ABSTRACT
OBJECTIVE: This study was performed to estimate the efficacy of GnRH antagonist (cetrorelix) protocol in poor responders comparing with GnRH agonist protocol. METHODS: This study included 43 cycles of 38 patients who were defined as poor responders on previous consecutive two and more superovulation cycles. The study group consisted of 20 cycles of 18 poor responders treated with cetrorelix according to single dose protocol with clomiphene citrate, who were compared with 23 cycles of 20 poor responders (control group) stimulated according to GnRH agonist flare up protocol. RESULTS: Although the use of GnRH antagonist with clomiphene citrate gave a pregnancy rate of 15% which was in the range expected for patients with poor response, the study group had higher E2 level on hCG day (1246.5 +/- 89.4 vs 644.7 +/- 34.8 pg/ml) with higher number of mature oocytes (7.8 +/- 1.3 vs 4.3 +/- 0.5), and length of stimulation (15.5 +/- 1.4 vs 19.4 +/- 2.6 days), number of hMG ampules administered (19.4 +/- 3.2 vs 45.4 +/- 5.9 ampules), and cancellation rate (35.0 vs 47.8%) were significantly lower in the cetrorelix group. Although it was not statistically significant between two groups, the pregnancy rate (15 vs 8.6%) showed higher tendency in cetrorelix group. CONCLUSION: The use of GnRH antagonist cetrorelix ended with significantly more mature oocytes, less ampules of gonadotropin, shorter duration of stimulation and lower cancellation rate in this study. So the GnRH antagonist protocol may be an alternative protocol for the treatment of poor responders.
Subject(s)
Humans , Clomiphene , Gonadotropin-Releasing Hormone , Gonadotropins , Oocytes , Pregnancy Rate , SuperovulationABSTRACT
OBJECTIVE: This study was performed to compare the clinical outcomes of GnRH antagonist (Cetrorelix) single dose and multiple dose protocols for controlled ovarian hyperstimulation with GnRH agonist long protocol. MATERIALS AND METHOD: From September 2001 to March 2002, 48 patients (55 cycles) were performed controlled ovarian hyperstimulation for ART using by either GnRH antagonist and GnRH agonist. Single dose of 3 mg GnRH antagonist was administered in 15 patients (17 cycles, single dose group) at MCD #8 and multiple dose of 0.25 mg of GnRH antagonist was administered in 15 patients (18 cycles, multiple dose group) from MCD #7 to hCG injection day. GnRH agonist was administered in 18 patients (20 cycles, control group) by conventional GnRH agonist long protocol. We compared the implantation rate, number of embryos, and clinical pregnancy rate among three groups. Student-t test and Chi-square were used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: There were no significant differences in ampules of used gonadotropins, number of mature oocytes, obtained embryos between single and multiple dose group, but compared with control group, ampules of used gonadotropins, number of mature oocytes, obtained embryos were decreased significantly in both groups. Clinical pregnancy rate and implantation rate were not different in three groups. There were no premature LH surge and ovarian hyperstimulation syndrome in three groups. Multiple pregnancy were occurred 1 case in multiple dose group and 2 case in control group. CONSLUSIONS: GnRH antagonist is a safe, effective, and alternative method in the controlled ovarian hyperstimulation compared with GnRH agonist. Clinical outcomes and efficacy of both single and multiple dose protocol are similar between two groups.
