• Clinical and Experimental Reproductive Medicine
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• 제36권1호
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• pp.55-61
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• 2009

목 적: 폐쇄성 무정자증 (obstructive azoospermia) 환자와 정자형성저하증 (hypospermatogenesis) 환자의 고환 정자를 이용한 체외수정 및 배아이식술의 결과를 비교, 분석하고자 하였다. 연구방법: 2003년 1월부터 2006년 12월까지 체외수정 및 배아이식술을 위해 고환조직 정자채취술을 시행한 폐쇄성 무정자증 환자 155명 (241주기)과 정자형성저하증 환자 28명 (34주기)을 대상으로 하였다. 고환조직 정자채취술과 세포질내 정자주입술을 실시한 후 수정률, 착상률, 임신율, 출산율을 비교하였으며, 통계적 분석은 t-test와 ${\chi}^2$-test를 사용하였다. 결 과: 정자형성저하증 환자의 고환정자 회수 결과, 신선고환을 사용한 21주기 중 1주기에서는 정자를 회수하지 못하였으나, 정자를 확인하고 고환조직 동결보존 후 융해한 13주기에서 모두 정자를 회수할 수 있었다. 수정률은 정자형성저하증 환자보다 폐쇄성 무정자증 환자에서 통계적으로 유의하게 높았다 (75.6 % vs. 62.6%, p<0.001). 난할 배아 발생률도 정자형성저하증 환자보다 폐쇄성 무정자증 환자에서 통계적으로 유의하게 높았다 (66.8% vs. 54.8% p<0.001). 그러나 우수배아 형성률, 임상적 임신율, 착상률, 출산율에는 차이가 없었다. 결 론: 정자형성저하증 환자의 고환정자를 사용하여 세포질내 정자주입술을 실시할 경우 수정률과 초기 난할율은 폐쇄성 무정자증 환자보다 낮지만, 정상적으로 발달한 배아를 이식할 경우 임신율, 착상률, 그리고 출산율에는 영향을 미치지 않는 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제24권3호
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• pp.281-292
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• 1997

The objective of this study was to compare retrospectively the survival and pregnancy rates(PR) of cryopresered-thawed embryos obtained from intracytoplasmic sperm injection (ICSI) or conventional in vitro fertilization (IVF). Ninety-six cycles of cryopresered-thawed embryo transfer (ET) were performed in 79 patients from June, 1996 to September, 1997 and grouped as followings: 20 cycles (16 patients) inseminated by ICSI (ICSI Group) and 76 cycles (63 patients) by conventional IVF (IVF Group). Slow-freezing and rapid-thawing protocol was used with 1.5M propanediol (PROH) and 0.1M sucrose as cryoprotectant. All embryos were frozen-thawed at the two pronuclear (2 PN) stage excluding four cycles in which the early cleavage stage embryos were frozen, and allowed to cleave in vitro for one day before ET. The duration from freezing to thawing was comparable in both groups ($mean{\pm}SD$, $112.1{\pm}80.0$ vs. $124.8{\pm}140.1$ days). The age of female ($31.2{\pm}3.4$ vs. $32.6{\pm}3.3$ years) and the endometrial thickness prior to progesterone injection ($9.4{\pm}2.0$ vs. $9.3{\pm}1.8$ mm) were also comparable in both groups. There was no significant difference in the outcomes of cryopreserved-thawed ET between two groups: survival rate ($85.2{\pm}16.1%$ vs. $82.2{\pm}19.7%$), cleavage rate ($96.9{\pm}6.7%$ vs. $94.7{\pm}13.0%$), cumulative embryo score (CES, $54.5{\pm}31.1$ vs. $49.0{\pm}20.0$), preclinical loss rate (5.0% vs. 5.3%), clinical miscarriage rate (0% vs 29.4%), clinical PR per transfer (35.0% vs. 22.4%), implantation rate (9.9% vs. 5.6%), and multifetal PR (42.9% vs. 17.6%). In conclusion, human embryos resulting from ICSI can be cryopreserved-thawed and transferred successfully, and the survival rate and PR are comparable to conventional IVF.

