• The Journal of Korean Obstetrics and Gynecology
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• v.33 no.3
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• pp.60-79
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• 2020

Objectives: This review plans to assess the efficacy and effectiveness of oriental medicine for the treatment of Ovarian Hyperstimulation Syndrome (OHSS) through literature research and overview. Methods: Database searching was conducted to identify relevant randomized controlled trials (RCTs) on oriental medicine for the treatment of Ovarian Hyperstimulation Syndrome. Studies were searched from Journal of Korean Obstetrics and Gynecology, Korean Medical Database, Korean studies Information Service System, China National Knowledge Infrastructure, Cochrane library, PubMed and EmBase up to 21^st May, 2020. Results: Seventeen studies were finally selected. Fifteen studies intervened with oral Chinese herb medicine, two studies intervened with acupuncture and moxibustion. Nine studies concluded that intervention with oriental medicine significantly relieved OHSS symptoms. Three studies reporting ovary diameter, four studies reporting abdominal circumference and other four studies reporting pelvic effusion showed significant reduction compared to control groups. Six studies showed significantly shorter duration for hospitalization in intervention groups. Only one study showed significantly higher pregnancy rate. Factors related with vascular permeability and blood cell coagulation were significantly lowered in intervention groups in general. Conclusions: From seventeen studies, oriental medicine relieved OHSS symptoms and showed treatment effectiveness. Further strictly designed studies and long-term observed studies are needed to establish evidences.

• Clinical and Experimental Reproductive Medicine
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• v.36 no.2
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• pp.137-142
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• 2009

Ovarian hyperstimulation syndrome (OHSS) is one of the most common iatrogenic complications induced by assisted reproductive technology. Hydrothorax develops in about 10 percent of patients with severe OHSS and it is usually associated with marked ascites. On the other hand, severe hydrothorax without marked ascites is uncommon, and its pathogenesis remains unclear. We recently experienced a case of severe unilateral hydrothorax with minimal ascites induced by quintuplet pregnancy following intrauterine insemination with controlled ovarian hyperstimulation. Severe hydrothorax was resolved after only conservative and symptomatic management without invasive procedure such as thoracentesis or paracentesis. We report this case with brief review of literature.

• The Journal of Korean Obstetrics and Gynecology
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• v.33 no.1
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• pp.1-18
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• 2020

Objectives: This review is aimed at assessing the efficacy and effectiveness of oriental medicine for the prevention of Ovarian Hyperstimulation Syndrome (OHSS) through literature research and overview. Methods: Database searching was conducted to identify relevant randomized controlled trials (RCTs) on oriental medicine for the prevention of Ovarian Hyperstimulation Syndrome. Studies were searched from Journal of Korean Obstetrics and Gynecology, Korean studies Information Service System, Korean Medical Database, China National Knowledge Infrastructure, Cochrane library, PubMed and EmBase up to 7^th November, 2019. Results: Ten RCTs were finally selected. Eight studies intervened with oral Chinese herb medicine, one is intervened with Chinese medicine enema and the other with acupuncture. Eight studies concluded that intervention with oriental medicine significantly decreased OHSS incidence. Five studies showed significantly higher pregnancy rate in the intervention groups. Two studies reported higher ovulation rate and other two studies showed more maturated eggs than the control groups. Four studies showed opposite results in serum Estradiol level. Vascular Endothelial Growth Factor level was significantly lower in the intervention groups in two studies. Conclusions: From ten studies, oriental medicine reduced OHSS incidence rate and showed preventable effectiveness. Further strictly designed studies and acupuncture intervened studies are needed to establish evidences.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.4
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• pp.368-373
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• 2021

Objective: In this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes. Methods: A prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses. Results: In the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients. Conclusion: Baseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.

• Clinical and Experimental Reproductive Medicine
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• v.39 no.1
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• pp.33-39
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• 2012

Objective: We devised a novel strategy, a GnRH antagonist protocol with a GnRH agonist trigger followed by frozen-thawed blastocyst transfers with long zona dissection (LZD). The purpose of this study was to investigate the clinical outcomes of this new strategy according to age. Methods: Ninety women aged less than 35 (group A) and 32 women aged 35 to 39 (group B) underwent the GnRH antagonist protocol with a GnRH agonist trigger in order to obtain many oocytes and prevent early-onset ovarian hyperstimulation syndrome (OHSS). All oocytes were cultured to the blastocyst stage and all blastocysts grade 3BB or better were cryopreserved. Embryo transfers were only performed in freeze-thaw cycles to prevent late-onset OHSS and to overcome embryo-endometrium dyssynchrony. LZD was performed just after thawing to improve hatching and implantation rates. Results: The average numbers of retrieved oocytes and blastocysts grade 3BB or better were $12.8{\pm}5.5$ and $4.4{\pm}2.6$ in group A and $10.9{\pm}7.4$ and $2.5{\pm}2.2$ in group B, respectively, and OHSS did not occur in any of the women. Implantation rates were 46.7% in group A and 39.3% in group B. Cumulative clinical pregnancy rates per retrieval were 77.8% in group A and 62.5% in group B. Cumulative ongoing pregnancy rates per retrieval were 71.1% in group A and 53.1% in group B. Conclusion: GnRH antagonist protocol with GnRH agonist trigger followed by frozen-thawed blastocyst transfers with LZD can generate many blastocysts without OHSS and maximize cumulative pregnancy rates per retrieval. This strategy is more effective in young women aged less than 35 than in women aged 35 to 39.

