Objective: To evaluate the significance and efficacy of trans-cervical fallopian tube catheterization (TFTC) in diagnosis and optimal treatment modality for tubal blockage. Methods: The retrospective study was performed in those underwent TFTC from January 2005 to December 2009. A total of 342 fallopian tubes in 215 patients which showed tubal blockage in hysterosalpingography (HSG), were subjected to TFTC. Recanalization rate (RR) was compared according to portion of tubal blockage; proximal, isthmic and distal portion and blockage type; tapering, concave, and convex type. Results: In total, RR was 72.5% (248/342 tube). According to the portion of tubal blockage, RR was 83.8% in proximal, 45.6% in isthmic and 100% in distal portion. RR was 92.3% in tapering, 80.2% in concave and 25.5% in convex type, respectively. There were 98 pregnancies in 156 patients after successful recanalization, which shows 62.7% pregnancy rate. Conclusio: TFTC were capable of recanalizing tubal blockage in 248 of 342 tubes in 156 of 215 patients (72.5%). The RR was increased with proximal portion and tapering type tubal blockage.
Objectives: The purpose of this study was to compare the decidual NK cell populations between increased pre-conceptional peripheral NK cell population and normal pre-conceptional peripheral NK cell population in women with a history of recurrent abortion. Methods: Fourteen women with history of recurrent abortion and elevated pre-conceptional peripheral NK cell, above 15% of peripheral lymphocyte population were included in this study. As a control, twelve women with history of recurrent abortion and their peripheral NK cell percentage showed below 15% were included. Distribution of $CD56^+$ and $CD16^+$ NK cells in paraffin embedded decidual tissues including implantation sites were examined by immunohistochemical staining using anti-CD56, 16 monoclonal antibodies. After immuohistochemical staining, the numbers of decidual NK cells were counted and compared these results between study and control groups. Results: There was significant difference in decidual $CD56^+$ NK cell count ($170.1{\pm}132.1$ vs. $68.3{\pm}66.1$, p=0.02) between increased peripheral $CD56^+$ NK cell group and control group. But, there showed no statistically significant correlation between decidual $CD56^+$ NK cell count and peripheral $CD56^+$ NK cell percentage (r=0.229, p=0.261). Also there was no statistically difference decidual $CD16^+$ NK cell count between study and control group ($25.70{\pm}11.72$ vs. $31.17{\pm}22.67$), and no correlation between decidual $CD16^+$ NK cell and peripheral $CD16^+$ NK cell percentage (r=-1.40, p=0.535). Conclusions: This study shows that decidual $CD56^+$ NK cell are significantly increased in decidua of women exhibiting a history of recurrent abortion with increased $CD56^+$ peripheral NK cell. This study suggests that the percentage of peripheral NK cell reflect the expression of decidual NK cell. Consequently, pre-conceptional peripheral blood NK cell population can be the useful marker for detecting the risk of subsequent miscarriage.
Objectives: This study was performed to elicit the effectiveness of a herbal formula, Kamisoyo-san (Jiaweixiaoyaosan) on enhancing ovarian function in infertile woman with ovarian dysfunction. Methods: 28 patients who initially visited between November 2006 and February 2009 and were administered Kamisoyo-san until May 2009 were retrospectively evaluated for their ovarian function by means of basal FSH (b-FSH), menstrual cycle, body mass index (BMI), and body fat ratio. To identify the major factor of improving ovarian function, 28 patients were classified into two groups by criteria of patent factors, such as pre-administration b-FSH, patient age, and treatment duration, respectively. Two groups were compared in terms of pregnancy percentage, b-FSH, menstrual cycle, BMI, and body fat ratio. Results: Post-administration b-FSH significantly decreased in comparison with pre-administration (p=0.004). The higher group (b-FSH $\geq$ 25mIU/mL) in pre-administration b-FSH was more effective in decrease of post-administration b-FSH than the lower one (10mIU/mL < b-FSH < 25mIU/mL). Conclusion: Kamisoyo-san may have a therapeutic effect on the infertility of child bearing period woman with ovarian dysfunction.
Gonadotropin-releasing hormone (GnRH) has been known to play a role in the regulation of hCG secretion by human placenta. Recently, a gene encoding the second f개m of GnRH (GnRH-II) was identified in human. Herein, we demonstrate that GnRH-II is expressed in human placenta and assess GnRH-II expression by nested RT-PCR and immunohistochemistry in human placenta during the first trimester. We found that two altematively spliced transcripts of GnW-II mRNA were expressed in human placental tissues of first trimester and the shorter variant had a 21-bp deletion in GnRH-associated peptide (GAP). Immunoreactive GnRH-II was localized in both cytotrophoblastic and syncytiotrophoblastic cytoplasm. The immunostaining intensity was stronger in cytotrophoblast. Villous stromal cells also showed GnRH-II immunoreactiyiry. The results of our study report that the second isoform of GnRH (GnRH-II) is expressed in the first trimester human placenta and we suggest that GnRH-II may also play a regulatory role in maintenance of early pregnancy and hCG secretion in human placenta.
