• Clinical and Experimental Reproductive Medicine
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• v.27 no.1
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• pp.75-81
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• 2000

Objective: The objective of this study is to influence of sequential embryo transfers in an invitro fertilization was examined. Method: After in vitro fertilization, a maximum of 6 fertilized oocytes was enrolled in this study. At day 3 after an oocytes retrieval, embryos with good quality were transferred (mean 4.9), remaining embryos (mean 2.0/cycle) were cryopreserved at blastocyst stage (Group 1). At day 5 after oocytes collection, second a embryo transfer (mean 1.2/cycle) was performed, if one of these embryos had reached the blastocyst stage (Group 2) using P1 supplemented with 10 SSS and 30% Follicular fluid. No statistical difference in the pregnancy rate could be seen between the group without a second embryo transfer (n=21; 28.6%) and the group with a second transfer (n=52; 28.8%). Results: The incidence of multiple pregnancy rate per embryo transfer was not statistically different between both group and no high-rank multiple pregnancy (greater than triplete) were observed (0.9%, 15.4%, respectively, p=0.74, ${\chi}^2$). Out of 114 cycles (506 embryos) cultured embryos in group 2, 52 cycles (159 embryos, 29.8%) reached the blastocyst stage. Conclusion: The second transfer did not have a significant effect on the pregnancy rate. The most important factor for the pregnancy seems to be the quality of the embryos transferred on day 3 following oocyte retrieval. We recommend embryo transfer is performed only one, day $2{\sim}3$ or D5.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.2
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• pp.184-187
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• 2021

Radical trachelectomy is a fertility-preserving alternative to radical hysterectomy in carefully selected young women with early-stage cervical cancer. However, in cases with subsequent severe cervical stenosis, assisted reproductive techniques can be difficult. This is a case report of a 34-year-old patient who underwent robot-assisted radical trachelectomy and cerclage for early-stage (IB2) adenosquamous carcinoma. Three months after surgery, the patient underwent ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol. As it was impossible to perform transcervical embryo transfer due to the almost complete absence of the cervical opening, transmyometrial embryo transfer under ultrasound guidance was performed. This resulted in a successful singleton pregnancy. This is the first case of successful pregnancy conceived by in vitro fertilization with transmyometrial embryo transfer in a patient who had previously undergone robot-assisted radical trachelectomy.

• Clinical and Experimental Reproductive Medicine
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• v.31 no.4
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• pp.225-234
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• 2004

Objectives: To evaluate the efficacy of GnRH antagonist cetrorelix in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and to determine changes in serum hormone concentrations during cetrorelix administration. Methods: We performed a clinical trial on 30 patients undergoing COH with highly purified follicular stimulating hormone (HP-FSH) and gonadotropin releasing hormone antagonist (GnRHant), cetrorelix. FSH was administrated from day 2 or 3 of cycle with fixed dose and adjusted according to individual response. 0.25 mg of cetrorelix was injected daily subcutaneously from stimulation day 5 until the day of hCG administration. Daily ultrasound monitoring was performed for growing follicles and serum levels of luteinizing hormone (LH), estradiol ($E_2$) and progesterone were measured daily during cetrorelix administration. Up to 4 embryos were transferred. Results: Mean age of enrolled patients was $32.0{\pm}3.4$ years (mean $\pm$ S.D.). All of 30 patients underwent oocyte pick-up, and embryo transfer was done in 28 patients. The total and mean numbers of received oocytes were 196 and $6.5{\pm}4.7$, the number of fertilized eggs was 111, and the fertilization rate was 56.6%. Total duration of FSH administration was $9.2{\pm}2.2$ days and mean of $24.3{\pm}7.7$ ampules of HP-FSH was administered. Total duration of cetrorelix administration was $5.7{\pm}1.9$ days. Serum LH and progesterone levels were maintained in the range of $1.4{\sim}2.9\;mIU/mL$ and $0.3{\sim}0.6\;ng/mL$, which respectively reflected effective prevention of premature LH surge. Clinical pregnancies were achieved in 9 patients, and overall clinical pregnancy rate was 30.0% per oocyte retrieval, and 32.1% per embryo transfer. Conclusion: GnRH antagonist is safe and convenient for COH for IVF-ET and effective with optimal pregnancy rate.

