• The Journal of Korean Medicine
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• v.32 no.5
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• pp.25-40
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• 2011

Objectives: This study was performed to assess whether herbal medicine and acupuncture before in vitro fertilizationembryo transfer (IVF-ET) is effective on clinical pregnancy. Methods: From May 2010 to January 2011, a prospective analysis study was performed in 38 patients planning to undergo IVF-ET after taking herb medicine and acupuncture treatment. This study investigated the pregnancy rate and analyzed the change of dysmenorrhea by visual analog scale (VAS), body heat and condition of premenstrual syndrome (PMS), vaginal discharge and menstruation status. Results: 1. During herbal medicine and acupuncture treatment, five patients (13.16%) naturally became pregnant and six patients (15.79%) withdrew. After treatment, 15 patients (39.47%) received IVF-ET, 12 patients (31.58%) did not. 2. The biochemical pregnancy rate was 26.67%, the clinical pregnancy rate 26.67%, miscarriage rate 25% and ectopic pregnancy rate was 0%. 3. After treatment, PMS, dysmenorrhea and dysmenorrhea VAS was significantly decreased and the overall menstrual status improved. 4. After treatment, temperature difference of CV17-CV12 and CV4-CV12 increased, but it was not a statistically significant difference. 5. After treatment, decrease of hemoglobin and protein and increase of total bilirubin and creatinine were statistically significant. All the blood test results were within normal levels which proves safety of treatment. Conclusions: This study suggests that herbal medicine and acupuncture treatment before IVF-ET shows similar pregnancy rates with existing rates, but contributes to increasing the possibility of natural pregnancy.

• Clinical and Experimental Reproductive Medicine
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• v.27 no.2
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• pp.173-177
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• 2000

연구목적: 한국여성의 다낭성 난포증후군 환자에서 황체형성 호르몬 exon 2 유전자의 변이를 탐색하여 이들 변이와 질환과의 관련성 여부를 밝히고자 하였다. 연구재료 및 방법: 21명의 다낭성 난포증후군 환자를 대상으로 황체형성 호르몬 exon 2(Trp8Arg;TGG to CGG and Ile15Thr; ATC to ACC)의 변이를 탐색하였다. 혈액에서 Genomic DNA를 추출하여 PCR로 증폭한 후 RFLP 방법으로 변이형을 구분하였다. 결과: 황체형성 호르몬 exon 2의 변이형이 다낭성 난포증후군 환자에서 28.6%로 이미 조사된 바 있는 대조군의 16.7% 보다 약간 높게 나타났으나 통계적으로 유의한 차이는 없었다(p>0.05). 결론: 황체형성 호르몬 exon 2의 변이가 한국인의 다낭성 난포증후군 발병과 관련이 있는지를 밝히기 위해 더 많은 개체에 대한 연구가 요구된다.

• Clinical and Experimental Reproductive Medicine
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• v.13 no.1
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• pp.21-28
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• 1986

It is now apparent that many cases of amenorrhea. oligomenorrhea. corpus luteum deficiency, galactorrhea, and infertility are due to hyperprolactinemia. We investigated the relationships between serum prolactin values and factors such as menstrual pattern, frequency of galactorrhea etc, in 135 hyperproIactinemic patients at the Seoul National University Hospital during a period of 6 years, from January, 1979 to December, 1984. The results was as follows: 1. Menstrual pattern changed according to the serum prolactin level. The frequency of amenorrhea is 1.7 percent in patients with serum prolactin levels ranged from $25{\sim}40ng/ml$, whereas 72.4 percent in patients with serum prolactin levels above 100ng/ml. 2. The incidence of galactorrhea in hyperprolactinemic patients was 3.1 percent and the frequency of galactorrhea had direct relationship with the serum prolactin level and/or the frequency of abnormal menstrual pattern. 3. The incidence of pituitary tumor in hyperprolactinemic patients was 104 percent and sixty percent of patients with serum prolactin levels above 100ng/ml had a pituitary tumor . 4. There was an inverse correlation between serum prolactin and progesletone value. 5. The frequency of anovulatory menstrual cycle evidenced by basal body temperature is 23.9 percent in patients with serum prolactin levels ranged from $20{\sim}40ng/ml$, whereas 76.9 percent in patients with serum prolactin levels above 100ng/ml.