Objectives: Pelvic tuberculosis (TB) causes infertility despite of anti-TB chemotherapy and IVF-ET is effective treatment to achieve pregnancy. The aim of this study is to assess the outcomes of IVF-ET in pelvic TB, especially according to main Tb lesion, and to investigate the factors affecting the successful outcome. Methods: A total of 135 IVF-ET cycles were performed in 54 patients with pelvic TB and the outcome was compared with that of control group with tubal factor not associated with TB in 301 cycles, 227 patients. Anti-TB chemotherapy was performed in the patients with pelvic TB. Pregnancy rate was compared according to main TB lesion as salpingitis, peritonitis, and endometritis. In the patients with endometrial TB, when complicated with uterine synechia, hysteroscopic lysis was done before IVF-ET and pregnancy rate was compared according to the presence of uterine synechia. Results: There was no significant difference in peak E2 ($2,790{\pm}280.1$ vs $2,554{\pm}101.2$, p>0.05), the number of retrieved oocytes ($13.5{\pm}0.7$ vs $12.5{\pm}0.4$, p>0.05) and fertilized oocytes ($7.7{\pm}0.5$ vs $7.8{\pm}0.3$, p>0.05) between patient and control group. Clinical pregnancy rate per transfer in pelvic TB group was 22.9% and showed no difference from that of control group (24.3%, p>0.05). Although it was not statistically significant, pregnancy rate in the endometrial Tb (18%) was lower than that in the salpingitis (28.5%) or peritonitis (26.5%) (p>0.05). In the endometrial TB with uterine synechia, pregnancy rate was significantly lower than that of the patients without synechia even after hysteroscopic lysis (9.7% vs 31.6%, p<0.05). Conclusion: IVF-ET after anti-TB chemotherapy is the most effective treatment to achieve pregnancy in infertile patients with pelvic TB. Because the presence of endometrial TB and resulting uterine synechia affects the outcome of IVF-ET, thorough evaluation for endometrium with endometrial biopsy and hysteroscopy is important to predict the prognosis of IVF-ET treatment.
Mammalian oviductal epithelial cells have been known to improve in vitro fertilization and embryonic development. Recently, co-cultured human embryos with the epithelial cells in human genital tract has been reported to improve the pregnancy rate. The purpose of the study was to investigate the effects of the epithelial cells of human genital tract on the development of mouse early embryos and human fertilized oocytes. The epithelial cells of human genital tract were collected from the fallopian tubes which were obtained during hysterectomy in fertile women and from the endometrium during endometrium biopsy. Collected human ampullary cells(HACs) and endometrial cells(HECs) were cultured for 10 days to establish primary monolayer. Second passaged HACs and HECs were obtained by trypsinization were cryopreserved in PBS with 1.5 M DMSO for later use. To investigate the effect when co-cultured with HACs and HECs, we tried to apply strict quality control on mouse embryo, from two cell to blastocyst prior to human trial. The results of quality control were as follows; In Group I (Ham's F10 with 10% FCS), Group IT (co-cultured with HACs) and Group ill (co-cultured with HECs), developmental rates to blastocyst were 63.3%(253/400), 76.0%(304/ 400),74.0%(296/400), respectively. Hatching rates were 36.8%(147/400), 41.80/0(167/400), 38.0%(152/400), respectively(p<0.05). To perform the human IVF, cryopreserved HACs were thawed at 37$^{\circ}C$ waterbath, seeded on the well dish and cultured for 48 hI'S. The pronuclear stage embryos were transferred to the seeded well dish. After 24 hRS, co-cultured embryos were examined and transferred to patient's uterus. The results of human IVF when co-cultured with HACs were that fertilization and developmental rates were 61.8% (256/414), 95.3% (244/256) as compared with 57.2% (279/488) and 94.6%(264/279) in Ham's F10 supplemented with 10% FCS(control). However, 62.9% (161/256) of co-cultured human embryos showed good embryos(no or slight fragmentation) as compared with 53.8 % (150/279) in control(p < 0.05). Pregnancy rate was 40.0% (12/30) when co-cultured with HACs whereas 30.6%(11/36) in control. In conclusions, co-culture system using HACs and HECs improved the developmental and hatching rates of mouse embryo. Also, in human IVF system when co-cultured with HACs, it improved both the quality of human embryos and the pregnancy rate.