• Clinical and Experimental Reproductive Medicine
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• v.43 no.2
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• pp.82-89
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• 2016

Objective: The long interspersed elements (LINE-1, L1s) are a group of genetic elements found in large numbers in the human genome that can translate into phenotype by controlling genes. Growing evidence supports the role of epigenetic in polycystic ovary syndrome (PCOS). The purpose of this study is to evaluate the DNA methylation levels in LINE-1 in a tissue-specific manner using cumulus cells from patients with PCOS compared with normal controls. Methods: The study included 19 patients with PCOS and 22 control patients who were undergoing controlled ovarian hyperstimulation. After oocyte retrieval, cumulus cells were extracted. LINE-1 DNA methylation levels were analysed by bisulfite treatment, polymerase chain reaction, and restriction enzyme digestion. The Connection Up- and Down-Regulation Expression Analysis of Microarrays software package was used to compare the gene regulatory functions of intragenic LINE-1. Results: The results showed higher LINE-1 DNA methylation levels in the cumulus cells of mature oocytes in PCOS patients, 79.14 (${\pm}2.66$) vs. 75.40 (${\pm}4.92$); p=0.004, but no difference in the methylation of cumulus cells in immature oocytes between PCOS and control patients, 70.33 (${\pm}4.79$) vs. 67.79 (${\pm}5.17$); p=0.155. However, LINE-1 DNA methylation levels were found to be higher in the cumulus cells of mature oocytes than in those of immature oocytes in both PCOS and control patients. Conclusion: These findings suggest that the epigenetic modification of LINE-1 DNA may play a role in regulating multiple gene expression that affects the pathophysiology and development of mature oocytes in PCOS.

• Clinical and Experimental Reproductive Medicine
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• v.22 no.2
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• pp.171-181
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• 1995

Ovarian hyperstimulation syndrome(OHSS) is one of the well-known complication of controlled ovarian hyperstimulation(COH). Though there have been numerous measures to prevent the occurrence of OHS, it has not been completely preventable until now. The fluid shift from the intravascular space to the third space is due to decreased oncotic pressure of the serum. The objective of this study was to evaluate if IV administration of 20% albumin in those patients with OHSS risk can make prevention of severe OHSS. We retrospectively analysed 70 patients undergoing IVF-ET who had serum peak estradiol($E_2$) level of >2,500 pg/ml and/or the number of oocytes retrieved over 20. The treatment group(n=39) received albumin while the control group(n=31) did not. After 40 grams of human albumin diluted in 1,000 ml of 0.9% sodium chloride solution, the treatment group received half of the fluid during oocyte retrieval, the remainder in the recovery suite. The results were as follows; There were significant differences in the levels of serum peak $E_2$ and number of oocytes retrieved between the two groups(p<0.05). However, there were no significant differences in the incidence of OHSS and pregnancy rate or multifetal pregnancy rate. In conclusion, administration of albumin to OHSS risk patients did not reduce the rate of OHSS in IVF-ET. However, if we consider the fact that there were differences in the level of peak serum $E_2$ and oocyte numbers, further prospective study may be needed.

• Korean Journal of Animal Reproduction
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• v.24 no.1
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• pp.83-88
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• 2000

