ABSTRACT
OBJECTIVE: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. MATERIALS AND METHODS: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. RESULTS: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. CONCLUSIONS: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.
Subject(s)
Child , Female , Humans , Pregnancy , Cautery , Fallopian Tubes , Lost to Follow-Up , Pregnancy Rate , Seoul , Sterilization, TubalABSTRACT
Multifetal pregnancy reduction(MFPR) has been suggested to improve pregnancy outc-ome in multifetal pregnancies with three or more fetuses after assisted reproductive techn-ology(ART) such as IVF-ET program, and now it seems to be a rather safe and effective mothod to reduce perinatal loss associated with multifetal pregnancies. To investigate the effectiveness of MFPR, the perinatal outcome of twin pregnancies in IVF-ET patients was analyzed in 3 groups : Group I-12 infertile patients who had conceived more than quadru-plet pregnancy and underwent MFPR to twin pregnancy, Group II-29 patients who had conceived triplet pregnancy and underwent MFPR to twin pregnancy, and Group III-30 pat-ients who had conceived twin pregancy initially and served as control group. Among 3 gr-oups, fetal loss rate before 24 weeks of gestation, pregnancy non-reduced, complications, gestational age at delivery, and birth weight were compared. Fetal loss rate after MFPR was significantly higher in Groups I(41.7%) and Group II(17.2%) compared with Group III(3.3%), and positively correlated with the number of fetuses before MFPR in Groups I and II. However, pregnancy complication rate was not significantly different among 3 groups(41.7%, 48.3%, and 36.7%). After exclusion of fetal loss cases before 24 weeks, mean gestational age at twin delivery and mean birth weight were not significantly different among 3 groups(36.2 weeks, 36.6 weeks, and 36.1 weeks ; 2.37 kg, 2.45 kg and 2.47kg).In conclusion, MFPR in multifetal pregnancies is an ethically justified procedure that may improve perinatal outcome in cases of multifetal pregnancies.
Subject(s)
Humans , Pregnancy , Birth Weight , Embryo Transfer , Embryonic Structures , Fertilization in Vitro , Fetus , Gestational Age , Pregnancy Complications , Pregnancy, Triplet , Pregnancy, TwinABSTRACT
This study was performed to review and evaluate a series of 1,118 patients who und-erwent microsurgical reanastomosis of previously sterilized fallopian tubes in the 134-month span encompassing January, 1980 to Febrary, 1991 at Seoul National University Hospital. Clinical characteristics of patients, pregnancy rates, and factors influencing the outcome of microsurgical tubal reversal were analyzed. Of 1,118 patients, 633(56.6%) had been sterilized by laparoscopic cautery. Loss of ch- ildren was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. The postoperative tubal length was 6 cm or more in 76.0%. Nine hundred and twenty-two(82.5%) patients were followed up for more than 5 years. Overall pregnancy rate after microsurgical tubal reanastomosis was 54.8%(505 /922) with delivery rate of 71.5%(418/585), and the estimated anatomical success rate was 88.2%(814/922). In 505 pregnant cases, mean age of patients was younger and postoperati- ve tubal length was longer with statistical significance compared with 417 nonpregnant cases. Pregnancy rate was significantly correlated with postoperative tubal length, but not with method and duration of sterilization or operative procedure. These data suggest that only the postoperative tubal length is a factor influencing si- gnificantly pregnancy rate after microsurgical reversal of tubal sterilization.