Subject(s)
Female , Humans , Pregnancy , Embryonic Structures , Gonadotropin-Releasing Hormone , Gonadotropins , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy Rate , Pregnancy, MultipleABSTRACT
OBJECTIVE: This study was performed to compare the clinical outcomes of GnRH antagonist (Cetrorelix) single dose and multiple dose protocols for controlled ovarian hyperstimulation with GnRH agonist long protocol. MATERIALS AND METHOD: From September 2001 to March 2002, 48 patients (55 cycles) were performed controlled ovarian hyperstimulation for ART using by either GnRH antagonist and GnRH agonist. Single dose of 3 mg GnRH antagonist was administered in 15 patients (17 cycles, single dose group) at MCD #8 and multiple dose of 0.25 mg of GnRH antagonist was administered in 15 patients (18 cycles, multiple dose group) from MCD #7 to hCG injection day. GnRH agonist was administered in 18 patients (20 cycles, control group) by conventional GnRH agonist long protocol. We compared the implantation rate, number of embryos, and clinical pregnancy rate among three groups. Student-t test and Chi-square were used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: There were no significant differences in ampules of used gonadotropins, number of mature oocytes, obtained embryos between single and multiple dose group, but compared with control group, ampules of used gonadotropins, number of mature oocytes, obtained embryos were decreased significantly in both groups. Clinical pregnancy rate and implantation rate were not different in three groups. There were no premature LH surge and ovarian hyperstimulation syndrome in three groups. Multiple pregnancy were occurred 1 case in multiple dose group and 2 case in control group. CONSLUSIONS: GnRH antagonist is a safe, effective, and alternative method in the controlled ovarian hyperstimulation compared with GnRH agonist. Clinical outcomes and efficacy of both single and multiple dose protocol are similar between two groups.
Subject(s)
Female , Humans , Pregnancy , Embryonic Structures , Gonadotropin-Releasing Hormone , Gonadotropins , Oocytes , Ovarian Hyperstimulation Syndrome , Pregnancy Rate , Pregnancy, MultipleABSTRACT
OBJECTIVES: Our purpose was to evaluate the efficacy of pelviscopic classic intrafascial supracervical hysterectomy (CISH) & compare it with total abdominal hysterectomy (TAH). METHODS: We analyzed retrospectively, the clinical data of 1126 patients admitted from January 1993 to December 1998, at 11 university or general hospitals in Korea, for CISH group and 363 patients admitted from January 1993 to December 1998, at Chung-Ang university hospitals, Seoul, Korea, for TAH group. These patients were operated on with the indication of benign uterine disease without cervical malignant lesion. The patients with malignant cervical lesion were excluded in this study. RESULTS: (1) The average age of CISH group was 42.2 (range 24-63) years old and TAH group was 46 (range 31-54) years old. (2) The mean operative time was 150.7+/-49.9 (mean+/-SD, range 55-395) minutes in CISH group and 133.8+/-35 (mean+/-SD, range 65-350) minutes in TAH group. The mean estimated blood loss was 206+/-183.6 (mean+/-SD, range 20-2000) ml in CISH group and 596+/-452.3 (mean+/-SD, range 100-6500) ml in TAH group. The mean hemoglobin change was 1.52+/-0.98 (mean+/-SD, range 0-7) g/dL in CISH group and 3.03+/-1.47 (mean+/-SD, range 0.2-8.4) g/dL in TAH group. The mean time in hospital was 6.3+/-1.43 (mean+/-SD, range 3-18) days in CISH group and 11.0+/-4.08 (mean+/-SD, range 7-37) days in TAH group. (3) Overall complications occured at 5.3% in CISH group and 9.1% in TAH group. (4) Pathologic findings of cervix were benign in 1121 patients (99.6%) and severe dysplasia or carcinoma in situ in 5 patients (0.4%) among CISH groups. In TAH groups, 351 patients (96.7%) had benign cervical lesion and 12 patients (3.3%) had more than oderate dysplasia or carcinoma in situ. In both groups, no invasive cervical cancer was found and the transformation zone of the cervix was included within the resection margin of the cervix in all cases. CONCLUSION: The pelviscopic CISH group has less operative blood loss, less postoperative hemoglobin change, shorter hospital stay and less operative complication than TAH group. Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery and coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we believe that pelviscopic CISH is preferred in cases of benign uterine diseases, because it lowers operative complications and it may have several benefits compared with total hysterectomy, especially, in women with no pathologic lesion of the cervix.
