• Clinical and Experimental Reproductive Medicine
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• 제42권4호
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• pp.149-155
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• 2015

Objective: The goal of this study was to investigate the relationship between serum progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration and the pregnancy rate among women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) using a flexible antagonist protocol. Methods: This prospective study included 200 IVF and ICSI-ET cycles in which a flexible antagonist protocol was used. The patients were divided into five distinct groups according to their serum P4 levels at the time of hCG administration (0.80, 0.85, 0.90, 0.95, and 1.00 ng/mL). The clinical pregnancy rate (CPR) was calculated for each P4 interval. Statistically significant differences were observed at a serum P4 level of 0.9 ng/mL. These data suggest that a serum P4 concentration of 0.9 ng/mL may represent the optimal threshold level for defining premature luteinization (PL) based on the presence of a significant negative impact on the CPR. Results: The CPR for each round of ET was significantly lower in the PL group defined using this threshold (25.8% vs. 41.8%; p=0.019), and the number of oocytes retrieved was significantly higher than in the non-PL group ($17.3{\pm}7.2$ vs. $11.0{\pm}7.2$; p=0.001). Elevated serum P4 levels on the day of hCG administration were associated with a reduced CPR, despite the retrieval of many oocytes. Conclusion: Measuring serum P4 values at the time of hCG administration is necessary in order to determine the optimal strategy for embryo transfer.

• Clinical and Experimental Reproductive Medicine
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• 제25권3호
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• pp.239-244
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• 1998

The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol<600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected $3\sim4$ times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 pg/ml and mean follicle diameter>16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of $E_2$ ($810{\pm}112$ vs $412{\pm}55$ pg/ml) and greater number of retrieved oocytes ($3.0{\pm}0.2$ vs $2.0{\pm}0.2$) than CC group. CC group had transferred embryos $(1.8{\pm}0.2)$ compared with $(2.1{\pm}0.2)$ in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly (p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.

• 보건행정학회지
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• 제1권1호
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• pp.54-71
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• 1991

Health of a nation is quite often represented by the statistics such as infant death rate and maternal mortality rate. It is indisputable that maternal child health(MCH) is the basis of health of a nation. MCH is also one of the cardinal component of primary health care. The importance of MCH is conspicuous especially in the developing countries. In Korea, People in the rural communities still have high access barrier to basic health care needs, including MCH services. Access to quality care during pregnancy and delivery seems to be the crucial factor in preventing deaths in women and children. The beneficial effects of prenatal and postnatal care on the outcome of pregnancy for mother and child, and those of health professional-attended institutional delivery on the health of mother and child have been well documented in many studies. Recognizing these effects, the government of Korea received IBRD loan of $30 million in 1979 for th purpose of constructing 89 rural MCH centers. The construction is complete now and all 89 MCH centers are under operation ti imporve primary health care for mothers and children in Korea. However, it has been observed over time that overall performance of public MCH centers is declining. The decline has been attributed partly to low quality services by public MCH centers, poor management by health center mangers, competition with for-profit private clinics, and to the development of national health insurance. This study investigates the utilization by rural communities in Korea of MCH services provided by public sector health centers deemed to be physically and financially accessible to the community but suboptimally used. It seeks also to determine the factors that influence people's utilizations. This study sets out to discover a desirable form of MCH center from among alternative forms of centers, thereby to construct a MCH model.

• Clinical and Experimental Reproductive Medicine
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• 제31권1호
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• pp.29-39
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• 2004

