• Title/Summary/Keyword: Pregnancy Outcomes

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Comparison of assisted reproductive technology outcomes in infertile women with polycystic ovary syndrome: In vitro maturation, GnRH agonist, and GnRH antagonist cycles

  • Choi, Min Hye;Lee, Sun Hee;Kim, Hye Ok;Cha, Sun Hwa;Kim, Jin Young;Yang, Kwang Moon;Song, In Ok;Koong, Mi Kyoung;Kang, Inn Soo;Park, Chan Woo
    • Clinical and Experimental Reproductive Medicine
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    • v.39 no.4
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    • pp.166-171
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    • 2012
  • Objective: We compared the assisted reproductive technology (ART) outcomes among infertile women with polycystic ovary syndrome (PCOS) treated with IVM, conventional IVF, GnRH agonist, and GnRH antagonist cycles. Methods: The prospective study included a total of 67 cycles in 61 infertile women with PCOS. The women with PCOS were randomized into three IVF protocols: IVM/IVF with FSH and hCG priming with immature oocyte retrieval 38 hours later (group A, 14 cycles), GnRH agonist long protocol (group B, 14 cycles), and GnRH antagonist multi-dose flexible protocol (group C, 39 cycles). IVF outcomes, such as clinical pregnancy rate (CPR), implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR), were compared among the three groups. Results: Age, BMI, and basal FSH and LH levels did not differ among the three groups. The number of retrieved oocytes and 2 pronucleus embryos was significantly lower in group A compared with groups B and C. The CPR, IR, MR, and LBR per embryo transfer showed no differences among the three groups. There was no incidence of ovarian hyperstimulation syndrome in group A. Conclusion: The IR, MR, and LBR in the IVM cycles were comparable to those of the GnRH agonist and GnRH antagonist cycles. The IVM protocol, FSH and hCG priming with oocyte retrieval 38 hours later, is an effective ART option that is comparable with conventional IVF for infertile women with PCOS.

Antenatal Corticosteroids and Clinical Outcomes of Preterm Singleton Neonates with Intrauterine Growth Restriction

  • Kim, Yoo Jinie;Choi, Sung Hwan;Oh, Sohee;Sohn, Jin A;Jung, Young Hwa;Shin, Seung Han;Choi, Chang Won;Kim, Ee-Kyung;Kim, Han-Suk;Kim, Beyong Il;Lee, Jin A
    • Neonatal Medicine
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    • v.25 no.4
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    • pp.161-169
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    • 2018
  • Purpose: We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants. Methods: A retrospective study was conducted with singletons born at $23^{+0}$ to $33^{+6}weeks$ of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at <2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed. Results: 304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups. Conclusion: ACS was not effective in reducing morbidities in IUGR preterm infants.

The Effect of the Serum Progesterone and Estradiol Levels of hCG Administration Day on the Pregnancy and Fertilization Rate in IVF-ET Patients (체외수정 과배란 유도에서 hCG 주사 당일의 혈청 Progesterone과 Estradiol 농도가 수정율 및 임신율에 미치는 영향에 관한 연구)