Subject(s)
Female , Humans , Cautery , Fallopian Tubes , Pregnancy Rate , Seoul , Sterilization , Sterilization Reversal , Sterilization, Tubal , Surgical Procedures, OperativeABSTRACT
In performing in vitro fertilization and embryo transfer(IVF-ET) program, we haveIdentified multifollicular ovarian pattern which can be distinguished from polycystic ovaries(PCO) by transvaginal ultrasonograpy. Mutifollicular ovaries(MFO) are normal in size ofslightly enlarged, and filled with six or more cysts 4~10 mm in diameter: in contrast toPCO, ovarian stroma is not increased. Women with MFO have the characteristic clinical andEndocrine features which are distinct from those associated with PCO.The objective of this retrospective clinical study was to evaluate the outcomes ofcontrolled ovarian yperstimulation(COH) in infertile patients with MFO, and to compare thepregnancy outcomes in MFO patients with those of PCO or tubal factor only patients. IVF-ET was performed using COH with midluteal GnRH agonist suppression and gonadotropinsin 61 MFO patients(68 cycles), 9 PCO patients(11 cycles), and 188 patients(296 cycles) withtubal factor infertility at Seoul National University Hospital from January, 1995 to August,1996.There were no statistically significant differences in the age of patients, the durationof infertility, and the cancellation rate of COH among three groups. Although patients withMFO of PCO needed less amount of gonadotropins, they showed higher peak serum E2Level and more oocytes were retrieved compared with tubal factor patients(p < 0.05). However,no significant differences existed in the fertilization rate, the number of embroys transferred,and the cumulative embryo score(CES) among three groups. The clinical pregnancy rate(PR) per ET and the implantation rate per embroy were 33.3%(22/66) and 10.1%(36/358),respectively, in MFO, 40.0%(4/10) and 9.4%(5/53) in PCO, and 28.7%(83/289) and 7.6%(108/1,403) in tubal factor patients, and they showed no significant differences. In addition,the ectopic PR, the abortion rate, and the multiple PR were not different among three groups.The occurrence rate of ovarian hyperstimulation syndrome(OHSS) was higher in MFO(10.3%) and PCO(18.2%) compared with tubal factor patients(2.7%,p < 0.05).These data suggest that althought patients with MFO or PCO have the different clinicaland endocrine features, the outcomes of IVF-ET using midluteal GnRH agonist andgonadotropins are similar each other. However, as patients with MFO parttern in transvaginalultrasonography have a higher incidence of OHSS than tubal factor patients, morecareful monitoring of COH for IVF-ET is required.
Subject(s)
Female , Humans , Pregnancy , Abortion, Induced , Embryo Transfer , Embryonic Structures , Fertilization , Fertilization in Vitro , Gonadotropin-Releasing Hormone , Gonadotropins , Incidence , Infertility , Oocytes , Retrospective Studies , Seoul , UltrasonographyABSTRACT
Recent evidence suggests that a high level of serum LH during follicular recruitment and development is associated with poor reproductive outcome. Consequently, exogenous LH administration for controlled ovarian hyperstimulation(COH) in in vitro fertilization and embryo transfer(IVF-ET) may be harmful to folliculogenesis. The purpose of this clinical study was to evaluate and compare the efficacy of human menopausal gonadotropin(hMG) and human follicle-stimulating hormone(hFSH) for COH with long protocol of gonadotropin-releasing hormone(GnRH) agonist in IVF-ET program. Randomized clinical trial was performed in 125 patiens undergoing IVF-ET at Seoul National University Hospital from May to Septebmer, 1995. The inclusion criteria of patients included age < 40 years and normal semen analysis, and the study population was also classified into two groups by the etiology of infertility : Group T - 95 patients with only tubal factor and Group O - 30 patients with endometriosis or anovulatory factor. There were no statistically significant differences in dosage(29.0+/-7.9 vs 26.0+/-6.8 ampoules) and duration(12.3+/-1.3 vs 12.2+/-1.5 days) of gonadotropin administration, serum E2 level on hCG day(1,943+/-1,255 vs 1,580+/-1,067 pg/mL), cancellation rate(7.5% vs 6.7%), number of oocytes retrieved(9.9+/-6.0 vs 11.3+/-6.0), fertilization rate(68.4% vs 64.5%), number of embryos transferred(4.7+/-2.0 vs 4.7+/-2.0), and preganancy rate per cycle(26.3% vs 24.4%) and per ET(28.4% vs 26.2%) between hMG(N=80) and hFSH(N=45) Groups. In Group T, no significant differnces in results of IVF-ET were also detected between hMG (N=61) and hFSH(N=34) Groups. In Group O, serum E2 level on hCG day was significantly higher in hMG Group (N=19) compared with hFSH Group(N=11), but other results of IVF-ET were similar in both Groups. As this study could not demonstrate any significant differences in results of IVF-ET between hMG and hFSH when used for COH in IVF-ET program, it could be concluded that hFSH is at least as efficacious as hMG for COH.