• Clinical and Experimental Reproductive Medicine
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• v.14 no.1
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• pp.1-6
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• 1987

The Radionuclide test (RN test) using radioactively labelled human albumin microspheres was developed recently to evaluate the patency and functional capacity of the fallopian tubes. 57 infertile women underwent this procedure as a part of their infertility work up. The results of the radionuclide evaluation were compared with those of the hysterosalpingography (HSG) and further the surgical findings of the laparoscopy and laparotomy. In 64.9%(37/57) of the cases, there was complete agreement between radionuclide test (RN test), hysterosalpingography(HSG) and surgical findings. In comparison with surgical findings, RN test showed a complete agreement rate of 89.4%(51/57), a partial agreement rate of 5.3%(3/57) and no agreement rate of 5.3%(3/57), respectively. Likewise, HSG revealed a complete agreement rate of 80.7%(46/57), a partial agreement rate of 10.5%(6/57) and no agreement 8.8%(5/57), respectively. It would appear that as opposed to the traditional HSG, RN test may give a better understanding of the functional capacity of the tube and may prove a useful method before and after tubal surgery.

• Clinical and Experimental Reproductive Medicine
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• v.24 no.3
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• pp.293-300
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• 1997

The aim of present study was to determine the efficacy of immunotherapy with paternal lymphocytes for unexplained infertility. It has been apparent that reproductive success may be affected by the presence of abnormal autoantibodies. Unexplained infertility and repeated pregnancy wastage has been reported in the presence of abnormal autoantibodies. These data suffest that abnormal immune function may be an important pathologic entity contributing subfertility in patients with unexplained infertility. Therefore, immunotherapy may be a possible treatment modality for patients with unexplained infertility. Some investigators have reported that a proportion of infertile couples with repeatedly unsuccessful ET showed close histocompatibility similar to those of spontaneous recurrent abortion. Recently, it has been noted that immunotherapy with paternal lymphocytes achieves a high efficacy in preventing subsequent abortion in women with primary recurrent abortion of unknown cause, which was mediated by immune reaction including blocking antibody. To substantiate the hypothesis, we applied immunotherapy preceding Peritoneal Oocyte and Sperme transfer (POST) to 43 patients, 47 cycles of 82 patients, 89 cycles with at least three previous IUI failure from April, 1993 to February, 1995. There were no significant differences between treatment and control group in clinical response and hormonal response to controlled hyperstimulation. there was no significant difference between treatment and control group in pregnant rates per cycles (42.6% versus 28.6%), but a significantly lower abortion rate per pregnancy in treatment group, with 10.0% (2/20) compared with 50.03% (6/12) in control group. This study may suggest that immune therapy for patients with unexplained infertility with paternal lymphocytes might be beneficial.

• Clinical and Experimental Reproductive Medicine
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• v.32 no.4
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• pp.315-324
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• 2005