Objectives: This study was performed to evaluate the laboratory system for successful PGD using fluorescence in situ hybridization (FISH) and the clinical outcome of PGD cycles in five years experiences. Methods: A total of 181 PGD-FISH cycles of 106 couples were performed, and diagnosed chromosome normality in the preimplantation embryos. The laboratory and clinical data were classified by the following optimization steps, and statistically analyzed. Phase I: Blastomere biopsy with two kinds of pipettes, removal of cytoplasmic proteins without treatment of pepsin and culture of biopsied embryos with single medium; Phase II: Blatomere biopsy with single pipette, removal of cytoplasmic proteins with pepsin and culture of biopsied embryos with single medium; Phase III: Blastomere biopsy with single pipette, removal of cytoplasmic proteins with pepsin and culture of biopsied embryos with sequential media. Results: A total of 3, 209 oocytes were collected, and 83.8% (2, 212/2, 640) of fertilization rate was obtained by ICSI procedure. The successful blastomere biopsies were accomplished in 98.6% (2, 043/2, 071) of embryos, and the successful diagnosis rate of FISH was 94.7% (1, 935/ 2, 043) of blastomeres from overall data. Embryo transfers with normal embryos were conducted in 93.9% (170/181) of started cycles. There was no difference in the successful rate of biopsy and diagnosis among Phase I, II and III. However, the pregnancy rate per embryo transfer of Phase III (38.8%, 26/67) was significantly (p<0.05) higher than those of Phase I (13.9%, 5/36) and Phase II (14.9%, 10/67). Conclusions: The laboratory optimization and experience for the PGD with FISH procedure can increase the pregnancy rate to 38.8% in the human IVF-ET program. Our facility of PGD with FISH provides the great possibility to get a normal pregnancy for the concerned couples by chromosomal aberrations.

• Clinical and Experimental Reproductive Medicine
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• 제47권2호
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• pp.147-152
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• 2020

Objective: The purpose of this study was to determine the effect of vaginal progesterone for luteal phase support (LPS) on the clinical pregnancy rate (CPR) in natural frozen embryo transfer (FET) cycles via a meta-analysis. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) and retrospective studies that met our selection criteria. Four online databases (PubMed, Embase, Medline, and the Cochrane Library) were searched between January 2017 and May 2017. Studies were selected according to predefined inclusion criteria and meta-analyzed using R software version 2.14.2. The main outcome measure was CPR. Results: A total of 18 studies were reviewed and assessed for eligibility. One RCT (n = 435) and three retrospective studies (n = 3,033) met the selection criteria. In a meta-analysis of the selected studies, we found no significant difference in the CPR (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.60-1.55) between the vaginal progesterone and control groups. An analysis of the two retrospective cohort studies that reported the live birth rate (LBR) following FET showed a significantly higher LBR in the vaginal progesterone group (OR, 1.72; 95% CI, 1.21-2.46). A subgroup meta-analysis of FET conducted 5 days after injection of human chorionic gonadotropin showed no significant differences between the two groups with regard to the CPR (OR, 1.18; 95% CI, 0.90-1.55) or miscarriage rate (OR, 0.73; 95% CI, 0.36-1.47). Conclusion: The results of this meta-analysis of the currently available literature suggest that LPS with vaginal progesterone in natural FET cycles does not improve the CPR.

• Clinical and Experimental Reproductive Medicine
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• 제24권1호
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• pp.135-141
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• 1997

The early studies demonstrated that the relative amount of FSH was important for stimulating normal ovarian activity and demonstrated the existence of a threshold level for FSH, above which follicular growth was activated. It was found that only a modest increase in circulating FSH level above the threshold (between 10 and 30%) was required to stimulate folliculogenesis. In addition, FSH is primary responsible for initiating estradiol production through the activation of the aromatase enzyme system in granulosa cells, follicular secretion and growth. LH on the other hand, plays a supportive role in ovarian steroidogenesis, stimulating the ovarian thecal cells to produce androgen, the precursor for estradiol synthesis. But there is now an increasing number of reports in the literature demonstrating an adverse effect of LH on fertility and miscarriage in infertile and fertile women. So HP-FSH is the drug of a highly purified FSH preparation which has a higher specific activity and far fewer impurities than FSH. This study was performed to evaluate the efficacy and safety of HP-FSH administered (SC; subcutaneous) versus FSH(IM; intramuscular) for ovulation induction. 20 candidates patients for ovulation induction were participated. All patients underwent pituitary desensitizing with a long gonadotropin-releasing hormone (GnRH) agonist protocol and ovulation induction was started with HP-FSH SC (10 patients; group I) or FSH IM (10 patients; group II). After ovulation, outcome of ovulation induction and local reaction of injection site were compared. There were no difference of outcome of ovulation in two groups except pregnancy rate/embryo transfer. Group I had a higher pregnancy rate/ embryo transfer than Group II (44.4% Vs 28.6%). Pain, redness, tenderness, bruising and itching when the injection received on the first 5 days of treated (50 SC and 50 IM injections) were assessed. There were no significant difference (P>0.05) in the incidence of tenderness, bruising and itching between the IM and SC injection. But IM injection (FSH) had a tendency of higher above incidence. The number of reports of pain, redness were significantly increased in IM injection group (P<0.05). These results indicate that SC administration of HP-FSH has been shown to be as effect for superovulation as traditional gonadotropins, with an improved safety profile due to the removal of extaneous proteins.