  • Lee, Eun-Sook;Lee, Sang-Hoon;Bae, Do-Hwan
    • Clinical and Experimental Reproductive Medicine
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    • v.23 no.1
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    • pp.51-59
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    • 1996
  • Controlled Ovarian hyperstimulation(COH) is generally used to obtain synchronous high quality oocytes in in vitro fertilization-embryo transfer(IVF-ET). Many investigators have studied the relationship between serum hormone levels and outcomes of IVF-ET because there is no accurate estimation method of oocyte quality. Early premature luteinization of follicles before oocyte retrieval is the most troublesome problem in COH for IVF-ET. Gonadotropin-releasing hormone agonists(GnRH-a) are used as adjuncts with gonadotropins for COH in patients undergoing in IVF. The possible benefits of GnRH-a pretreatment include improving oocyte quality, allowing a more synchronous cohort of follicles to be recruited, and preventing premature lueinization hormone surges. In COH of IVF cycles, we investigated whether an elevated progesterone(P4) level on the day of human chorionic gonadotropin(hCG) administration indicates premature luteinization and is associated with a lower fertilization rate. Many investigators have studied that the lower fertilization rates seen in patients with elevated P4 levels might result from an adverse effect of P4 on the oocytes. We hypothesizes that serum P4 levels around the day of hCG may be helpful prediction of out come in IVF-ET cycles. Success rates after COH of IVF-ET cycles are dependent upon many variable factors. Follicular factors including the number of follicles, follicular diameters and especially serum estradiol(E2) levels as an indirect measurement of follicular function and guality have been thought to influence the outcomes of IVF-ET. To assess whether serum P4 and E2 levels affect the fertilization and pregnancy rate, we reviewed the stimulation cycles of 113 patients (119 cycles) undergoing IVF-ET with short protocol with GnRH-a, from March 1993 to August 1994 retrospectively. The serum P4 and E2 levels were compared on the day of hCG in the pregnant group, 45 patients(47 cycles) and in the non-pregnant group, 68 patients (72 cycles) respectively. The serum E2 level in non-pregnant group was $1367{\pm}875.8$ pg/ml which was significantly lower than that of pregnant group, $1643{\pm}987.9$ pg/ml( p< 0.01 ). And the serum P4 level in non-pregnant group was $2.1{\pm}1.4$ ng/ml which was significantly higher than that of pregnant group, $1.0{\pm}0.7$ ng/ml( p< 0.001 ). The fertilization rate was $61.3{\pm}21.3%$ in pregnant group which was higher than that of non-pregnant group, $41.1{\pm}20.2%$ (p< 0.01). We suggest that the serum levels of P4 and E2 on the day of hCG administration are additional parameters that predict the outcomes of IVF-ET cycles.

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Impact of fetal diagnosis of congenital heart disease on parents (선천성 심질환의 산전 진단이 보호자의 임신 유지 결정에 미치는 영향)

  • Choi, Eun Young;Lee, Chang Hoon;Yoon, Myung Ja;Han, Eun Sook;Hong, Joon Suk;Jung, Yun Sook;Choi, Jung Yun
    • Clinical and Experimental Pediatrics
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    • v.49 no.10
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    • pp.1073-1078
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    • 2006
  • Purpose : This study was performed to assess how a fetal diagnosis of congenital heart disease affects parents, as regards pregnancy management and care of infants after birth. Methods : Database search to find out abnormal fetal echocardiography performed at Seoul National University Children's Hospital from July 1988 to June 2003 revealed 370 examinations. After excluding both arrhythmias without structural cardiac disease and multiple pregnancies, 299 pregnancies remained and this data formed the basis of this analysis. We retrospectively reviewed the medical records with special attention to pregnancy outcomes and also tried to find out factors influencing parental decisions on whether to continue or terminate pregnancy. Results : In this study, the mean gestation age at diagnosis was $28{\pm}6.0weeks$. The mean age of mothers was $30{\pm}3.9$ years old. Younger gestational ages at diagnosis(P=0.000), more severe grades of fetal heart disease(P=0.002) and younger mothers(P=0.014) correlated with terminations of pregnanies. But the grades of fetal status, the grades of associated anomaly, whether in-vitro-fertilization was carried out or not and numbers of previous children were not significant. Conclusion : This study found that the earlier gestational ages at diagnosis, younger maternal age and higher grades of fetal heart disease tended to lead parent to select abortions. Fetal echocardiographies were performed too late. Moreover Koreans have a biased view that malformation is a something incurable and a tragedy not only to oneself, but also to a family. So parents select terminations of pregnancy, even in curable cases. This is very unethical.