Objectives: To compare the efficacy of GnRH antagonist multiple dose protocol (MDP) with that of GnRH agonist long protocol (LP) in controlled ovarian hyperstimulation for in vitro fertilization in patients with high basal FSH (follicle stimulating hormone) level or old age, a retrospective analysis was done. Methods: Two hundred ninety four infertile women (328 cycles) who were older than 41 years of age or had elevated basal FSH level (> 8.5 mIU/mL) were enrolled in this study. The patients had undergone IVF-ET after controlled ovarian hyperstimulation using GnRH antagonist multiple dose protocol (n=108, 118 cycles) or GnRH agonist long protocol (n=186, 210 cycles). The main outcome measurements were cycle cancellation rate, consumption of gonadotropins, the number of follicles recruited and total oocytes retrieved. The number of fertilized oocytes and transferred embryos, the clinical pregnancy rates, and the implantation rates were also reviewed. And enrolled patients were divided into three groups according to their age and basal FSH levels; Group A - those who were older than 41 years of age, Group B - those with elevated basal FSH level (> 8.5 mIU/mL) and Group C - those who were older than 41 years of age and with elevated basal FSH level (> 8.5 mIU/mL). Poor responders were classified as patients who had less than 4 retrieved oocytes, or those with $E_2$ level <500 pg/mL on the day of hCG injection or those who required more than 45 ampules of exogenous gonadotropin for stimulation. Results: The cancellation rate was lower in the GnRH antagonist group than in GnRH agonist group, but not statistically significant (6.8% vs. 9.5%, p=NS). The amount of used gonadotropins was significantly lower in GnRH antagonist group than in agonist group ($34.8{\pm}11.3$ ampules vs. $44.1{\pm}13.4$ ampules, p<0.001). The number of follicles > 14 mm in diameter was significantly higher in agonist group than in antagonist group ($6.7{\pm}4.6$ vs. $5.0{\pm}3.4$, p<0.01). But, there were no significant differences in clinical pregnancy rate (24.5% in antagonist group vs. 27.4% in agonist group, p=NS) and implantation rate (11.4% in antagonist group vs. 12.0% in agonist group, p=NS) between two groups. Mean number of retrieved oocytes was significantly higher in GnRH agonist LP group than in GnRH antagonist MDP group ($5.4{\pm}3.5$ vs. $6.6{\pm}5.0$, p<0.0001). But, the number of mature and fertilized oocytes, and the number of good quality (grade I and II) and transferred embryos were not different between two groups. In each group A, B, and C, the rate of poor response did not differ according to stimulation protocols. Conclusions: In conclusion, for infertile women expected poor ovarian response such as who are old age or has elevated basal FSH level, a protocol including a controlled ovarian hyperstimulation using GnRH antagonist appears at least as effective as that using a GnRH agonist, and may offer the advantage of reducing gonadotropin consumption and treatment period. However, much work remains to be done in optimizing the GnRH antagonist protocols and individualizing these to different cycle characteristics.

• Clinical and Experimental Reproductive Medicine
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• v.28 no.3
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• pp.215-223
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• 2001

Objective: The purpose of this study was to make a guideline of uterine artery embolization for the treatment of uterine leiomyomas accompanying with adenomyosis in Korea. Materials and Methods : We performed the retrospective study for 37 women who had uterine leiomyomas accompanying with adenomyosis. Bilateral uterine artery embolization was performed in 37 patients (age range 25-65) during 17 months with pain, hypermenorrhea, urinary frequency etc due to leiomyomas. Ultrasound imaging was performed before the procedure and at mean 6.9 months after the procedure. Results: All procedures were technically successful. Mean clinical follow-up was 12.8 months. Minor complication occurred in 82% patients after the procedure. After imaging follow-up (mean, 6.9 months postprocedure), median uterine volume decreased 34.4%, and dominant myoma volume decreased 86%. There was no statistical difference in uterine volume reduction and dominant myoma size reduction whether occluding agents was polyvinyl alcohol, polyvinyl alcohol plus gelfoam, and gelfoam, and whether ultrasound measured Resistance Index value before the procedure was low or high. Conclusion: Primary candidates for uterine artery embolization include those with symptomatic uterine leiomyomas who no longer des ire fertility but wish to avoid surgery or are poor surgical risks. To our study, uterine volume reduction and dominant myoma size reduction in patients who had adenomyosis were similar to previous other studies in patients who had not adenomyosis. Therefore adenomyosis should not be considered as a contraindication for uterine artery embolization. Because there is little data about subsequent reproductive potential after this procedure, it should not be routinely advocated for infertile women. Further investigation is warranted for occluding agents and Resistance Index.