• Clinical and Experimental Reproductive Medicine
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• 제37권4호
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• pp.361-368
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• 2010

목적: 중격자궁은 흔하게 보고되는 선천성 자궁기형 중 하나이며 여성의 생식능력에 미치는 영향에 대해 아직 이견이 많고, 따라서 치료의 필요성에 대해서도 아직 정립되지 않았다. 본 연구에서는 중격자궁의 존재 및 치료 여부가 생식수행에 미치는 영향에 대해 알아보고자 하였다. 연구방법: 2008년 1월부터 2009년 12월까지 불임 또는 습관성 유산을 주소로 제일병원 산부인과를 방문하여 자궁난관 조영술을 시행한 총 2,838명의 환자들 중 중격자궁이 진단된 44명의 환자들을 대상으로 하였으며, 이 중 27명은 자궁경 하 자궁중격 절제술을 시행 받았으며, 17명은 진단 후 추가적인 치료를 받지 않았다. 대조군은 동일 기간 내에 자궁기형이 진단되지 않은 환자 42명을 나이를 고려 후 무작위 선정하였다. 연구 대상군의 임신율, 자연유산율, 그리고 생존분만율 등에 대한 의무기록을 후향적으로 분석하였으며, 대상군들의 평균 추적 관찰 기간은 진단 후 21.8개월 이었다. 결과: 추적 관찰 기간 중 자궁경 하 질식 자궁중격 절제술을 시행 받은 환자 (n=27)의 55.6% (15/27)가 임신에 성공한 반면 치료를 받지 않은 환자 (n=17)의 약 23.5% (4/17)만이 임신에 성공하여 치료받은 군에서 통계적으로 의미있는 높은 수치를 보였다 (p<0.05). 한편 생존분만율은 치료를 받은 환자군 및 자궁기형이 진단되지 않은 불임 또는 습관성 유산 환자 (대조군, n=42)에서 각각 75%와 84.6%를 보인 반면 치료 받지 않은 군에서는 50% (2/4)를 보여 치료 받지 않은 중격자궁 환자에서 낮은 경향을 보이지만 통계학적 의미는 없었다. 결론: 중격자궁이 생식수행에 미치는 영향은 자연유산 등 산과적 합병증 뿐 아니라 오히려 임신력의 저하에 더 큰 악영항을 미칠 수 있으며 불임 환자에서 중격자궁의 존재 시 적극적인 치료가 임신성공률의 향상에 도움이 될 것으로 생각 되지만 보다 명확한 결론을 위해 규모가 크고 관찰 기간이 긴 대단위 연구가 필요 할 것으로 생각된다.

• Clinical and Experimental Reproductive Medicine
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• 제41권4호
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• pp.158-164
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• 2014

Objective: To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR). Methods: A retrospective cohort study. A total of 218 infertile women who underwent IVF between January 2011 and February 2013. The initial cohort (Cohort I) that underwent IVF between January 2011 and March 2012 included a total of 68 attempted IVF cycles. Thirty-four cycles were treated with the conventional GnRH antagonist protocol, and 34 cycles with an early GnRH antagonist start protocol. The second cohort (Cohort II) that underwent IVF between June 2012 and February 2013 included a total of 150 embryo-transfer (ET) cycles. Forty-three cycles were treated with the conventional GnRH antagonist protocol, 34 cycles with the modified early GnRH antagonist start protocol using highly purified human menopause gonadotropin and an addition of GnRH agonist to the luteal phase support, and 73 cycles with the GnRH agonist long protocol. Results: The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04). The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%). Conclusion: The modified early antagonist start protocol may improve the mature oocyte yield, possibly via enhanced follicular synchronization, while resulting in superior CPR as compared to the conventional antagonist protocol, which needs to be studied further in prospective randomized controlled trials.