Obstetric Complications by the Accessibility to Local Obstetric Service (지역별 분만서비스 접근도에 따른 산과적 합병증 비교)

  • Choi, Young Hyun;Na, Baeg Ju;Lee, Jin Yong;Hwang, Ji Hye;Lim, Nam Gu;Lee, Seong Ki
    • Journal of agricultural medicine and community health
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    • v.38 no.1
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    • pp.14-24
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    • 2013
  • Objectives: Pregnant women in rural areas do not have access to sufficient obstetric services in their own communities due to the shortage of obstetricians. Therefore, most of these women must seek obstetrician outside of their communities. The purpose of this study was to investigate the relationship between obstetric complications and accessibility to local obstetric care in Korea. Methods: This study was an ecological study in which the unit of analysis was an administrative district. Using Korea National Health Insurance Corporation data, the total number of deliveries and the delivery proportion within and outside of the community from 2001 to 2008 were calculated for 232 administrative districts nationwide. Three outflow levels were categorized based on each district's out-of-community delivery proportion: high outflow (upper one third), moderate outflow (middle one third), and low outflow (lower one third). In addition, three obstetric complication rates (the rate of complications following abortion, ectopic and molar pregnancy, the abortion rate, and the eclampsia rate) were calculated for the 232 districts. One-way ANOVA and multivariate linear regression were used to evaluate obstetric complications among the three outflow levels. Results: The high outflow districts had higher rates of eclampsia and complications following abortion, ectopic, and molar pregnancy compared to the other districts (ANOVA, p<0.05). However, there was no significant difference in the abortion rate among the three groups. Multiple linear regression analysis showed that high outflow districts were statistically significant in the rate of complications following abortion, ectopic and molar pregnancy and eclampsia rate after adjusting for local tax per capita (p<0.01). Conclusion: These results indicate that poor access to local obstetric care correlate with poor obstetric outcomes (delayed or excessive bleeding, embolism, genital tract or pelvic infection, shock or other complications following abortion and ectopic or molar pregnancy, or eclampsia).

Air Pollution Exposure and Low Birth Weight of Firstborn Fetus -A Birth Cohort Study in Seoul, 1999-2003- (대기오염 노출이 첫 출산아 저체중에 미치는 영향에 관한 연구 -서울지역 1999년~2003년 출생코호트를 중심으로-)

  • Cho, Yong-Sung;Son, Ji-Young;Lee, Jong-Tae
    • Journal of Environmental Health Sciences
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    • v.33 no.4
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    • pp.227-234
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    • 2007
  • Recent epidemiologic studies show that gestational exposure to air pollution adversely affects pregnancy outcomes including low birth weight in preform birth. In this study, we evaluated the effect of air pollutants on LBW (low birth weight) on firstborn fetus throughout the gestational period using the birth cohort between 1999 and 2003 in Seoul. Using birth cohort data from the National Statistics Office of Korea we identified 288,346 firstborn births (excluded missing data on lack of information for birth weight and discordance between residential and certificated address from a total of 316,451) during 1999 to 2003 with complete covariate (gender, parity, date of birth, gestational age, parental age and educational level, maternal occupation etc.) and maternal residential history data. Our subjects were defined as more than 37 weeks and less than 44 weeks of completed gestation and we identified 5,457 persons (1.89%) by low birth weight (<2.5 kg) in this study. Using logistic regression, we estimated the risk of mean (entire pregnancy and trimester period) air pollution concentrations for CO, $O_3,\;PM_{10},\;NO_2\;and\;SO_2$. In terms of trimester-specific exposure, we found that some air pollutants exposure in each trimester would increase the risk for LBW. Results also showed that the effect size of air pollutants exposure during the first and third trimester is higher than during the second trimester. In all trimester, the estimated risk of LBW was 1.831 (95% CI=1.573-2.132) with unit increase for CO, 1.139 (95% CI=1.107-1.172) for 50, and 1.009 (95% CI=1.001-1.017) for $O_3$. Our results suggest that exposure during the gestation period to relatively low levels of some air pollutants may be associated with a reduction in birth weight on first-born fetus. These findings implicate the effective risk management strategies should be applied to minimize the public health impacts for pregnant women.