This study was conducted to determine the effect of repeated ultrasound-guided transvaginal retrieval of oocytes recovery, estrous cycle and ovarian adhesion in Korean native, Hanwoo heifers. Heifers were at unknown stages of the estrous cycle at the start of experiments in which all follicles $\geq$6mm in diameter were ablated. The results obtained in this study were as follows; Follicle developing number and oocytes collected number were no effected to repeated OPU to nine session, 4 e.a range oocytes collected to repeated OPU session. Oocytes were observated follicles were 8.7$\pm$4.2 e.a, collected oocytes were 4.1$\pm$3.4 e.a to two times collected per week and observated follicles was 10.2$\pm$6.1 e.a, collected oocytes were 4.3$\pm$2.9 e.a to one times collected per week, but no difference significantly(P＜0.05). Ovaries adhesive percentage to repeated OPU was eight ovaries adhisived(20%) of forty ovaries, three ovaries(7.5%) to 1~3 times oocytes collected, four ovaries(l0%) to 4~6 times, one ovaries(2.5%) to 7~9 times oocytes collected session. To repeated OPU effection, ovaries adhisive heifers were long estrous cycle(＞25 day) to 7 heads(87.5%) of 8 head, non-adhesive ovaries heifers were 5 heads(41.7%) were long estrous cycle to repeated OPU 12 heads. Although, now unknown about the dynamics of follicles wave and about functional changes to repeated OPU ovaries, more question about ovaries adhesive cause remain.

• Clinical and Experimental Reproductive Medicine
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• v.44 no.4
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• pp.224-231
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• 2017

Objective: We studied the association between sperm DNA fragmentation (SDF) and several clinical in vitro fertilization outcomes. Methods: We retrospectively analyzed 169 consecutive fresh IVF cycles. Semen was collected on the day of oocyte retrieval, and we assessed standard semen parameters and the SDF level (by terminal deoxynucleotidyl transferase dUTP nick-end labeling). Poor ovarian response (POR) was defined as the collection of three or fewer mature oocytes. Oocytes were inseminated by the conventional method or intracytoplasmic sperm injection. Results: SDF did not affect the fertilization or pregnancy rate, but did have a significant effect on the miscarriage rate. In the miscarriage group (n = 10), the SDF level was significantly higher (23.9% vs. 14.1%) and number of mature oocytes was significantly lower (4.3 vs. 7.6) than in the live birth group (n = 45). Multiple regression analysis showed that SDF was an independent predictor of miscarriage (odds ratio, 1.051; 95% confidence interval, 1.001-1.104). The cutoffs for the SDF level and number of mature oocytes that could predict miscarriage were > 13% and ${\leq}3$, respectively. In the low-SDF group (${\leq}13%$), the miscarriage rate was similar in POR patients and those with a normal ovarian response (NOR; 14.2% vs. 4.3%). In the high-SDF group ( > 13%), the miscarriage rate was significantly higher in the POR group than in the NOR group (60.0% vs. 13.3%, p= 0.045). Conclusion: Our study demonstrated that a high SDF level ( > 13%) was associated with a high miscarriage rate, and that it mainly contributed to miscarriage in the POR group. The results suggest that SDF measurements should be considered in couples with POR in order to predict the prognosis of the pregnancy.

• Development and Reproduction
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• v.1 no.1
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• pp.67-77
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• 1997

Mammalian ovary consists of various growing stages of follicles. Ovarian follicular growth and differentiation, however, can be distinguished into recruitment, growth, selectiona nd ovulation. while only minute of the selected follicles ovulate their oocytes, all the rest follicles disappear by atresia. this atresia is an important event of which physiological mechanism must be resolved. The present study was carried out to investigate the effects of various doses of pregnant mare's serum gonadotropin (PMSG) on the oocyte quality, ovulation rate, and the early embryonic development in immature mice. Immature mice were administrated with 5, 20, or 40 IU PMSG. At every 12 hour up to 72 hour after treatment, body and ovary weights were measured. Oocytes were flushed from the oviducts under the dissecting microscope and observed under the inverted microscope. Late 2-cell embryos were collected from the mice which were superovulated by the same dosage of PMSG followed by 5 IU hCG 47 hours after PMSG-treatment. The percentage of abnormal oocytes was higher in 20 or 40 IU PMSG-treated animals than 5 IU PMSG-treated ones. Ovulation occured at 12 hours afger PMSG injection in all experimental groups. The percentage of retrieved abnormal oocytes increased in the 20 or 40 IU PMSG-treated goups but not in 5 IU PMSG-treated group. There was no significant difference in the mating rate among the groups [52.6% (10/19), 66.7% (10/15), 44.0% (11/25) : 5, 20, 40 IU group respectively] ; however, ther was a significant (p<0.01) increase of embryo retrieval rates in 5 and 20 IU-treated groups compared with that in 40 IU-treated group [89.2% (239-268), 85.5% (224/262), 40.0% (18/45)]. There was significant (p<0.01) increase of embryo development rates in 5 IU-treated group compared with that in 20 and 40 IU-treated group [231/239(96.7), 179/224(79.9), 77.8(14/18)]. In conclusion, higher doses of PMSG injection increased the occurrence of abnormal oocytes ovulation in immature mice. The most of oocytes collected from 5 or 20 IU-PMSG-treated group has fertilizabioity. But in mice injected iwth higher doses of PMSG, their oocytes exhibit less fertilizability and, even fertilized, all oocytes are not fully capable of development.