• Clinical and Experimental Reproductive Medicine
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• 제39권4호
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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.

• 대한영상의학회지
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• 제79권6호
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• pp.315-322
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• 2018

목적: 속발성 분만 후 출혈 환자에서 임상 양상 및 혈관 조영술의 특징과 경도관 동맥 색전술의 결과를 알아보고자 하였다. 대상과 방법: 속발성 분만 후 출혈로 인해 단일 3차 의료기관에서 동맥 색전술을 시행한 38명의 환자를 대상으로 분만 방식, 출혈 원인, 임상 증상, 혈관 조영술 소견, 색전 물질과 방법, 결과 등에 대하여 후향적으로 분석하였다. 결과: 20명(53%)의 환자가 제왕절개를 시행하였으며, 출혈 원인은 의인성 혈관 손상(n = 11), 잔류 태반(n = 10), 자궁근 무력증(n = 8), 후천성 자궁 동정맥 기형(n = 5) 등이었다. 간헐적(50%) 및 지속적(50%) 대량 질 출혈이 임상적으로 관찰되었다. 7명(18%)의 환자에서 내원 시 저혈량 쇼크를 보였다. 혈관 조영술 상 18명이 양성 소견을 보였으며, 제왕절개 후 가성동맥류 빈도가 통계학적으로 의미 있게 높았다(p < 0.001). 젤폼 이외에 N-butyl cyanoacrylate (7예), 미세 코일(7예)을 사용하였다. 출혈 부위 초선택이 가능하였던 10명의 환자(26.3%)에서는 단측 혈관 선택 색전술만으로 지혈이 성공적이었다. 기술적 성공률은 100%였으며, 임상적 성공률은 97.4%이었다. 추적 관찰이 가능했던 16명에서 정상 월경 주기를 보였으며, 1예의 정상 임신이 관찰되었다. 결론: 속발성 분만 후 출혈은 저혈량 쇼크를 보일 수 있으며, 양성 출혈 소견을 보이는 빈도가 높았다. 따라서 조기 혈관 조영술과 동맥 색전술이 필요하리라 생각된다.

• Clinical and Experimental Reproductive Medicine
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• 제26권3호
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• pp.355-362
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• 1999

Objective: This study was performed to compare the clinical response to controlled ovarian hyperstimulation (COH) of in vitro fertilization and embryo transfer (IVF-ET) according to the size of baseline ovarian cyst. Method: From February 1992 to March 1999, a retrospective analysis was done of 272 cases who underwent COH using mid-luteal phase long protocol of gonadotropin-releasing hormone agonist (GnRH-a) for IVF-ET. These cases were divided into four group; group 1 (n=63) had cysts with mean diameters between 20.0 and 29.0 mm on their baseline ultrasound on cycle day 3, group 2 (n=57, $30.0{\sim}49.0mm$), group 3 (n=68, >50.0 mm) and control group (n=84). Cases were excluded according to the following criteria; pure male factor infertility, the presence of only one ovary, high CA-125 level and previous endometriosis. Results: There were no statistically significant differences between cases with baseline ovarian cyst <50.0 mm in diameter and control group in any of the parameters. However, cases with baseline ovarian cyst>50.0 mm in mean diameter needed more amount of human menopausal gonadotropin (hMG), showed significantly lower estradiol ($E_2$) level, the number of follicle >15.0 mm on the day of human chorionic gonadotropin (hCG) administration, the number of oocytes retrieved, the number of mature oocytes, and pregnancy rate compared with control group. Conclusion: This study suggests that cases with baseline ovarian cyst <50.0 mm in diameter do not adversely impact on IVF-ET outcome. However, cases with baseline ovarian cyst >50.0 mm in diameter had adverse effects on various parameters. Therefore, to improve the outcome of IVF-ET in these cases, ovarian cyst aspiration prior to initiating COH may be required.