Artificial oocyte activation in intracytoplasmic sperm injection cycles using testicular sperm in human in vitro fertilization

  • Kang, Hee Jung;Lee, Sun-Hee;Park, Yong-Seog;Lim, Chun Kyu;Ko, Duck Sung;Yang, Kwang Moon;Park, Dong-Wook
    • Clinical and Experimental Reproductive Medicine
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    • v.42 no.2
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    • pp.45-50
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    • 2015
  • Objective: Artificial oocyte activation (AOA) is an effective method to avoid total fertilization failure in human in vitro fertilization-embryo transfer (IVF-ET) cycles. AOA performed using a calcium ionophore can induce calcium oscillation in oocytes and initiate the fertilization process. We evaluated the usefulness of AOA with a calcium ionophore in cases of total fertilization failure in previous cycles and in cases of severe male factor infertility patients with non-motile spermatozoa after pentoxifylline (PF) treatment. Methods: The present study describes 29 intracytoplasmic sperm injection (ICSI)-AOA cycles involving male factor infertility at Cheil General Hospital from January 2006 to June 2013. Patients were divided into two groups (control, n=480; AOA, n=29) depending on whether or not AOA using a calcium ionophore (A23187) was performed after testicular sperm extraction-ICSI (TESE-ICSI). The AOA group was further split into subgroups according to sperm motility after PF treatment: i.e., motile sperm-injected (n=12) and non-motile sperm-injected (n=17) groups (total n=29 cycles). Results: The good embryo rate (52.3% vs. 66.9%), pregnancy rate (20.7% vs. 52.1%), and delivery rate (10.3% vs. 40.8%) were lower in the PF/AOA group than in the control group. When evaluating the effects of restoration of sperm motility after PF treatment on clinical outcomes there was no difference in fertilization rate (66.6% vs. 64.7% in non-motile and motile sperm, respectively), pregnancy rate (17.6% vs. 33.3%), or delivery rate (5.9% vs. 16.7%) between the two groups. Conclusion: We suggest that oocyte activation is a useful method to ensure fertilization in TESE-ICSI cycles regardless of restoration of sperm motility after PF treatment. AOA may be useful in selected patients who have a low fertilization rate or total fertilization failure.

The Efficacy of Recombinant Human Follicle Stimulating Hormone (rhFSH) in Human IVF-ET Program (체외수정시술시 유전자 재조합 난포자극호르몬제의 효용성)

  • Han, Kuk-Sun;Lee, Hong-Bok;Song, In-Ok;Park, Yong-Seog;Byun, Hye-Kyung;Jun, Jin-Hyun;Koong, Mi-Kyoung
    • Clinical and Experimental Reproductive Medicine
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    • v.29 no.1
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    • pp.45-56
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    • 2002
  • Objectives: Recently, recombinant FSH (rFSH) has been manufactured using a Chinese hamster ovary cell line transfected with the gene encoding human FSH. Both rFSH and urinary gonadotropin (uFSH) could be used for controlled ovarian hyperstimulation (COH). However, uFSH implies a number of disadvantages, such as batch-to-batch inconsistency, no absolute source control, dependence on large amounts of urine, low specific activity, and low purity. The purpose of this study was to evaluate the efficacy of rFSH in human IVF-ET program. Materials and Methods: A total of 508 infertile women was enrolled in this study. They are classified into rFSH group (n=177) or uFSH group (n=331), and all of them were matched by age and cause of infertility in same period. The $Puregon^{(R)}$ (Organon, Holland) was used as rFSH, and the Metrodin-$HP^{(R)}$ (Serono, Switzeland) and $Humegon^{(R)}$ (Organon, Holland) was used as uFSH. We subdivided the patients into three age groups. The outcomes of IVF-ET program were analyzed using the statistical package for social sciences (SPSS). Results: There was no significant differences in the level of estradiol on hCG injection day, the numbers of retrieved oocytes, matured oocytes, fertilized oocytes, transferred embryos, frozen embryos between the two groups. The total dose (IU) of gonadotropin for COH was significantly lower in the rFSH group compared to uFSH group ($1339{\pm}5491.1$ vs $2527.8{\pm}1075.2$ IU, p<0.001). Clinical pregnancy rate per embryo transfer in the rFSH group showed increasing tendency, compared to the uFSH group, but there was no statistical significance (35.2% vs 29.3%). Our results demonstrated that the relative efficiency of rFSH compared with uFSH is higher in older patients. Conclusions: The ovarian stimulatory effect and clinical outcome of recombinant FSH was similar to that of the urinary gonadotropin. The IVF-ET cycles with significantly lower dose of gonadotropin in rFSH group showed comparable results. Therefore, we suggest that recombinant FSH is more potent and effective than urinary gonadotropin.

