• Clinical and Experimental Reproductive Medicine
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• 제34권1호
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• pp.49-56
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• 2007

목 적: 성선자극호르몬과 GnRH agonist (GnRH)를 동시에 중단하는 1$\sim$2 일간의 단기 coasting이 임신율을 포함한 난소과자극증후군 예방에 미치는 효과를 조사하고자 한다. 연구방법: 체외수정시술을 위한 과배란유도 시 15 mm 이상의 난포가 20 개 이상이고 혈중 E$_2$ 농도가 4,000 pg/ml 이상일 때 coasting을 시도한 37 명의 여성들을 대상으로 하였다. Coasting은 성선자극호르몬과 GnRH agonist를 동시에 중단하였으며, 초음파상 난포의 상태와 혈중 E$_2$ 농도 에 따라 1일 또는 2일 동안 시행하였다. 혈중 E$_2$ 농도, 채취된 난자 수, 수정율, 임신율 등을 후향적으로 비교 분석하였다. 결 과: 평균 혈중 E$_2$ 농도는 coasting 시작 당일 6,993 pg/ml 에서 hCG 투여일에 3,396 pg/ml로 감소하였다. 평균 채취 난자 수와 수정율은 15.7개와 70%였다. 15명 (40.6%)이 임신을 하였고 착상율은 15.2%였다. 26명 (70.3%)이 1일, 11명 (29.7%)이 2일 동안 coasting 하였다. 평균 혈중 농도의 감소율은 1일 coasting한 군에서 43%, 2일 costing한 군은 15% (첫날)와 81% (둘째날)이었다. 임신율은 두 군간 유사하였고, 중증도 이상의 OHSS는 발생하지 않았으며 3명 (8.1%)에서 경미한 OHSS가 나타났다. 결 론: 성선자극호르몬과 GnRH agonist의 통시 중단에 의한 1$\sim$2 일의 단기 coasting은 체외수정의 결과에 영향을 주지않고 OHSS 를 예방하는데 성공적으로 적용될 수 있을 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제36권4호
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• pp.293-300
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• 2009

목 적: 본 연구는 배아이식일의 자궁동맥혈류가 인간 체외수정술에서 임신예후의 예측인자가 될 수 있는지 알아보기 위해 시행되었다. 연구방법: 51회의 체외수정술 주기에 대해 전향적인 임상 관찰로 시행되었으며 혈청 estradiol 농도는 hCG 투여일에 측정되었고, 자궁동맥 박동율 (PI)과 저항율 (RI)은 배아이식 3일째에 측정되었다. 결 과: 51회의 주기 중 22주기에서 임상적으로 임신이 확인되었고 (43.1%), 착상률은 14.7%였다. 자궁동맥 PI와 RI는 혈청 estradiol 농도과 의미 있는 음의 상관관계 (p<0.05)를 보였으며 자궁혈류량은 임신된 그룹과 임신 되지 않은 그룹에서 차이가 없었다. 임신율은 PI가 3.0 이상인 군에서 PI가 3.0 이하인 군보다 조금 높게 측정되었으나 통계학적인 유의성은 없었다. 결 론: 배아이식일의 자궁동맥 PI와 RI는 체외수정술에서 임신의 예측인자로는 효용성이 떨어지지만 estradiol 농도와는 음의 상관관계를 보여 자궁혈류와 estradiol 농도가 상관관계가 있음을 알 수 있다.

