Decrease in acceptance of genetic amniocentesis after alteration of social conditions toward pregnancy termination / 대한산부인과학회지

OBJECTIVE: To investigate the effect of alteration of social conditions towards pregnancy termination on the acceptance of genetic amniocentesis. METHODS: Retrospective review of medical records was conducted for women ( 35 years in the 2010 group (5/30, 17%) were less likely to accept genetic amniocentesis than 2009 group (15/30, 50%; P=0.01). Similar results were observed in those who were indicated for genetic amniocentesis. (9/35, 26% vs 19/34, 56%; P=0.02). Acceptance rate of genetic amniocentesis was increased for those who were referred from private clinic, but without statistical significance (15/21, 71% vs 13/14, 93%; P=0.20). CONCLUSION: After strict regulation of pregnancy termination, acceptance rate of genetic amniocentesis was significantly decreased among women who had increased risk for chromosomal abnormalities or neural tube defect at our center. Whereas, there were no significant change in acceptance rate for those who were referred for amniocentesis from private clinic.

Two Cases of Pregnancies Complicated with Central Diabetes Insipidus / 대한산부인과학회지

Diabetes insipidus is an unusual cause of urinary frequency during pregnancy. It occurs in 2 to 6 per 100,000 pregnancies. It is a disorder in which the abnormal secretion, degradation, or activity of vasopressin cause hypotonic polyuria, polydipsia, and dehydration. And this syndrome appears to be associated with multiple gestations, preeclampsia, and abnormal liver function. We report two cases of pregnancies complicated with diabetes insipidus. One patient was diagnosed during pregnancy and DDAVP (L-deamino-8-d-arginine vasopressin) was used to manage diabetes insipidus. The other patient was diagnosed before pregnancy and DDAVP was not used.

Effects of Metformin and Rosiglitazone in Overweight or Obese Women with Polycystic Ovarian Syndrome / 대한불임학회지

OBJECTIVE: The purpose of this study was to evaluate and compare the effects of metformin and rosiglitazone in overweight or obese women with polycystic ovarian syndrome. METHODS: Twenty Six overweight or obese patients with polycystic ovarian syndrome were randomly treated with either metformin (500 mg three times daily, n=13) or rosiglitazone (4 mg once daily, n=13) for 6 months. Hormonal studies were performed before and after treatment. Insulin resistances were calculated by computerized HOMA 2 Calculator v2.2. RESULTS: Testosterone decreased while SHBG increased after 6 months treatment in both metformin and rosiglitazone treatment groups. Fasting glucose decreased after metformin or rosiglitazone treatment. HOMA insulin resistance improved after treatment with either drug. There was no differences in hormonal changes and insulin resistance between 2 treatment groups. CONCLUSIONS: This study shows that metformin and rosiglitazone are effective in improving insulin sensitivity and ameliorating hyperandrogenism in overweight/obese polycystic ovarian syndrome women.

Internet Survey on the Sexual Life and Attitude of Sexual Life of Young Women / 대한남성과학회지

PURPOSE: To obtain basic information for studies of female sexual dysfunction, we investigated the sexual activities and attitudes of young Korean women. MATERIALS AND METHODS: We conducted a questionnaire survey via the Internet. From July 2004 to August 2004, we sent e-mail to 43,000 women who registered with an internet research company. The recipients of the e-mail were asked to join our study if they had stable sexual activities more than once a month for the most recent 6 months. RESULTS: A total of 508 subjects completed the questionnaire, a response rate of 24.7%. Among 423 questionnaires analyzed, 176 women were single and 247 were married. The mean frequency of coitus per month was 5.5 3.9. About 40% of the women had experienced masturbation, and 112 women (26.5%) had masturbated regularly, even though they had stable sexual activities with their partner(s). Among the 423 subjects, 349 had no plan to have a baby; however, only 287 subjects (67.8%) had used a contraceptive method(s). Among those who used contraceptive methods, 183 subjects (63.8%) used methods with low success rates, such as menstrual timing or extra-vaginal ejaculation. Most of the women answered that they have a positive attitude toward sex (3.4 0.8 point on a 5 point scale) and their sex life has great importance in their life. CONCLUSIONS: Via an Internet survey, we investigated the sexual life and attitudes of young Korean women. An Internet survey requires less manpower, a shorter study period, and less research funds than classical survey methods such as mail or interview surveys. The study results obtained will be useful as basic data for studies of female sexual function in Korean women.

