were surgically transferred into the oviducts of the recipient at day 4 or 5 following $CIDR^(R)$ removal, and morula to blastocyst stage embryos were surgically transferred into uterus at day 9. Pregnancy was diagnosed by transrectal ultrasound scanning at $20{\sim}30d$ and 8 weeks following embryo transfer. The pregnancy rate was affected by several factors, such as estrus induction, the number of previous transfer, transfer site, stage of CL (corpus luteum), the number of recipient CL, stage of embryos and the number of transferred embryo. The pregnancy rate was significantly higher in recipients that came into estrus naturally than recipients that induced to come into estrus with $CIDR^(R)$(59.1% vs. 36.8%; P<0.05). The pregnancy rate was higher when the embryos were transferred into the left oviduct than transferred into the right oviduct (42.9% vs. 35.3%; P<0.05). The pregnancy rate of recipients with $CH_1$ (early) stage corpus hemorrhagicum in ovary was hi틴or than recipient with $CH_3$ (late) stage hemorrhagicum (47.5% vs. 17.9%; P<0.01). Higher pregnancy rates were obtained by transfer of 1-cell stage embryos into oviduct while late blastocysts (51.6% vs. 66.7%; P<0.01) into uterus. The pregnancy rates when 3 embryos were transferred to recipients were significantly higher than when 2 embryos we.e transferred (47.6% vs. 27.0%; P<0.05). Although there were no significant difference among the group, adhesion of reproductive organs, uterine size, ovulation rate of recipients, presence of large follicle and difficulty of transfer affected pregnancy rate of recipient. Higher pregnancy rates were obtained in the recipients with $8{\sim}15m$ diameter uterine horn as compared to the recipients with <5m diameter or >20mm diameter uterine hem (38.9%, 20% vs. 18.2%), in the recipients with large follicle in the ovulated ovary ipsilaterally (53.6% vs. 37.1%) and in the transfer which was carried out easily (39.2% vs. 27.8%, 0%). In conclusion, the high rate of pregnancy was achieved following transfer of pronuclear microinjected embryos when three or four 1-cell stage embryos were transferred into oviduct with $CH_1$ stage corpus hemorrhagicum in the ovary of recipient which came into estrus naturally.

• Clinical and Experimental Reproductive Medicine
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• v.31 no.2
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• pp.133-139
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• 2004

Objective: To investigate the association of FSH receptor (FSHR) polymorphism at position 680 with outcomes of controlled ovarian hyper-stimulation for IVF-ET in Korean women. Design: Genetic polymorphism analysis. Materials and Methods: The FSHR polymorphism was analyzed by PCR-RFLP in 172 ovulatory women below the age of 40 year. Patients with polycystic ovary syndrome, endometriosis, or previous history of ovarian surgery were excluded. Results: Genotype distribution was 41.9% for the Asn/Asn, 47.7% for the Asn/Ser, and 10.5% for the Ser/Ser FSHR genotype group. There was no difference in age of subjects and infertility diagnosis between genotype groups. When the patients were grouped according to their FSHR genotype, the basal levels of FSH (day 3) were significantly different among the three groups ($6.0{\pm}0.3\;IU/L$ (mean $\pm$ SEM), $5.8{\pm}0.3\;IU/L$, and $8.6{\pm}1.2\;IU/L$ for the Asn/Asn, Asn/Ser, and Ser/Ser groups, respectively, p=0.002). The Ser/Ser group showed a higher total doses of gonadotropins required to achieve ovulation induction, and a lower serum estradiol levels at the time of hCG administration compared with other two groups, but the differences were of no statistical significance. The numbers of oocytes retrieved were significantly different among the three groups ($8.6{\pm}0.8$, $9.9{\pm}0.6$, and $6.3{\pm}0.9$, for the Asn/Asn, Asn/Ser, and Ser/Ser groups, respectively, p=0.049). Clinical pregnancy rates were 42.4%, 25.9%, and 29.4% for the Asn/Asn, Asn/Ser, and Ser/Ser groups, respectively. Conclusion: Homozygous Ser/Ser genotype of FSHR polymorphism at position 680 was associated with decreased ovarian response to gonadotropin stimulation for IVF-ET.