• Clinical and Experimental Reproductive Medicine
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• 제32권4호
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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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• 제37권1호
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• pp.49-56
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• 2010

목 적: 저성선자극호르몬 성선저하증 환자에서 보조생식술의 임신 결과에 대해 알아보고자 하였다. 연구방법: 저성선자극호르몬 성선저하증으로 진단받고 본원에서 보조생식술을 시행받은 23명을 연구군으로, 동일기간 난관요인으로 보조생식술을 시행받은 이들 중 연구군과 연령 및 체질량지수가 일치하는 120명의 여성을 대조군으로 설정하여, 이들의 의무기록을 후향적으로 열람하였다. 보조생식술 관련 여러 계측치 및 임신율, 유산율, 출산율 등을 비교 분석하였다. 결 과: 연구군의 평균 연령은 $32.7{\pm}3.3$세였고, 평균 체질량지수는 $21.0{\pm}3.2kg/m^2$였다. 생리주기 제 2~3일에 측정한 황체형성호르몬과 난포자극호르몬은 각각 $0.61{\pm}0.35$, $2.60{\pm}2.35$ mIU/ml였고, 에스트라디올은 $10.13{\pm}8.17$ pg/ml이었다. 난소자극 주기에서 사용된 생식샘자극호르몬의 총 양과 투여기간 및 hCG 투여일의 $E_2$ 수치는 연구군에서 유의하게 높았다. 보조생식술 방법에 따라 분석한 결과, 체외수정 및 배아이식 (IVF-ET) 주기에서는 연구군에서 자궁내막두께와 수정율, 출산율이 유의하게 낮았고, 유산율은 유의하게 높았으며, 그 외 난소자극 및 인공수정 (SO-IUI) 및 동결보존배아이식 (FET) 주기에서는 두 군간에 유의한 차이를 보이지 않았다. 결 론: 저성선자극호르몬 성선저하증 여성에서 생식샘자극호르몬 치료를 통한 전반적인 보조생식술의 임신율은 22.0%로 대조군의 그것과 유사하지만, 이를 위해서는 더 많은 용량의 호르몬이 필요하다. 연구군의 IVF-ET의 경우, 주기 중 현저하게 높은 $E_2$ 수치와 유의하게 얇은 자궁내막을 보이며, 더 높은 유산율과 더 낮은 생존출산율을 보여, 이의 극복을 위해 자궁내막 수용성 개선방안에 대한 연구가 추가로 필요하다.

• 한국발생생물학회지:발생과생식
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• 제17권3호
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• pp.207-213
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• 2013

This study was performed to investigate the effect of peroxisome proliferators activated receptor-${\gamma}$ (PPAR-${\gamma}$) ligand, pioglitazone, on production of regulated upon activation normal T-cell expressed and secreted (RANTES) and in vitro fertilization (IVF) outcome in infertile patients with endometriosis. Sixty-four infertile patients with stage III or IV endometriosis undergoing IVF were randomly allocated to the study or the control group. The long protocol of GnRH agonist (GnRH-a) was used for controlled ovarian stimulation (COS) in all patients. Patients in the study group were treated with pioglitazone at a dose of 15 mg/day orally from the starting day of GnRH-a treatment to the day of hCG injection. Blood samples were drawn for serologic assay of RANTES on the first day of GnRH-a treatment and the day of hCG injection. There were no differences between the study and control groups in patient characteristics. There were also no differences between the two groups in COS duration, and the numbers of retrieved oocytes, fertilized oocytes and embryos transferred. The clinical pregnancy rate per cycle was higher in the study group, but this difference was not statistically significant. However, embryo implantation rate was significantly higher in the study group of 12.5% compared with 8.6% in the control group (P<0.05). The serum RANTES levels after pioglitazone treatment were significantly lower than those before pioglitazone treatmen in the study group (P<0.05). Our data suggest that pioglitazone treatment can suppress RANTES production and improve the embryo implantation rate in patients with endometriosis undergoing IVF.