Subject(s)
Female , Humans , Embryo Transfer , Embryonic Structures , Endometriosis , Fertilization , Fertilization in Vitro , Follicle Stimulating Hormone , Follicle Stimulating Hormone, Human , Gonadotropins , Infertility , Oocytes , Semen Analysis , SeoulABSTRACT
The insulin-like growth factor(IGF) system consists of IGFs, their receptor and binding proteins(IGFBPs). The IGFs are important growth factors in the regulation of fetal growth. Since IGFBPs control IGF actions, the IGFBPs themselves may also be important in fetal growth and development. The goals of this study are to investigate the profiles of IGFBPs in cord sera of appropriate-for-gestatinal age(AGA, n=27), small-for-gestatinal age(SGA, n=14), large-for-gestatinal age(LGA, n=10) infants and preterm(PT, n=14) infants and to evaluate the relationship between these IGFBP levels and gestational weeks and birth weight and between total IGFBP levels in cord sera and paired maternal sera(n=65). The IGFBPs were analyzed by Western ligand blot and immunoprecipitation. In cord sera of AGA infants IGFBPs with molecular weight with 37/43 kilocatons(kDa; IGFBP-3), 31 kDa(IGFBP-2), 26 kDa(IGFBP-1), 24 kDa(IGFBP-4) were detected. In cord sera of LGA infants there was a significant increase in IGFBP-3 levels and a reduction of IGFBP-1 and IGFBP-4 levels compared with those in AGA infants. SGA infants had significantly higher IGFBP-1 and IGFBP-2 levels in cord sera than AGA infants. There was a similiar trend in IGFBP-1 levels in cord sera of PT infants. The relative proportion of IGFBP-4 in cord sera of SGA and PT infants was significantly higher than that of AGA infants. There was no significant correlation beween total IGFBP levels in cord sera and paired maternal sera. The ratios of total IGFBP in cord sera to that in maternal sera to that in maternal sera were significantly higher in SGA and PT infants than in AGA infants. The IGFBP-1 and IGFBP-2 levels correlated with birth weight but did not correlate with gestational weeks. These data suggest that there is an unique profile of IGFBPs in cord sera of infants according to their weight, and that IGFBPs may play a major role in the control of fetal growth.
Subject(s)
Humans , Infant , Infant, Newborn , Birth Weight , Fetal Development , Gestational Age , Immunoprecipitation , Infant, Premature , Insulin-Like Growth Factor Binding Protein 1 , Insulin-Like Growth Factor Binding Protein 2 , Insulin-Like Growth Factor Binding Protein 3 , Insulin-Like Growth Factor Binding Protein 4 , Insulin-Like Growth Factor Binding Proteins , Intercellular Signaling Peptides and Proteins , Molecular WeightABSTRACT
No abstract available.
Subject(s)
Female , Humans , Humans , Pregnancy , Culture Media , Embryonic Structures , Pregnant WomenABSTRACT
No abstract available.
Subject(s)
Female , Humans , Gonadotropin-Releasing Hormone , Gonadotropins , Ovarian Diseases , Ovulation Induction , OvulationABSTRACT
No abstract available.
Subject(s)
Female , Humans , Dydrogesterone , Estradiol , Hormone Replacement TherapyABSTRACT
No abstract available.
Subject(s)
Female , Humans , Antibodies , Primary Ovarian InsufficiencyABSTRACT
No abstract available.
Subject(s)
Female , Humans , Oocyte Retrieval , Oocytes , Ovarian DiseasesABSTRACT
No abstract available.
Subject(s)
Female , Pregnancy , Pregnancy , Fertilization in Vitro , Gamete Intrafallopian Transfer , Oocytes , Pregnancy OutcomeABSTRACT
No abstract available.