• Clinical and Experimental Reproductive Medicine
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• 제27권1호
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• pp.59-65
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• 2000

Objective: The purpose of this study was to determine the important factors affecting survival and pregnancy rate in frozen-thawed embryo transfer cycles. Methods: we performed retrospective analysis in 738 cycles of frozen-thawed embryo transfers, in relation to the insemination methods, the freezing stage of embryo, patient's age, infertility factors and the origin of injected sperm in ICSI cycles. After conventional IVF or ICSI, the supernumerary PN stage zygotes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propanediol (PROH) as a cryoprotectant. Results: The survival rates of thawed embryos were 69.3% (1585/2287) in conventional IVF group and 71.7% (1645/2295) in ICSI group. After frozen-thawed embryo transfers, 27.0% (92/341) and 32.0% (109/341) of pregnancy rates were achieved in conventional IVF and ICSI group, respectively. There were no significant difference in the survival and pregnancy rates according to the insemination methods, the freezing stage and patient's age. However, the pregnancy rate (36.2%) of male factor infertility was significantly higher than the tubal (27.2%) and other female factor infertility (22.9%). In ICSI group, the origin of injected sperm did not affect the outcome of frozen-thawed embryo transfer cycles. Conclusion: The present study demonstrates that acceptable clinical outcomes can be achieved after the transfer of frozen-thawed embryos regardless of the stage of embryos for freezing, the patient's age and the origin of injected sperm.

• Clinical and Experimental Reproductive Medicine
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• 제21권1호
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• pp.21-29
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• 1994

Subzonal insemination(SUZI) has been proposed for patients with severe male factor and previous fertilization failure. However, very low fertilization rates still persisted. The aims of this study were firstly, to examine the relationships between the fertilization rate and sperm parmeters, sperm incubation media and time, secondly, to evaluate the outcome of 119 cycles of SUZI applied the modified sperm preparation method. The fertilization rates were influenced more sensitively by sperm preincubation media and time than by sperm parameters. According to preincubation media and time, the fertilization rates were 43.3% in 50% follicular fluid (HFF), 36.6% in 10% fetal cord serum(FCS), and with the time, increased in FCS, but decreased in HFF. In regrd with sperm parameters, the fertilization rates were 42.9% in normal and 37.6% in subnormal group. The best results were obtained from SUZI by the spermatozoa incubated in 50% HFF for 6-8 hours. So we tried 119 cycles of SUZI(normal; 39 cycles, subnormal; 80 cycles) using the preparation method of 6-8 hour incubation in 50% HFF. There were no signigicant differences in the fertilization rates between normal(125/269, 46.4%) and subnormal sperm(264/635, 41.6%). Contrary to the fertilization rates, pregnancy outcomes were different between both groups. Better results obtained from the subnormal group than the normal in the number of transferred embryos, that of good embryos, and developmental rate of the fertilized eggs. The pregnancy rates per transfer were totally 13.3%(13/98),20.0%(13/65) in subnormal group. In the normal group, 2 patients showed ${\beta}$-hCG positive, but resulted in chemical pregnancy. Of 13 clinical pregnancies, two aborted, 6 on-going, and 5 delivered. In conclusion, SUZI is an effective technique to overcome fertilization failure for male factor and unexplained. The fertilization rate is influenced by sperm parameters, sperm incubation media and time. Also the quality of oocytes might be important for pregnancy as same as that of sperm.

• Clinical and Experimental Reproductive Medicine
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• 제28권3호
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• pp.225-233
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• 2001