Molecular Biological Approach to Find Out the Etiology of Hypertensive Disorder in Pregnancy: Analysis of the Polymorphism in the Promoter of Human Angiotensinogen Gene in Korean Population / 대한산부인과학회잡지

OBJECTIVE: We undertook this study to find out general characteristics of hypertensive disorder in pregnancy and to clarify whether polymorphic marker of promoter region of angiotensinogen G(-6)A polymorphism is associated with the development of hypertensive disorder in pregnancy. METHODS: From August 1998 to March 2002, we recruited 230 pregnant women complicated by hypertension in pregnancy. Retrospective chart review was done. They were assigned to each group according to a new classification. Hypertensive groups were divided into two groups: high blood pressure group (High) was defined as having diastolic blood pressure (DBP) higher than 110 mmHg and low blood pressure group (Low) as having DBP lower than 110 mmHg. Maternal blood was collected and DNA was extracted from 161 normotensive and 200 hypertensive Korean pregnant women. Genomic DNA was prepared and the relevant genomic region was amplified using polymerase chain reaction (PCR). PCR products were digested with the restriction enzyme, Mva I, size fractionated on 3% agarose gels containing ethidium bromide. RESULTS: Family history of hypertension was more common in women with chronic hypertension or superimposed preeclampsia than in women with transient hypertension or preeclampsia (p<0.05). No significant difference in genotype distribution was found between diagnostic groups and control. However, among hypertensive disorder in pregnancy, high blood pressure group had AA genotype more frequently than low blood pressure group (p<0.05). CONCLUSION: Family history is more common in women with underlying hypertension. Angiotensinogen AA genotype may be associated with high blood pressure level in hypertensive disorder in pregnancy.

Serum CA 19-9 levels in patients with endometriosis / 대한산부인과학회잡지

OBJECTIVE: To explore the efficacy of serum CA19-9 determination for the detection of endometriosis. DESIGNS: A retrospective analysis. MATERIALS AND METHODS: Preoperative serum CA19-9 and CA125 concentrations were measured in 53 patients with surgically and/or histologically diagnosed endometriosis. The extent of disease was staged according to the revised American Fertility Society (1985) classification system. RESULTS: Serum CA19-9 levels were elevated (>or=37 U/ml) in 13 (24.5%) out of 53 patients with endometriosis and serum CA125 levels were elevated (>or=35 U/ml) in 13 (24.5%). Either CA19-9 or CA125 levels in serum were elevated in 18 (34.0%) patients. In patients with stage III or IV endometriosis, elevated CA19-9 levels were noted in 11 (31.4%) of 35 patients, while CA125 in 12 (34.3%). Either CA19-9 or CA125 levels in serum were elevated in 15 (42.9%) of 35 patients with stage III or IV. CONCLUSION: These results suggest that serum CA19-9, in addition to CA125, measurement could help in identifying patients with moderate to severe endometriosis.

Detection of Y Chromosome-specific Sequences in Patients with Turner Syndrome / 대한산부인과학회잡지

Existence of Y derived chromosome in Turner patients is significant due to the risk of gonadoblastoma development, but cytogenetic analysis may fail to detect low levels of Y chromosomal materials. Recent studies using PCR based methods showed higher sensitivity to detect Y-specific sequences, in patients who were Y chromosome-negative cytogenetically. In this study PCR was performed on 44 Turner patients with no Y chromosome by cytogenetic analysis to detect the SRY, AMELY, ZFY, and DYZ1 sequences. Of seven patients whose karyotypes were 45,X/46,X,+mar, three patients were positive for SRY, ZFY, and AMELY. DYZ1 sequences was negative in them. And any of SRY, ZFY, AMELY, and DYZ1 sequences was detected in the remaining 37 patients. This result shows that PCR analysis for Y-specific sequences in Turner patients, especially in patients who have marker chromosome is a significant effort.

A Study of Estrogen only Therapy and Estrogen Plus Androgen Combination Therapy in Surgical Menopause Patients / 대한불임학회지

OBJECTIVE: To evaluate the difference between estrogen only therapy and estrogen-androgen combination therapy in surgical menopause patients. MATERIALS AND METHOD: Surgical menopause patients received 0.625 mg conjugated equine estrogens or 0.625 mg conjugated equine estrogens plus 1.25 mg methyltestosterone for 2 years. Bone mineral density, menopausal symptoms, lipoprotein profiles were measured. RESULTS: Both groups showed increased bone mineral density. In the combination group, total cholesterol, high density lipoprotein cholesterol and triglycerides decreased. In the estrogen only group, low density lipoprotein cholesterol decreased but high density lipoprotein cholesterol increased significantly. In both groups, menopausal symptoms were much improved. Side effects were easily tolerated in both groups. CONSLUSIONS: Estrogen-androgen combination therapy had comparable benefits compared with estrogen only therapy.