Kim, Hye Ok;Yang, Kwang Moon;Hur, Kuol;Park, Chan Woo;Cha, Sun Hwa;Kim, Hae Suk;Kim, Jin Yeong;Song, In Ok;Koong, Mi Kyung
Clinical and Experimental Reproductive Medicine
/
v.32
no.1
/
pp.27-32
/
2005
Objective: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. Material and Methods: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. Results: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (${\geq}15mm$) was lower in the AI group ($1.08{\pm}0.45$ vs. $1.64{\pm}0.75$) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group ($10.35{\pm}1.74$ vs. $9.23{\pm}1.61$) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group ($116.9{\pm}75.8$ vs. $479.5{\pm}300.8$) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed $10.6{\pm}1.6mm$ in the endometrial thickness and $106.6{\pm}66.8pg/ml$ in $E_2$ concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number ($1.25{\pm}0.5$) compared to prior CC cycle. Conclusions: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.
Park, Chan-Woo;Seo, Ju-Tae;Park, Yong-Seog;Kim, Hye-Ok;Yang, Kwang-Moon;Kim, Jin-Young;Koong, Mi-Kyoung;Kang, Inn-Soo;Song, In-Ok
Clinical and Experimental Reproductive Medicine
/
v.35
no.4
/
pp.293-301
/
2008
Objective: To evaluate outcomes of patients with non-obstructive azoospermia (NOA) undergoing the testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI) with different histopathologic subgroups. Method: A total of 122 embryo-transferred TESE/ICSI cycles were compared among NOA subgroups; Germ-cell aplasia (GA, 40 cycles), Maturation arrest (MA, 32 cycles) and severe hypospermatogenesis (S-HS, 50 cycles). Obstructive azoospermia (OA, 667 cycles) patients were served as a control. TESE/ICSI outcomes such as fertilization rate (FR), clinical pregnancy rate (CPR) and live birth rate (LBR) were evaluated. Results: The 2PN FR of embryo-transferred TESE/ICSI cycle was 58.1% in GA, 42.2% in MA and 48.0% in S-HS, which was significantly lower than that of OA (72.9 %, p<0.001). For ICSI-spermatozoa cycles, there were no significant differences in CPR (22.6%, 29.4% and 26.1%) and LBR (16.1%, 29.4% and 19.6%) among NOA subgroups. The CPR of ICSI-spermatid cycles was 0.0%, 9.1% and 0.0% without a live birth. For ICSI-spermatocyte cycles, no clinical pregnancies occurred in any group. Conclusion: There was no significant difference in the FR of embryo-transferred TESE/ICSI cycles among NOA subgroups. The FR among all NOA subgroups was significantly lower than that of OA. Testicular histopathology in NOA did not affect successful pregnancy if spermatozoa extraction from the testis is successful and embryo transfer is possible.
Objective: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome(OHSS) without compromising pregnancy outcome. Method: Thirty-seven women who had been coasted during COH for IVF were coasted when $\geq$20 follicles > 15 mm with serum E$_2$ level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E$_2$ level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E$_2$ levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. Results: The mean serum E$_2$ level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E$_2$ level was 43% in one day coasting group and 15% (1$^{st}$ day) and 81% (2$^{nd}$ day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3(8.1%) patients. Conclusions: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.
Despite a considerable amount of investigation there continues to be disagreement concerning the proteins present in human seminal plasma. Recently their identification has assumed a greater importance following evidence that infertility in men and women may have an immunological cause (Katsh, 1959; Quinlivan, 1969). Seminal plasma is composed of fluids secreted by the prostate, seminal vesicles, ampullae, ducti deferentes, bulbourethral (Cowper's) glands, urethral(Littre's) glands and the epididymes. Prostatic juice, one of the major components of seminal plasma, has an important role in secretion of acid phosphatase and prostaglandin. A few studies have been reported of human prostatic juice, since, in human subjects, there were some problems in studying prostatic juice due to quite small amount of secretion and possibility of contamination with fluids from the seminal vesicles and ejaculatory ducts. The purpose of the present study was to determine the basic components of proteins in human prostatic juice. Prostatic juice was obtained from normal healthy man of $20{\sim}30\;year-old$ by massage of the prostate, and protein components were separated by means of disc electrophoresis. The results are summarized as follows; 1) Total numbers of protein fractions of normal human serum and prostatic juice are $14{\sim}18$ bands and $9{\sim}12$ bands, respectively. Prostatic juice produces two deeply staining bands which appear similar to those formed by $beta-_1$ globulin and albumin. 2) $Alpha-_1$ globulin area in the fractions of prostatic juice shows 4 bands and one more band is found than that of serum. On the other hand, the fractions of immunoglobulin and $alpha-_2$ globulin areas are eight in serum and it has three bands more than that of prostatic juice. 3) $Alpha-_1$ globulin area in the prostatic juice is more deeply stained than that of serum. In contrast with $alpha-_1$ globulin area, immunoglobulin and $alpha-_2$ globulin areas in the prostatic juice show weaker staining than serum.
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