Subject(s)
Female , Humans , Carcinoma in Situ , Cervix Uteri , Hospitals, General , Hospitals, University , Hysterectomy , Korea , Length of Stay , Operative Time , Retrospective Studies , Seoul , Uterine Cervical Neoplasms , Uterine DiseasesABSTRACT
OBJECTIVE: Proteinuria is a major clinical manifestation as well as hypertension and generalized edema in pregnancy-induced hypertension(PIH) and it should be considered an important marker of perinatal outcome. We studied the impact of proteinuria on maternal and perinatal outcome according to the degree of urine protein in PIH. METHODS: Maternal urine protein and serum albumin levels were studied in 64 cases of PIH who were admitted to Department of Obstetrics and Gynecology, Pil-Dong Hospital, College of Medicine, Chung-Ang University for the period of 10 years from January 1, 1989 to December 31, 1998. RESULTS: Serum albumin level was 2.9+/-0.7g/dL in mild preeclampsia group and 2.7+/-0.7g/dL in severe peeclampsia group and there was a significant difference between them. Birth weight of infant was 3001+/-659g in mild preeclampsia group and 2446+/-878g in severe peeclampsia group, and there was a significant difference between them. 1 minute Apgar score was 8.4+/-2.4 and 7.6+/-3.4, respectively and there was a significant difference between them. 5 minute Apgar score was 9.5+/-1.8 and 8.4+/-2.9, respectively and there was a significant difference between them. There were several maternal complications above 2(+) urine protein and no maternal complications below 1(+) urine protein. Small for gestational age infant was more common above 2(+) urine protein than below 1(+) urine protein and fetal death was more common in 3(+) urine protein. CONCLUSIONS: There was a decreasing trend in gestational weeks at delivery as proteinuria become more severe and also in birth weight, 1 minute Apgar score and 5 minute Apgar score. Maternal and fetal complications were more common as proteinuria become more severe.
Subject(s)
Female , Humans , Infant , Pregnancy , Apgar Score , Birth Weight , Edema , Fetal Death , Gestational Age , Gynecology , Hypertension , Hypertension, Pregnancy-Induced , Obstetrics , Pre-Eclampsia , Proteinuria , Serum AlbuminABSTRACT
OBJECTIVE: To evaluate the efficacy of low dose gonadotropin releasing hormone agonist(GnRH-a) therapy combined with high dose human menopausal gonadotrpin(hMG) following estrogen & progesteron therapy for poor responders. METHODS: From May 1997 to Feb 1999, 36 patients who were defined as poor responders on previous consecutive two and more superovulation cycles were randomly allocated to lowdose GnRH-a short protocol with high dose hMG protocol pretreated with estrogen & progesterone(E/P therapy)(n=16)(study group) and the clomiphene citrate with hMG(n=20)(control group). All patients were planned to undergone in-vitro- fertilization(IVF) and embryo transfer(ET) after controlled ovarian hyperstimulation(COH). RESULTS: Two groups were similar with respect to clinical features and basal FSH and E2 levels. The mean level of E2 on day 5, 304.3+/-148.ng/ml in study group was significantly higher than that in control group, 182+/-34.9ng/ml. The mean levels of E2 on hCG day was also significantly higher in study group than control group(1324+/-320ng/ml, vs 414+/-168ng/ml). The mean day of hCG day in study group, 12.3+/-0.3 was shorter than that in control group, 13.8+/-0.4. The concellation rates of cycles were significantly lower in study group than control group(13.2% vs 84.2%). But clinical pregnancy rates did not showed the significant difference between two groups. CONCLUSION: The study suggested that a lowdose GnRH-a short protocol with high dose hMG pretreated with estrogen & progesterone can improve the ovarian response in poor responder group.