• Clinical and Experimental Reproductive Medicine
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• 제34권4호
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• pp.285-291
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• 2007

목 적: 자신의 난자를 사용하여 체외수정시술을 시행한 40세 이상의 여성 환자에서 시술 결과를 분석하여 체외수정시술의 유용성을 평가하였다. 연구방법: 본원에 내원하여 체외수정-배아이식 시술을 받은 환자 중 40세 이상의 여성 환자 170명 271주기를 대상으로 하여 시술 결과를 분석하였다. 이들 환자 중 44세 미만 군과 44세 이상 군으로 나누어 시술 결과를 비교하였다. 통계학적 분석은 student t-test 및 Fishers exact test를 이용하였다. 결 과:총 임상적 임신율이 11% (30/271), 임상적 임신이 확인된 후 유산된 경우가 33% (10/30), 총 분만율이 7.4% (20/271)이었다. 44세 미만 군과 44세 이상 군의 비교에서는 주기취소율이 13%와 23%로 44세 이상군에서 높았고, 평균 회수된 난자 수, 수정된 배아 수, 이식한 배아 수는 각각 6.17$\pm$4.62와 4.13$\pm$4.07, 4.83$\pm$3.61와 3.46$\pm$3.12, 3.52$\pm$1.72와 2.81$\pm$1.83로 44세 이상 군에서 통계적으로 유의하게 낮았다. 임상적 임신율과 분만율도 각각 13.0%와 2.1%, 9.0%와 0.0%로 44세 이상 군에서 유의하게 낮았다. 결 론: 본 연구 결과에 의하면 자신의 난자를 사용한 체외수정-배아이식 시술이 44세 미만의 여성불임 환자에게는 유용한 시술이지만, 44세 이상의 환자에서는 시술을 통한 성공적인 임신과 분만에 어려움이 많았다.

• Clinical and Experimental Reproductive Medicine
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• 제36권4호
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• pp.275-281
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• 2009

목 적: 본 연구는 반복적으로 체외수정시술/난자세포질내 정자주입술을 실패했던 환자에서 배아 이식시 옥시토신 길항제의 투여가 임신율 및 착상율에 미치는 영향을 알아보고자 하였다. 연구방법: 2회 이상의 체외수정시술/난자세포질내 정자주입술을 실패했던 40명의 환자들을 대상으로 전향적 무작위 연구를 진행하였다. 과배란유도 방법으로 생식샘자극호르몬분비호르몬 길항제 다회투여법이 사용되었다. 실험군에서는 옥시토신 길항제로 atosiban (vasopressin $V_{1A}$/oxytocin antagonist)을 배아 이식 한 시간 전에 atosiban 6.25 mg을 일회 정주한 뒤, 18 mg/hour의 속도로 지속적 정맥 주입하였다. 배아 이식이 끝난 뒤 atosiban을 6 mg/hour로 감속하여 2시간 동안 추가로 정맥 주입하였다. 실험군과 대조군간의 체외수정시술 결과를 비교 분석하였다. 결 과: 실험군과 대조군간의 평균 나이, 불임 기간 및 체질량 지수와 기저 혈중 난포자극호르몬 및 에스트라디올 농도, 기저 난포강 난포의 수에 통계적으로 유의한 차이는 없었다. 또한 투여된 재조합 인간 난포자극호르몬 (rhFSH)의 총 용량과 투여 기간, 발달된 난포의 개수 및 자궁내막의 두께 역시 통계학적 유의한 차이를 보이지 않았다. 수집된 난자 및 성숙 난자의 수와 수정된 난자와 1등급 혹은 2등급의 배아 및 이식된 배아의 수에도 두 군간의 통계학적으로 유의한 차이를 보이지 않았다. 착상율을 비교하였을 때 실험군은 16.9% (11/65), 대조군은 6.0% (4/67)로 나타났고, p=0.047로 두군 간에 통계학적으로 유의한 차이를 보였다. 임상적 임신율의 경우 실험군은 40.0%로 대조군의 20.0%에 비해 높게 나타나으나 통계학적 유의성엔 도달하지 못하였다. 또한 자궁외 임신 및 유산율에 있어서는 두 군 간에 유의한 차이를 보이지 않았다. 결 론: 체외수정시술/난자세포질내 정자주입술을 시행 받는 환자들에서 배아 이식 동안 옥시토신 길항제를 투여하는 것은 자궁의 수축을 감소시켜 착상율을 증가시킬 수 있을 것으로 생각된다.