A Study of Estrogen only Therapy and Estrogen Plus Androgen Combination Therapy in Surgical Menopause Patients / 대한불임학회지

OBJECTIVE: To evaluate the difference between estrogen only therapy and estrogen-androgen combination therapy in surgical menopause patients. MATERIALS AND METHOD: Surgical menopause patients received 0.625 mg conjugated equine estrogens or 0.625 mg conjugated equine estrogens plus 1.25 mg methyltestosterone for 2 years. Bone mineral density, menopausal symptoms, lipoprotein profiles were measured. RESULTS: Both groups showed increased bone mineral density. In the combination group, total cholesterol, high density lipoprotein cholesterol and triglycerides decreased. In the estrogen only group, low density lipoprotein cholesterol decreased but high density lipoprotein cholesterol increased significantly. In both groups, menopausal symptoms were much improved. Side effects were easily tolerated in both groups. CONSLUSIONS: Estrogen-androgen combination therapy had comparable benefits compared with estrogen only therapy.

Cumulative Pregnancy Rate of In Vitro Fertilization and Embryo Transfer With Intracytoplasmic Sperm Injection / 대한산부인과학회잡지

OBJECTIVE: To evaluate the cumulative pregnancy rate(CPR) of in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). METHODS: Medical records of 260 infertile patients undergoing 519 cycles of IVF-ET with ICSI from January, 1994 to December, 1999 were retrospectively reviewed. The CPR beyond 12 weeks of gestation was estimated by Kaplan-Meier method. The CPRs were compared by log-rank test between groups divided by age of patients, indication of ICSI, and method of sperm retrieval for ICSI. RESULTS: As 70 patients achieved an on-going pregnancy after IVF-ET with ICSI, the PR was 26.9% per patient and 13.5% per cycle. The overall CPR was 54.9% after 6 cycles of IVF-ET with ICSI. As expected, age had a significant strong effect on the CPR; CPRs afer 4 cycles of ICSI were 61.8% in the age group of 30 years(n=81), 43.7% in 31-35 years(n=106), and 15.3% in 36 years(n=73). There was no significant difference in the CPR between abnormal semen analysis group(n=184) and prior low fertilization rate group(n=66). In abnormal semen analysis group, the CPR of surgically retrieved sperm subgroup(n=60) was not significantly different from that of ejaculated sperm subgroup(n=124). CONCLUSIONS: The CPR of IVF-ET with ICSI was presented, and it could be of much help in the clinical counseling of IVF-ET patients. ICSI technique could be used successfully for IVF-ET in infertile couples who had the male factor infertility or the past history of low fertilization rate in the previous cycles.

The Usefulness of Biochemical Markers of Bone turnover for Bone Mineral Density in Early Postmenopausal Women Treated with Hormone Replacement or Calcium Supplementation / 대한산부인과학회잡지

OBJECTIVE: To identify the effectiveness of bone turnover indexes for bone loss or gain in early postmenopausal women. METHOD: This study was performed in 240 menopausal women(mean age, 50 yr), who were randomized to hormone replacement therapy(HRT) or calcium supplementation(CS, 500mg/day) for 1yr. Urinary N-telopeptide(NTx) and osteocalcin(OC), as well as spine and femoral neck bone mineral density(BMD) were measured at baseline and 1, 3, 6, 12 months after treatment. RESULTS: Women receiving HRT(n=110) showed a significant increase in spine BMD(+2.6%; P<0.0001) and hip BMD(+1.1%; P<0.05) compared to women receiving CS, who showed a decline at both sites (-1.0%; P<0.01). Both markers showed time dependent decreases in women receiving HRT(P<0.001) and no change in women receiving calcium alone. When baseline indexes of turnover were divided by quartile, there was a significantly greater increase in BMD among those with the highest NTx, OC levels compared to that in those with the lowest NTx, OC levles(P<0.05). When subjects receiving HRT were compared by their positive or negative skeletal response at 1yr and their baseline turnover marker, initial NTx values were significantly higher in those that gained bone than in those that lost bone (P<0.001). Calcium supplementation women in the highest quartile for NTx at baseline had significantly greater decreases in spine BMD than subjects with the lowest NTx values(P<0.005). CONCLUSIONS: For early postmenopausal women there are differential responses of biochemical markers to HRT and calcium supplementation. Baseline urinary NTx and serum osteocalcin were good predictors of change in spine BMD after 1yr of either HRT or calcium supplementation. It is concluded that markers of bone formation and resorption can be used clinically to predict future BMD in early postmenopausal women.

