• 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.

• Clinical and Experimental Reproductive Medicine
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• 제26권3호
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• pp.419-432
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• 1999

Objective: To establish the evaluation system of the quality of oocytes on the basis of the incidence of cumulus cells apoptosis, to investigate the relationships beween the incidence of cumulus cells and the outcomes of IVF-ET. Method: Thirth-four cycles undergoing controlled ovarian hyperstimulation for IVF-ET with tubal infertility (23 cycles) or unexplained infertility (11 cycles) were included in this study. Cumulus cell masses surrounding mature oocyte and co-culture of embryos with autologous cumulus cells during IVF-ET process. The incidence of apoptosis in cumulus cells was assessed by apoptosis detection kit fluorescein. The effect of co-culture using cumulus cells and the incidence of cumulus cells apoptosis. Results: The results were as follows: 1. The incidence of apoptosis in cumulus cells markedly increased in patients aged 40 or over, while the fertilization rate was greatly decreased in those age group. 2. Apoptosis in cumulus cells was found in both the fertilized oocytes and unfertilized oocytes, but the incidence of apoptosis was higher in unfertilized oocytes. 3. There is no clear correlation between apoptosis in cumulus cells and the number of oocytes retrieved. However, the incidence of apoptosis was increased when the number of oocytes retrieved was 5 and fewer in comparison with $6{\sim}10$. 4. Embryo grade was significantly affected by the incidence of apoptosis in cumulus cells. 5. Pregnancy rate of IVF-ET per cycle was 29.4%, and the pregnant group had the higher fertilization rate and a significantly lower incidence of apoptosis in cumulus cells compared with the nonpregnant group. 6. When cumulus cells were used as helper cells in the co-culture of the embryo, in vitro activity of cumulus cells based on morphological change and proliferation did not influence the quality of embryo, but was closely associated with the implantation rate and pregnancy rate, which was enhanced when morphological changes and proliferation of cumulus cells was more active. 7. This difference in the outcome of IVF-ET according to in vitro activity of cumulus cells used for co-cultue was not associated with the incidence of apoptosis in cumulus cells; but rather had likely relations with the different secretion pattern of protein, which may be an embryo trophic factor by cumulus cells. Conclusion: These results suggest that the incidence of apoptosis in cumulus cells can be used in predicting oocyte qualities and the outcomes of IVF-ET. And the effect of co-culture largely depends on the in vitro activity of cumulus cells as well.

• Clinical and Experimental Reproductive Medicine
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• 제37권1호
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• pp.73-81
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• 2010

목 적: 클로미펜을 이용한 배란유도 주기에서 불량한 자궁내막 발달을 보이는 불임 여성에서 레트로졸의 효용성을 알아보고자 하였다. 연구방법: 2004년 3월부터 2009년 8월까지 분당서울대학교병원에서 클로미펜을 이용한 배란유도 주기에서 자궁내막 두께가 6.5 mm 이하여서 다음 주기에 레트로졸을 사용하였던 18명의 불임 여성을 선정하였다. 환자들의 평균 연령은 $30.7{\pm}2.8$세, 불임 기간은 $33.1{\pm}26.6$개월이었다. 불임의 인자는 자궁내막증이 1명, 다낭성난소증후군이 5명, 원인불명의 불임증이 12명이었다. 레트로졸은 2.5 mg의 용량으로 월경 3~5일 사이에 시작하여 5일간 투여하였다. 결 과: 이전 클로미펜 사용시와 비교하였을 때 레트로졸 주기에서 우성난포의 개수는 더 적었으나 ($1.1{\pm}0.3$ vs. $2.2{\pm}1.5$, p=0.011) 자궁내막 두께는 유의하게 증가하였으며 ($8.4{\pm}1.7$ mm vs. $5.8{\pm}0.5$ mm, p<0.001) 자궁내막 패턴 중 type C의 빈도는 이전 클로미펜 주기에서 50%이었던 것이 레트로졸 사용시 94.4%로 유의한 증가를 보였다 (p=0.036). 레트로졸을 이용한 배란 유도 주기에서 임신율은 11.1%였다. 결 론: 얇은 자궁내막 발달을 보였던 클로미펜 주기에 비해 레트로졸 사용시 자궁내막이 좀 더 두꺼워지고 패턴이 호전되는 것으로 보아 클로미펜에 불량한 자궁내막을 보이는 여성에서 이차 선택약제로 레트로졸의 사용은 유용한 방법으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제13권2호
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• pp.121-127
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• 1986