• 대한한방부인과학회지
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• 제27권4호
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• pp.69-87
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• 2014

Objectives: We analyzed retrospective clinical data of Korean medical institutes for infertility care and investigated current status and outcome of the Korean medical treatment of infertility as a part of foundational research for verifying validity of constructing national support system and developing appropriate policy on Korean medical treatment of infertility. Methods: We investigated data uploaded on the homepage of The Society of Korean Medicine for Subfertility (http://www.okinfertility.org) by Korean medical institutes for infertility care to get informations such as patients' age, body height, weight, methods of Korean medical treatment, cost and duration of treatment, success or failure of pregnancy and result of treatment. Results: The average age of patients was $33.1{\pm}3.8$ and the average body height was $161.2{\pm}5.3cm$ and the average body weight was $55.2{\pm}8.5kg$. The method of Korean medical treatment was Herbal medicine (97.5%), acupuncture (80.4%), moxibustion (57.7%), cupping (32.7%). The average cost of treatment was $1,160,625{\pm}882,499$ won, and the average medical cost per visit was $357,845{\pm}241,602$ won. The average duration of treatment was $11.26{\pm}10.58$ weeks, and the average number of visits per patient was $4.78{\pm}6.10$ times. The average duration of treatment was the longest in the group of infertile patients with the highest average medical cost per visit. The average pregnancy success rate was 30.9% overall, and that of the group of infertile patients was 25.8%. Conclusions: When we develop the standard project model with expectation for about 25% success rate of pregnancy and delivery in the group of patients who have idiopathic and ovulatory factors, it is desirable to perform acupuncture and moxibustion treatment 1-2 times a week with herbal medicine. The treatment period is set to at least 12 weeks. Average treatment fee maybe calculated by converting the averaged treatment cost of clinic's one month worth of daily treatment fee and medical hospital's ten day treatment fee into weekly treatment cost.

• Clinical and Experimental Reproductive Medicine
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• 제32권1호
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• pp.55-64
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• 2005

Objective: Human infertility clinics have been faced the demand for improving clinical results. The purpose of this study was to evaluate the effect of microsurgical removal of damaged blastomeres (DB) in frozen-thawed embryos on the clinical outcomes. Methods: From January 2003 to May 2004, out of 258 thawing ET cycles were divided into three groups: Group-1 (n=46): Intact cleavaged embryos after thawing. Remained cycles with embryos containing DB were randomly divided into two groups. Group-2 (n=102): Drilling zona pellucida (ZP) of frozen-thawed embryos by acidified Tyrode's solution. Group-3 (n=110): Drilling ZP and removal of DB. Embryos after microsurgical manipulation were transferred into the uterus of patients. Results: Clinical profiles and the mean number of transferred embryos among three groups were not different. Pregnancy and implantation rates were similar in three groups. It were 30.4% and 9.3% in Group-1, 29.4% and 7.8% in Group-2, and 26.4% and 7.6% in group-3, respectively. Miscarriage rate in Group-3 (37.9%) was slightly higher than those in Group-1 and Group-2 (14.3% and 23.3%), but it was not statistically significant. Conclusion: Intact cleaving embryos after DB removal showed higher potent of pregnancy and implantation. We could not find any improvement of clinical outcome by removal of DB in frozen-thawed embryos.