Clinical Significance of a Cervical Cytologic Diagnosis of Atypical Squamous Cells of Undetermined Significance: Qualitification and HPV DNA Detection / 대한부인종양콜포스코피학회잡지

OBJECTIVE: To evaluate qualification and determine the usefulness of human papillomavirus(HPV) DNA testing in women with cytologic smears read as atypical squamous cell of undetermined significance (ASCUS). METHOD: The study was based on 88 women with cytologic smears reported of ASCUS favoring either a reactive process or squamous intraepithelial lesion (SIL) from July 1999 to June 2000. Cytologic examination by Papanicolaou smear was based on the Bethesda System and cervical biopsy was done via coloscopy. the presence of high risk HPV DNA was determined with Hybrid capture assay. RESULTS: The overall incidence of cervical intraepithelial lesion (CIN) was higher in the group with ASCUS favoring SIL than in the group with ASCUS favoring reactive process(42.2 % vs 18.6 %; p<0.05). Women with ASCUS favoring SIL were 9.1 times more likely to have high grade SIL(CIN II/III) develop than were women group with ASCUS favoring reactive process(95% confidence interval, 1.08-76.0). High-risk HPV DNA was demonstrated in 39.8%(35 cases) and was associated a 8.8 times increased likelihood of histologic conformation of CIN(95% confidence interval, 3.09-24.7). The sensitivity of HPV assay for any CIN was 74% and specificity was 75%, whereas the corresponding values for the repeat Pap smear was 67% and 33%, respectively. CONCLUSION: Women with ASCUS favoring SIL was associated with a relatively high risk that the women was harboring SIL. The addiction of a high-risk HPV DNA assay to cytologic examination appears to provide for early detection of high grade CIN in women with ASCUS.

Usefulness of insulin - like growth factors in predicting reduced bone mass in natural postmenopausal women / 대한산부인과학회잡지

No abstract available.

Clinical Usefulness of Early Pregnancy Factor in Women with Threatened Abortion, Normal PregnantWomen and in Vitro Fertilization-Embryo Transfer Patients / 대한산부인과학회잡지

Early pregnancy factor(EPF) is believed to be a pregnancy-associated immunosuppressivepolypeptide which might inhibit the function of maternal lymphocyte during pregnancy. Thephysiological role of EPF in human pregnancy has remained controversal. The purposes of thisstudy are to investigate whether EPF determinations have prognostic value in women withthreatened abortion, and to evaluate usefulness in diagnosing early pregnancy and in predictingthe outcome of embryo transferred in vitro fertilization-embryo transfer(IVF-ET) program.EPF activity was measured by a recently developed, micro rosette inhibition test in sera from76 normal pregnant women, 25 normal healthy women with tubal ligation, 58 women withtherapeutic surgical abortion(n=18) or threatened abortion(n=40) and 29 IVF-ET patients. Rosetteinhibition titer>or=3 was defined as an index for the presence of EPF activity. EPF activity wasundetectable in sera of normal healthy women with tubal ligation and in sera taken before ET.In normal pregnancy EPF was detected in 88~92% of sera during the first and second trimesterand almost disappeared in the third trimester. Surgical therapeutic abortion in the firsttrimester lead to disappearance of EPF activity in 92.3% of cases second day after procedure.The sensitivity of the EPF assay in predicting the outcome in pregnant women with threatenedabortion was 88.0% and the specificity was found to be 86.7%. In patients who became pregnantafter IVF-ET procedure EPF activity was detected in 85.7% of sera on the 5th day andin all sera on the 12th day. In 80.0%(9/13) sera of patients who failed to become pregnant afterET, EPT activity was detected on the 5th day but 17(94.4%) of 18 sera was proved to benegative for EPF activity on the 12th day. These data suggest that EPF assay by micro rosetteinhibition test may be useful in monitoring the embryo after ET, in dignosing early pregnancyand in predicting the outcome in women with threatened abortion.