Objective : To evaluate the efficacy of low-dose aspirin on IVF outcome and endometrium in patients undergoing IVF-ET. Materials and Methods : From February, 2001 to Jun, 2001, 60 infertile patients were randomly divided into study group (28 cycles) and control group (32 cycles). The study group received a daily oral dose of 25 mg of aspirin for at least 2 weeks from first visiting day. Controlled ovarian hyperstimulation was initiated in all patients with the GnRH agonist starting in the midluteal phase of the previous cycle. Results: There were no significant differences in age of the patients, basal serum E2, LH, FSH level and endometrial thickness among two groups. There were no statistically significant differences between the study group and the control group respectively in dosage ($26.5{\pm}4.8$ vs $26.2{\pm}5.3$ amples) and duration ($10.4{\pm}4.2$ vs $9.8{\pm}5.3$ days) of gonadotropin administration, serum E2 level on the hCG administration day ($1823{\pm}342$ vs $1854{\pm}543$), LH ($14.5{\pm}2.7$ vs $14.8{\pm}3.1$), FSH ($16.7{\pm}3.4$ vs $18.3{\pm}4.7$), the number of follicles > 15 mm ($13.2{\pm}6.3$ vs $12.8{\pm}5.9$), the number of oocytes retrieved ($9.2{\pm}2.4$ vs $8.4{\pm}1.7$), the number of embryos transferred ($4.7{\pm}2.0$ vs $4.7{\pm}2.0$), fertilization rate (68.4% vs 64.5%), implantation rate (21.3% vs 17.6%), and clinical pregnancy rate (28.4% vs 26.2%). The endometrial thickness and the percentage of endometrial trilaminar pattern on hCG day were significantly higher in study group than control group ($12.9{\pm}3.7mm$ vs $10.4{\pm}2.8mm$, 78.3% vs 64.5%). Conclusion: Many reports suggest that low-dose aspirin improve ovarian response, implantation rate, fertilization rate, implantation rate, and pregnancy rate by increasing the blood flow, but we couldn't prove the significant effect of low-dose aspirin on the IVF outcome except on endometrium. This may be affected by dose of aspirin, duration, and number of patients studied. This trial is small, so our results highlight the need for a large randomized controlled trial to identify the effect of low-dose as pirin on IVF-ET outcome.

• 대한한의학회지
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• 제36권2호
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• pp.1-7
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• 2015

Objectives: To report on the result of infertility treatment with Korean medicine in clinical settings. Methods: This study was single arm, retrospective observational study. Analysis of the medical records on thirty four infertile women who were treated by acupuncture, moxibustion, herbal medicine(Jokyungjongoktang-gagambang, Sutaehwan-gagambang). Pregnancy rate(PR) and Live birth rate(LBR) were analyzed as the primary outcomes. Changes of AMH, FSH, LH, $E_2$, $P_4$, endometrial thickness, fat mass, and BMI were also analyzed as the secondary outcomes. Results: A total of 34 patients were treated in the traditional Korean medical clinic. Nine patients were dropped, and 25 subjects completed the final examination at the end of this treatment schedule. Five of 25 subjects conceived during treatment, reaching 20% PR and LBR was also 20%. Except for FSH level, the results of the remaining outcome measures, including LFT, showed no significant changes. No serious adverse event has been reported. Conclusion: Although no significant changes in bio-markers were observed, complex treatment using Korean medicine has shown effectiveness on women's infertility. In addition, the safety of the treatment has been verified.

• Clinical and Experimental Reproductive Medicine
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• 제19권1호
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• pp.71-79
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• 1992

In vitro fertilization and embryo transfer (IVF & ET) is widely used for the males with subnormal or abnormal semen quality, as this was recommended in view of the relatively small numbers of spermatozoa required for fertilization and subsequent pregnancies could be obtained. The aim of this study is to know how the various functional parameters of spermatozoa in semen analysis affect the outcome IVF. This study was carried out between 1988-1989, with male factor patients selected on the basis of the semen quality. The selection criteria was based upon the mean values of concentration,% motility and % normal morphology from at least two semen analysis. There is a significant decrease in the fertilization and embryo transfer rates in the study group compared with control group (35.9% vs. 68% and 48.6% vs. 85.5% respectively), however, there was no significant difference in the pregnancy or delivery rates (19.6% vs. 21.4% and 60.0% vs. 62.5% respectively) per embryo transfer cycles. Fertilization rate is variously affected by the type and degree of sperm defect. No pregnancy was occurred in triple defect group and asthenoteratospermia group. There is no significant increase in the abortion rate in the male factor group. Improvement have to be made with the fertilization rate, as the pregnancy rate per OPU cycle in male factor group is still lower than that of normal group (9.5% vs. 18.3%). In conclusion, IVF can be used as a treatment for male factor infertility and the preparation of the semen sample can be modified to improve sperm recovery and obtain fertilization from abnormal semen samples.