Subject(s)
Humans , Clomiphene , Embryonic Structures , Estrogens , Gonadotropin-Releasing Hormone , Pregnancy Rate , Progesterone , SuperovulationABSTRACT
This study was performed to identify the effect of the hydrosalpinx fluid on sperm motility. It has been reported that the patients with hydrosalpinx show the outstandingly lower success rate than other patients having infertility by different factors. It is unclear that the cause of it is influenced by hydrosalpinx fluid directly or by secondary chronic inflammation of endometrium. We wanted to know if the hydrosalpinx fluid influences sperm motility parameters directly such that it is related to the development of infertility. Therefore, using computer assisted semen analyzer (CASA), we observed, from February to July, 1997, how sperm motility, sperm progressive motility, sperm curvilinear velocity, sperm lateral head displacement, sperm straightness and sperm linearity change after treating normal sperm with hydrosalpinx fluid to evaluate sperm function on infertility. The result was that the study group (n=32) has the tendency to differ from the control group (n=32) on sperm motility, progressive motility, curvilinear velocity, lateral head displacement, straightness and linearity. We concluded that the hydrosalpinx fluid, with varying degree, directly has the harmful effects on sperm motility parameters, that is, curvilinear velocity, lateral head displacement and linearity of sperm which are related to the hyperactivation, hence decreased capacitation.
Subject(s)
Female , Humans , Endometrium , Head , Infertility , Inflammation , Semen , Sperm Motility , SpermatozoaABSTRACT
Development of adhesions following pelvic surgery is a leading failure of reconstructive surgery. The aims of this study were to compare the occurrence of adhesions after a standard uterine injury infilicted by laparoscopy versus laparotomy, to compare the efficacy of 32% dextran 70 used for adhesion prophylaxis and to compare the tissue reactions to the catgut, polypropylene, polyglactin and polydioxanone suture materials. Forty rabbits were randomly assigned to four groups, of which group 1 and group 2 received operations via laparoscopy and group 3 and group 4 received via laparotomy. During operations, group 1 and group 3 were irrigated and administered with 10 ml of 32% dextran 70. The uterine horns were incised and anastomosed with four suture materials respectively. After six weeks, thirty eight rabbits were assigned to laparotomy to assess the extent of intraperitoneal adhesions. The intraperitoneal adgesions were graded according to their severity. Tissue block were obtained from the suture sites for histologic assessment. Adhesions were significantly less in laparoscopy-treated group than in laparotomy-treated group but there are no differences in the inflammatory reactions to suture material, operative manipulations or 32% dextran 70. Moderate fibrosis persisted around the catgut and oplypropylene suture, but not at all around the polydioxanone and polyglactin sutures. The routine use of intraperitioneal 32% dextran 70 has been suggested as an adjuvant to prevent postoperative adhesions, however it's user did not reduce the formation of adhesions in this study.
Subject(s)
Animals , Rabbits , Catgut , Dextrans , Fibrosis , Horns , Laparoscopy , Laparotomy , Polydioxanone , Polyglactin 910 , Polypropylenes , SuturesABSTRACT
No abstract available.
Subject(s)
Female , Humans , Estrogen Replacement Therapy , Estrogens , Gonadotropins , OvariectomyABSTRACT
No abstract available.
Subject(s)
Humans , Urethra , Urinary Bladder , Urinary IncontinenceABSTRACT
No abstract available.
Subject(s)
Humans , Urethra , Urinary Bladder , Urinary IncontinenceABSTRACT
No abstract available.
Subject(s)
Contraceptives, Oral , Fertilization in Vitro , GonadotropinsABSTRACT
Recent case reports of the successful application of electroejaculation techniques for seminal emission and subsequent pregnancies have offered promising fertility alternative for the men with neurogenic anejaculation. The success of his program requires multidisciplinary couple-oriented therapy combining both turologic and gynecologic infertility therapy. However, despite obtaining often normal numbers of spermatozoa. sperm motility rarely exceeds 10-20% in electroejaculation sample. Therefore, realistic potential for pregnancy with intrauterine insemination technique is extremely low. In this report we present the first domestic successful coordination of both electroejaculation and in vitro fertilization-embryo transfer in a neurogenic anejaculation patient with severe oligoasthenospermia.
Subject(s)
Humans , Male , Pregnancy , Fertility , Infertility , Insemination , Sperm Motility , SpermatozoaABSTRACT
No abstract available.
ABSTRACT
No abstract available.