Luteal estradiol supplementation in gonadotropin-releasing hormone antagonist cycles for infertile patients in vitro fertilization

  • Kwon, Su-Kyoung;Kim, Chung-Hoon;Lee, Kyung-Hee;Jeon, Il Kyung;Ahn, Jun-Woo;Kim, Sung-Hoon;Chae, Hee-Dong;Kang, Byung-Moon
    • Clinical and Experimental Reproductive Medicine
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    • v.40 no.3
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    • pp.131-134
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    • 2013
  • Objective: To evaluate the effect of the addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles for infertile patients undergoing IVF/ICSI. Methods: One hundred and ten infertile patients, aged 28 to 39 years, were recruited for this prospective randomized study. They were randomly assigned to receive vaginal progesterone gel (Crinone) along with 4 mg estradiol valerate (group 1, n=55) or only Crinone (group 2, n=55) for luteal support. A GnRH antagonist multiple dose protocol using recombinant human FSH was used for controlled ovarian stimulation (COS) in all of the subjects. The COS results and pregnancy outcomes of the two groups were compared. Results: Group 1 and 2 were comparable with respect to the patient characteristics. The COS and IVF results were also comparable between the two groups. There were no differences in the clinical pregnancy rate (PR) and multiple PR between the two groups. However, the embryo implantation rate were significantly higher in group 1 than that in group 2 (22.2% vs. 13.3%, p=0.035). The incidence of luteal vaginal bleeding (LVB) was significantly lower in group 1 (7.4% vs. 27.8%, p=0.010). Conclusion: The addition of estradiol to luteal progesterone supplementation in GnRH antagonist cycles reduces the incidence of LVB and increases the embryo implantation rate in infertile patients undergoing IVF/ICSI.

Comparison of mild ovarian stimulation with conventional ovarian stimulation in poor responders

  • Yoo, Ji-Hee;Cha, Sun-Hwa;Park, Chan-Woo;Kim, Jin-Young;Yang, Kwang-Moon;Song, In-Ok;Koong, Mi-Kyoung;Kang, Inn-Soo;Kim, Hye-Ok
    • Clinical and Experimental Reproductive Medicine
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    • v.38 no.3
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    • pp.159-163
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    • 2011
  • Objective: To compare the IVF outcomes of mild ovarian stimulation with conventional ovarian stimulation in poor responders. Methods: From 2004 to 2009, 389 IVF cycles in 285 women showed poor responses (defined as either a basal FSH level ${\geq}$12 mIU/mL, or the number of retrieved oocytes ${\leq}$3, or serum $E_2$ level on hCG day <500 pg/mL) were analyzed, retrospectively. In total, 119 cycles with mild ovarian stimulation (m-IVF) and 270 cycles with conventional ovarian stimulation (c-IVF) were included. Both groups were divided based on their age, into groups over and under 37 years old. Results: The m-IVF group was lower than the c-IVF group in the duration of stimulation, total doses of gonadotropins used, serum $E_2$ level on hCG day, the number of retrieved oocytes, and the number of mature oocytes. However, there was no significant difference in the number of good embryos, the number of transferred embryos, the cancellation rate, or the clinical pregnancy rate. In the m-IVF group over 37 years old, the clinical pregnancy rate and live birth rate were higher when compared with the c-IVF group, but this result was not statistically significant. Conclusion: In poor responder groups, mild ovarian stimulation is more cost effective and patient friendly than conventional IVF. Therefore, we suggest that mild ovarian stimulation could be considered for poor responders over 37 years old.