• Journal of Nutrition and Health
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• 제41권8호
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• pp.776-785
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• 2008

본 연구는 서울소재의 종합병원 산부인과에 외래로 방문한 임신부 248명을 대상으로 설문조사를 실시하였고, 임신 중 스트레스 정도와 영양섭취상태 및 임신결과와의 관계를 알아보고자 하였다. 조사를 통해 얻어진 결과를 요약하면 다음과 같다. 1) 조사대상자의 나이는 두 군이 비슷하였고, 스트레스 낮은 군이 스트레스 높은 군보다 교육수준, 경제 수준이 약간 높았으나 통계적으로 유의한 차이는 없었다. 스트레스 낮은 군은 스트레스 높은 군에 비해 취업률이 높게 나타났다 (p < 0.05). 가족 수에서는 스트레스 높은 군이 스트레스 낮은 군보다 3인 이상 가족구성의 비율이 높았다 (p < 0.01). 2) 신체 계측치에서 스트레스 높은 군이 키가 작고 임신전 체중이 높았으나 통계적인 유의성은 없었다. 임신 전 BMI는 스트레스 낮은 군보다 스트레스 높은 군에서 과체중 및 비만이 유의적으로 높았다 (p < 0.05). 3) 임신 중 활동은 스트레스 낮은 군이 스트레스 높은 군보다 가벼운 정도의 활동을 하고 있었으며 (p < 0.05), 임신 중 규칙적인 운동은 스트레스 낮은 군이 스트레스 높은 군보다 더 많이 하고 있었다 (p < 0.01). 4) 임신 중 스트레스 요인으로는‘아기에 대한 걱정’ (40.4%),‘건강에 대한 걱정’ (28.8%),‘경제적 어려움’ (13.2%),‘우울감’ (10.1%),‘가족관계’ (2.9%),‘가사 일에 대한 걱정’ (2.5%),‘인간관계’ (2%) 순으로 나타났다. 5) 대부분의 영양소섭취는 스트레스가 낮은 군이 스트레스가 높은 군보다 약간 많았으나 통계적 유의성은 없었다. 엽산, 칼륨, 칼슘, 철의 섭취는 KDRI의 2/3에도 못 미치는 수준이었고 나트륨, 콜레스테롤, 인, 비타민 E는 KDRI의 150% 이상 섭취하고 있었다. 6) 임신 중 스트레스와 섭취한 영양소와의 관계를 보았을 때, 대부분의 영양소와 통계적으로 유의성을 보이지 않았다. 하지만 지방, 콜레스테롤은 섭취량이 많을수록 스트레스 발생 위험도가 높아지는 경향을 보였고, 당질, 식이섬유는 섭취량이 많을수록 스트레스 발생 위험도가 감소하는 경향을 보였다. 7) 스트레스 정도는 두 군에서 임신부의 재태기간, 체중증가량, 신생아 출생 시 체중, 신장 및 Apgar scores와 통계적으로 유의한 차이를 보이지 않았다. 본 연구에서 임신 중 스트레스는 신생아의 건강에 대한 염려, 임신부의 처해있는 경제여건, 사회적 지위나 생활여건, 임신과 관련된 상황, 자신의 성격 및 배우자를 포함한 가족 관계 등 다양한 요인에 의해 나타났다. 본 연구 결과 스트레스 높은 군이 스트레스 낮은 군보다 취업률이 낮았고, 임신전 BMI가 비만 및 과체중군이 많았으며, 임신 중 규칙적인 운동을 하고 있지 않았다. 이런 생활습관들이 임신 중 스트레스에 영향을 미치는 것으로 사료된다. 하지만 임신 중 스트레스는 대부분의 영양섭취상태와 임신결과에 직접적인 영향을 미치지 않았다. 스트레스와 영양소 섭취와의 관련성이 뚜렷하게 나타나지 않은 것은 본 연구에서 임신부의 2일간 식이회상법 자료를 이용해 영양소 섭취실태를 조사하였기에 임신부의 평소식사를 반영하는데 한계가 있었기 때문으로 사료된다. 본 연구에서 임신 중 스트레스를 예방하기 위해서는 적절한 체중관리와 규칙적인 운동이 도움이 될 수 있다는 것을 확인하였다.