• Clinical and Experimental Reproductive Medicine
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• v.15 no.1
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• pp.25-34
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• 1988

The intrafo1licular echoes of cumulus oophoruses within ovarian follicles were assessed with the use of ultrasound in 86 women taking part in an in vitro fertilization(IVF) or gamete intrafallopian transfer(GIFT) program, stimulated with pure follicle-stimulating hormone(FSH)/human menopausal gonadotropin(hMG)/human chorionic gonadotropin (hCG). When intrafo1licular echoes were clearly separated from the follicular wall or relatively dispersed within the follicle, they were considered to be a dissociated cumulus, and when they were only slightly prominent from the follicular wall, they were suspected to be a nondissociated cumulus. A cumulus was seen in 62.1% of the follicles larger than 10 mm diameter and 75.1% of them were dissociated. The larger the follicles in size, the more the cumuluses in number and dissociation. The number of follicles and intrafollicular echoes per woman was not different whether or not she would be pregnant, but the number of dissociated cumuluses was significantly more in pregnant women. The number of observed dissociated cumuluses correlated significantly with the number of recovered mature oocytes. When an intrafollicular echo is seen, it can be taken as evidence of a sign of maturity of that particular follicle and oocyte. Ultrasonographic monitoring of intrafollicular echoes and follicular size is very helpful to predict follicular maturation in ovulation stimulation cycles.

• Clinical and Experimental Reproductive Medicine
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• v.42 no.3
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• pp.118-125
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• 2015

Objective: The goal of this study was to evaluate the pregnancy potential of immature (metaphase I or germinal vesicle stage) oocytes retrieved in intracytoplasmic sperm injection (ICSI) cycles. Methods: A total of 1,871 couples with infertility underwent 2,984 ICSI cycles. Cycles in which three or fewer oocytes were retrieved were included in this study in order to evaluate the pregnancy potential of immature oocytes. Cycles were divided into five groups (group I-V), according to the maturation status of the oocytes at the time of cumulus cell removal and ICSI. The fertilization and pregnancy rates after ICSI were analyzed and compared among the study groups based on the maturation status of the retrieved oocytes. Results: The retrieval of only immature oocytes was associated with a significant decrease in the fertilization rate ($76.1%{\pm}37.3%$ vs. $49.0%{\pm}49.1%$, $66.7%{\pm}48.7%$; group I vs. group II, group III, respectively) and the average number of transferred embryos ($1.5{\pm}0.7$ vs. $1.1{\pm}0.4$, $1.1{\pm}0.6$). The cycle cancellation rate was significantly higher when only immature oocytes were retrieved. The clinical pregnancy rate decreased significantly when the transferred embryos had originated from immature oocytes (16.9% vs. 10.3%, 1.2%). Conclusion: In ICSI cycles, the fertilization potential and pregnancy potential of the immature oocytes retrieved in ICSI cycles were inferior to those of mature oocytes. Therefore, increasing the number of injectable oocytes and transferrable embryos by using immature oocytes after their spontaneous in vitro maturation does not necessarily improve pregnancy outcomes.