We have reviewed 59 cases of patients amoung 65 cases who underwent IVF and ET with reasonable indications irom 1984 and the results as follows. 1. Major indications for IVF and ET were tubal factor (40.7%), unexplained infertility (25.4%), endometriosis (15.3%), failed AID and AIH (10.1 %), and sperm abnormality (8.5%). 2. For superovulation of human oocytes, l00mg of clomiphene citrate and 75 IU of HMG used. The monitoring of oocyte maturation was bone by ultrasound examination and serum 17-${\beta}$ estradiol, LH values. The peak $E_2$ value was 956.36${\pm}$702.13 pg/ml. 3. The oocytes were obtained by laparoscopy 24-36 hours after the injection of HCG. 4. The mean numbers of follicles at laparoscopy was 3.06 and the successful rate of laparoscopy was 79.7%. 5. And 165 follicles were aspirated from which 98 oocytes were recovered, 59.4% of all follicles had at least one oocyte aspirated. 21.4% of the eggs were mature, 52.0% were moderate, 26.5%. were immature. 6. 67.3% of oocytes were cleaved and were transferred at 4-6 cell stages. 7. Four pregnancies including one chemical pregnancy and one spontaneous abortion were established by ${\beta}$-subunit, u-hCG and ultrasound examinations.

• Clinical and Experimental Reproductive Medicine
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• 제44권3호
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• pp.141-145
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• 2017

Objective: Delaying embryo transfer (ET) enables us to select among the embryos available for transfer and is associated with positive effects on implantation and pregnancy outcomes. However, the optimal day for ET of human cleavage-stage embryos remains controversial. Methods: A retrospective study of 3,124 in vitro fertilization/intracytoplasmic sperm injection cycles (2,440 patients) was conducted. We compared the effects of day 2 and 3 ET on rates of implantation and pregnancy outcomes between young maternal age (YMA; < 38 years old, n = 2,295) and old maternal age (OMA; ${\geq}38years\;old$, n = 829) patient groups. Results: The YMA and OMA groups did not differ in terms of patient characteristics except for the proportion of unexplained factor infertility, which was significantly greater in the OMA group, and the proportion of arrested embryos, which was significantly greater in the YMA group. However, the biochemical pregnancy, clinical pregnancy, ongoing pregnancy, abortion, and implantation rates per cycle were not significantly different between day 2 and 3 ET in the YMA group or the OMA group. Conclusion: We suggest that offering patients the opportunity to decide which day would be suitable for ET could be part of a patient-friendly protocol that takes into consideration an infertile woman's circumstances and work schedule by allowing ET to be performed on day 2 instead of the traditional transfer on day 3.

• Clinical and Experimental Reproductive Medicine
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• 제48권4호
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• pp.368-373
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• 2021

Objective: In this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes. Methods: A prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses. Results: In the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients. Conclusion: Baseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS. This possibility should be confirmed in further research.

• Clinical and Experimental Reproductive Medicine
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• 제48권2호
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• pp.163-173
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• 2021

Objective: This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. Methods: This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-E_max, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. Results: The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women's age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. Conclusion: Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

• Clinical and Experimental Reproductive Medicine
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• 제50권1호
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• pp.44-52
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• 2023

Objective: The DNA integrity of spermatozoa that attach to fallopian tube (FT) cells is higher than spermatozoa that do not attach. FT epithelial cells can distinguish normal and abnormal sperm chromatin. This study investigated the effects of sperm with a high-DNA fragmentation index (DFI) from men with unexplained repeated implantation failure (RIF) on the Toll-like receptor (TLR) signaling pathway in human FT cells in vitro. Methods: Ten men with a RIF history and high-DFI and 10 healthy donors with low-DFI comprised the high-DFI (>30%) and control (<30%) groups, respectively. After fresh semen preparation, sperm were co-cultured with a human FT epithelial cell line (OE-E6/E7) for 24 hours. RNA was extracted from the cell line and the human innate and adaptive immune responses were tested using an RT2 profiler polymerase chain reaction (PCR) array. Results: The PCR array data showed significantly higher TLR-1, TLR-2, TLR-3, TLR-6, interleukin 1α (IL-1α), IL-1β, IL-6, IL-12, interferon α (IFN-α), IFN-β, tumor necrosis factor α (TNF-α), CXCL8, GM-CSF, G-CSF, CD14, ELK1, IRAK1, IRAK2, IRAK4, IRF1, IRF3, LY96, MAP2K3, MAP2K4, MAP3K7, MAP4K4, MAPK8, MAPK8IP3, MYD88, NFKB1, NFKB2, REL, TIRAP, and TRAF6 expression in the high-DFI group than in the control group. These factors are all involved in the TLR-MyD88 signaling pathway. Conclusion: The MyD88-dependent pathway through TLR-1, TLR-2, and TLR-6 activation may be one of the main inflammatory pathways activated by high-DFI sperm from men with RIF. Following activation of this pathway, epithelial cells produce inflammatory cytokines, resulting in neutrophil infiltration, activation, phagocytosis, neutrophil extracellular trap formation, and apoptosis.