• Clinical and Experimental Reproductive Medicine
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• 제16권1호
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• pp.81-91
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• 1989

It has been suggested that the prognosis for fertility of the infertile patients with healed pelvic tuberculosis is very poor. Total 60 patients(77 cycles) with previous history of pelvic tuberculosis who underwent IVF-ET from January 1988 to March 1989 at SNUH were classified into three groups according to the principal histopathological lesions : tuberculous endometritis group(N=20, 28 cycles), tuberculous salpingitis group(N=32, 37 cycles) and pelvic peritoneal tuberculosis group(N=8, 12 cycles). To evaluate the effects of previous pelvic tuberculous lesions on ovarian follicular growth and development in controlled ovarian hyperstimulation for IVF-ET and its final outcome, serum E2 levels on the day of hCG administration(Day 0) and the day after hCG administration(Day +1), the number of ovarian follicles with mean diamete ${\geqq}$ 12 mm on Day 0, the number of oocytes retrieved by transvaginal aspiration, and pregnancy rate per cycle were measured and compared with control group(N=123, 161 cycles). There were no significant differences in cancellation rate during controlled ovarian hyperstimulation, total dosage of FSH and hMG administrated, menstrual cycle date(MCD) of hCG injection, serum E2 levels, the number of ovarian follicles with mean diameter ${\geqq}$ 15 mm, and the number of oocytes retrieved between pelvic tuberculosis group and control group. But in pelvic tuberculosis group, the number of ovarian follicles with mean diameter 12-14 mm, total number of ovarian follicles(${\geqq}$ 12 mm), and pregnancy rate per cycle were significantly decreased. These data suggest that previous pelvic tuberculous lesions have no significant adverse effects on the ovarian response to gonadotropin stimulation. IVF-ET proved to be an useful treatment modality for infertile patients with previous history of pelvic tuberculosis in spite of its relatively lowered pregnancy rate.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1609-1613
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• 2015

Purpose: To determine the rate of lymph node metastasis, oncologic and pregnancy outcomes in apparent early-stage malignant ovarian germ cell tumor (MOGCT). Materials and Methods: Medical records of apparent early-stage MOGCT patients undergoing primary surgical treatment at Siriraj Hospital, Bangkok, Thailand, between January 2006 and December 2013, were retrospectively reviewed. Results: Thirty-eight patients had apparent stage I-II MOGCT. The mean age was $22.1{\pm}7.7years$ (median, 20.8 years; range, 7.7-35.6 years). The mean tumor size was $17.8{\pm}6.5cm$ with a median of 20 (range 4-30) cm. Three most common histopathologies were dysgerminoma (12 patients, 31.6%), immature teratoma (12 patients, 31.6%), and endodermal sinus tumor (6 patients, 15.8%). Twenty-seven of 38 patients underwent lymphadenectomy; 13 patients (48.2%) were stage IA and 8 patients (29.6%) were stage IC. The rate of retroperitoneal nodes metastasis was 7.4% (2/27 patients). At 26.1 months of median follow-up time (range 1.9-88.5 months), 9 patients retained fertility functions, with uneventful pregnancies in 3 of these. Only one patient (2.6%) had progression of disease at 4.9 months after surgery. The 5-year survival rate was 97.4%. Conclusion: As the rate of pelvic or para-aortic node metastasis in MOGCT is considerable, lymphadenectomy should be incorporated in surgical staging procedures.