• Clinical and Experimental Reproductive Medicine
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• v.39 no.1
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• pp.22-27
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• 2012

Objective: To evaluate the effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase (MDP-EL) in comparison with standard GnRH agonist luteal long protocol (LP) in each non-obese and obese polycystic ovary syndrome (PCOS) women undergoing IVF. Methods: Two hundred eleven infertile women with PCOS were recruited and randomized to undergo either GnRH antagonist MDP-EL (antagonist group) or standard GnRH agonist luteal LP (agonist group). IVF cycle outcomes were compared between the two groups. Results: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the antagonist group than in the agonist group. Incidence of severe ovarian hyperstimulation syndrome was significantly lower in the antagonist group. However, IVF and pregnancy outcomes were similar in the two groups. When all subjects were divided into non-obese and obese subgroups, in non-obese PCOS subgroup, IVF and pregnancy outcomes were comparable in the antagonist and agonist groups but total dose and days of rhFSH were also significantly fewer in the antagonist group. Similar findings were also observed in obese PCOS subgroup. Conclusion: GnRH antagonist MDP-EL is at least as effective as GnRH agonist LP and may be a more patient-friendly alternative in controlled ovarian stimulation for PCOS patients undergoing IVF, independent of body mass index.

• Clinical and Experimental Reproductive Medicine
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• v.43 no.2
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• pp.112-118
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• 2016

Objective: Ovarian reserve tests are commonly used to predict ovarian response in infertile patients undergoing ovarian stimulation. Although serum markers such as basal follicle-stimulating hormone (FSH) or random $anti-M{\ddot{u}}llerian$ hormone (AMH) level and ultrasonographic markers (antral follicle count, AFC) are good predictors, no single test has proven to be the best predictor. In this study, we developed appropriate equations and novel nomograms to predict the number of oocytes that will be retrieved using patients' age, serum levels of basal FSH and AMH, and AFC. Methods: We analyzed a database containing clinical and laboratory information of 141 stimulated in vitro fertilization (IVF) cycles performed at a university-based hospital between September 2009 and December 2013. We used generalized linear models for prediction of the number of oocytes. Results: Age, basal serum FSH level, serum AMH level, and AFC were significantly related to the number of oocytes retrieved according to the univariate and multivariate analyses. The equations that predicted the number of oocytes retrieved (log scale) were as follows: model (1) $3.21-0.036{\times}(age)+0.089{\times}(AMH)$, model (2) $3.422-0.03{\times}(age)-0.049{\times}(FSH)+0.08{\times}(AMH)$, model (3) $2.32-0.017{\times}(age)+0.039{\times}(AMH)+0.03{\times}(AFC)$, model (4) $2.584-0.015{\times}(age)-0.035{\times}(FSH)+0.038{\times}(AMH)+0.026{\times}(AFC)$. model 4 showed the best performance. On the basis of these variables, we developed nomograms to predict the number of oocytes that can be retrieved. Conclusion: Our nomograms helped predict the number of oocytes retrieved in stimulated IVF cycles.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.2
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• pp.135-142
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• 2010

Objective: To evaluate the effectiveness of soft stimulation protocol using GnRH antagonist/clomiphene citrate (CC)/recombinant FSH (rFSH) in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI), compared with GnRH antagonist multiple dose protocol (MDP) using GnRH antagonist/rFSH. Methods: Eighty infertile women were randomized to soft stimulation protocol group (n=40) or GnRH antagonist MDP group (n=40). In both groups, IUI was performed 36~40 hours after hCG injection. Statistical analysis was performed using Student's t-test, $\chi^2$ test or Fisher's exact test as appropriate. Results: Total dose and days of rFSH required for COS were significantly fewer in soft stimulation protocol group (p<0.001, p<0.001). A premature LH surge did not occur in any patients of both groups. Clinical pregnancy rate per cycle was similar between the two groups. Conclusion: Soft stimulation protocol provides comparable pregnancy rates to GnRH antagonist MDP despite fewer total dose and days of rFSH, and so can become one of the patient-friendly, cost-effective alternatives for infertile patients undergoing COS with IUI.