• Clinical and Experimental Reproductive Medicine
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• v.45 no.3
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• pp.135-142
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• 2018

Objective: To prospectively evaluate the efficacy and safety of a fixed early gonadotropin-releasing hormone (GnRH) antagonist protocol compared to a conventional midfollicular GnRH antagonist protocol and a long GnRH agonist protocol for in vitro fertilization (IVF) in patients with polycystic ovary syndrome (PCOS). Methods: Randomized patients in all three groups (early antagonist, n = 14; conventional antagonist, n = 11; long agonist, n = 11) received 21 days of oral contraceptive pill treatment prior to stimulation. The GnRH antagonist was initiated on the 1st day of stimulation in the early antagonist group and on the 6th day in the conventional antagonist group. The GnRH agonist was initiated on the 18th day of the preceding cycle. The primary endpoint was the number of oocytes retrieved, and the secondary endpoints included the rate of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and the clinical pregnancy rate. Results: The median total number of oocytes was similar among the three groups (early, 16; conventional, 12; agonist, 19; p= 0.111). The early GnRH antagonist protocol showed statistically non-significant associations with a higher clinical pregnancy rate (early, 50.0%; conventional, 11.1%; agonist, 22.2%; p= 0.180) and lower incidence of moderate-to-severe OHSS (early, 7.7%; conventional, 18.2%; agonist, 27.3%; p= 0.463), especially among subjects at high risk for OHSS (early, 12.5%; conventional, 40.0%; agonist, 50.0%; p= 0.324). Conclusion: In PCOS patients undergoing IVF, early administration of a GnRH antagonist may possibly lead to benefits due to a reduced incidence of moderate-to-severe OHSS in high-risk subjects with a better clinical pregnancy rate per embryo transfer. Further studies with more subjects are required.

• 대한생식의학회:학술대회논문집
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• 2004.11a
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• pp.46.2-47
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• 2004

• Clinical and Experimental Reproductive Medicine
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• v.28 no.1
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• pp.47-53
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• 2001

Objective: This study is to investigate the clinical efficacy of low-dose FSH regimen, comparing with clomiphene citrate and human menopausal gonadotropin (CC/hMG) regimen. Methods: Retrospective study of the ovulatory factor infertility 39 patients who had been treated by intrauterine insemination (IUI). The 31 cycles of 21 patients were stimulated by CC/hMG regimen, the 22 cycles of 18 patients were stimulated by low-dose FSH regimen. We compared the rate of clinical pregnancy, multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) of both group. Results: The rate of clinical pregnancy of the CC/hMG group was 25.7% per cycle, and that of the low-dose FSH group was 54.5% per cycle. The low-dose FSH group showed a higher rate of clinical pregnancy per cycle than CC/hMG group (p=0.028). However, no differences was found statistically in the rate of multiple pregnancy and OHSS between CC/hMG group (22.2%, 5.7%) and low-dose FSH group (33.3%, 13.6%). Conclusion: This study showed that the low-dose FSH regimen is superior to CC/hMG regimen in getting clinical pregnancy, but dose not reduce the ovulation induction complications.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.1
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• pp.49-56
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• 2007

Objective: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome(OHSS) without compromising pregnancy outcome. Method: Thirty-seven women who had been coasted during COH for IVF were coasted when $\geq$20 follicles > 15 mm with serum E$_2$ level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E$_2$ level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E$_2$ levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. Results: The mean serum E$_2$ level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E$_2$ level was 43% in one day coasting group and 15% (1$^{st}$ day) and 81% (2$^{nd}$ day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3(8.1%) patients. Conclusions: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.

• Clinical and Experimental Reproductive Medicine
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• v.42 no.2
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• pp.62-66
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• 2015

Objective: To evaluate the effect of a gonadotropin-releasing hormone (GnRH) antagonist protocol using corifollitropin alfa in women undergoing assisted reproduction. Methods: Six hundred and eighty-six in vitro fertilization-embryo transfer (IVF)/ intracytoplasmic sperm injection (ICSI) cycles were analyzed. In 113 cycles, folliculogenesis was induced with corifollitropin alfa and recombinant follicle stimulating hormone (rFSH), and premature luteinizing hormone (LH) surges were prevented with a GnRH antagonist. In the control group (573 cycles), premature LH surges were prevented with GnRH agonist injection from the midluteal phase of the preceding cycle, and ovarian stimulation was started with rFSH. The treatment duration, quality of oocytes and embryos, number of embryo transfer (ET) cancelled cycles, risk of ovarian hyperstimulation syndrome (OHSS), and the chemical pregnancy rate were evaluated in the two ovarian stimulation protocols. Results: There were no significant differences in age and infertility factors between treatment groups. The treatment duration was shorter in the corifollitropin alfa group than in the control group. Although not statistically significant, the mean numbers of matured (86.8% vs. 85.1%) and fertilized oocytes (84.2% vs. 83.1%), good embryos (62.4% vs. 60.3%), and chemical pregnancy rates (47.2% vs. 46.8%) were slightly higher in the corifollitropin alfa group than in the control group. In contrast, rates of ET cancelled cycles and the OHSS risk were slightly lower in the corifollitropin alfa group (6.2% and 2.7%) than in the control group (8.2% and 3.5%), although these differences were also not statistically significant. Conclusion: Although no significant differences were observed, the use of corifollitropin alfa seems to offer some advantages to patients because of its short treatment duration, safety, lower ET cancellation rate and reduced risk of OHSS.