The Preconceptional Level of Peripheral Natural Killer Cells which was Expected to Bring Successful Treatment Outcome using Low-dose Intravenous Gamma Immunoglobulin (IVIg) Infusion in Patients with Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVES: We aimed to investigate the clinical effect of low-dose intravenous immunoglobulin treatment in unexplained recurrent spontaneous aborters (RSA) with elevated peripheral CD56+ natural killer (NK) cell levels and to determine the pre-conceptional NK cell percentage predictive of subsequent successful pregnancy outcome. MATERIALS AND METHODS: Sixty four cases of unexplained recurrent miscarriage with elevated peripheral NK cells (>15%) were received low dose IVIg infusion at the dosage of 400 mg/Kg/month after confirmation of gestational sac and continued until 20 weeks. The patients were divided into two groups according to the pregnancy outcome: Group I was success of treatment defined as live birth at or after 25 gestational weeks and Group II was failure of treatment. The preconceptional levels of the peripheral blood NK cells were compared between two groups. RESULTS: Fifty-three pregnancies resulted in live births after 25 weeks and 11 resulted in abortion (Overall success rate of IVIG treatment was 82.8%). Preconceptional CD56+ NK cell percentage in group II (27.4+/-1.9%) was higher than those in group I (22.3+/-0.8%). By using ROC curve, optimal discrimination between success and failure of treatment was achieved with < or = 27% of preconceptional NK cell percentage. CONCLUSION: In RSA patients with elevated NK cells, we suggest that preconceptional peripheral blood CD56+ NK cell level could be a useful marker for predicting successful treatment outcome of low-dose IVIg infusion.

Effect of Aromatase Inhibitor (AI) in Polycystic Ovary Syndrome Patients with an Inadequate Response to Clomiphene Citrate / 대한불임학회지

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 (> or =15 mm) was lower in the AI group (1.08+/-0.45 vs. 1.64+/-0.75) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group (10.35+/-1.74 vs. 9.23+/-1.61) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group (116.9+/-75.8 vs. 479.5+/-300.8) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed 10.6+/-1.6 mm in the endometrial thickness and 106.6+/-66.8 pg/ml in E2 concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number (1.25+/-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.

A Change of Peripheral CD56+Natural Killer Cell Fraction in Recurrent Pregnancy Loss Patients who Successfully Treated with Intravenous Immunoglobulin in Previous Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the change of peripheral blood CD56+NK cell fraction in recurrent pregnancy loss patients who successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy. METHODS: The study subjects were women with a history of two or more documented consecutive spontaneous pregnancy loss under 20 weeks of gestation and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, excluding any aneuploidy by karyotype analysis, and with no evidence of genetic, endocrine, infections or anatomic factors. We retrospectively analyzed the medical record study subjects of the change of peripheral blood CD56+NK cell fraction before and after successful birth of baby beyond 25 weeks since June, 1998 to September, 2003 in Samsung Cheil Hospital. Healthy women with no history of recurrent pregnancy loss and having one baby with pregnancy ongoing at least 25 weeks selected as a control group and we compare the CD56+NK cell fraction to that of study group. RESULTS: Pre- and after conceptional CD56+NK cell fraction in women with next pregnancy beyond 25 weeks after IVIg treatment (n=16, pre: 24.5 +/- 1.2, after: 22.5 +/- 1.5) were significantly high compared with control group (n=14,8.9 +/- 1.3) (T-test, p<0.05), but the difference between pre- and after conceptional CD56+NK cell fraction was not statistically significant. Among 16 women with IVIg treatment in previous pregnancy, after conceptional CD56+NK cell fraction below 15%, who regarded as have no need of IVIg treatment in next pregnancy were 3 women (3/16, 18.7%), but most of women with IVIg treatment in previous pregnancy (13/16, 81.3%) were regard as need of IVIg treatment in next preganacy. CONCLUSION: For the safety of pregnancy in women with history of recurrent spontaneous abortion and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, IVIg treatment should be considered in consecutive pregnancy.

A Case of Ipsilateral Primary Ovarian Pregnancy After IVF-ET in a Patient with Previous Unilateral Salpingectomy / 대한산부인과학회잡지

Marcus and Brinsden have reported the first ovarian pregnancy achieved by IVT-ET in 1993. They reported seven cases of primary ovarian pregnancy from 116 ectopic pregnancies after IVF. With advancement of ART, the incidence of ectopic pregnancy is increasing, but ovarian pregnancy is still a rare complication. We report a case of ipsilateral primary ovarian pregnancy after IVF-ET with a patient with previous unilateral salpingectomy with a brief review of literature.

A Case Report of Bacterial Endocarditis in Pregnancy / 대한산부인과학회잡지

The heart disease during gestation complicates approximately 0.5-1.5% of pregnancies. The common cause of heart disease during gestation is acquired rheumatic valvular lesions and congenital heart defects. In contrast, infective endocarditis during pregnancy or the puerperium is quite rare, with fewer than 100 cases reported over the past 50 years. We present a case of bacterial endocarditis complicated by severe tricuspid valvular insufficiency and associated septic pulmonary emboli. Therapy consisted of cesarean section at 32 weeks gestation followed by tricuspid valvular replacement, removal of vegetation and primary closure of congenital ventricular septal defect.

Light and Electron Microscopic Observation in the Frozen-thawed Mouse Testicular Tissues / 대한불임학회지

OBJECTIVE: The aim of this study was to investigate the morphological aspects of testicular tissue before and after freezing-thawing by light and transmission electron microscopy. METHODS: Tissue biopsies were carried out on mouse testis for freezing. Samples in medium containing 20% glycerol were frozen by computer-controlled freezing program. The effect of freezing-thawing on the structural change of testicular tissues were examined by light and electron microscopy. RESULTS: The freezing-thawing procedure had no significant effect on tubular diameter. However, it caused folding of the lamina propria, and notable damage to Sertoli cells, spermatogonia and spermatocytes. The cells were detached, desquamated from the basal lamina and had increased vacuolization. Round spermatids, elongated spermatids and spermatozoa were less affected, and most of them maintained their normal structure. CONCLUSIONS: The structure of spermatogonia, spermatocyte and basal compartments in seminiferous epithelium was significantly altered by freezing-thawing procedure of mouse testicular tissues. Thus, we need to develop a more reliable method for the cryopreservation of testicular tissues.

Light and Electron Microscopic Observation in the Frozen-thawed Mouse Testicular Tissues / 대한불임학회지

OBJECTIVE: The aim of this study was to investigate the morphological aspects of testicular tissue before and after freezing-thawing by light and transmission electron microscopy. METHODS: Tissue biopsies were carried out on mouse testis for freezing. Samples in medium containing 20% glycerol were frozen by computer-controlled freezing program. The effect of freezing-thawing on the structural change of testicular tissues were examined by light and electron microscopy. RESULTS: The freezing-thawing procedure had no significant effect on tubular diameter. However, it caused folding of the lamina propria, and notable damage to Sertoli cells, spermatogonia and spermatocytes. The cells were detached, desquamated from the basal lamina and had increased vacuolization. Round spermatids, elongated spermatids and spermatozoa were less affected, and most of them maintained their normal structure. CONCLUSIONS: The structure of spermatogonia, spermatocyte and basal compartments in seminiferous epithelium was significantly altered by freezing-thawing procedure of mouse testicular tissues. Thus, we need to develop a more reliable method for the cryopreservation of testicular tissues.

Chromosomal Analysis of Aborted Conceptuses among Anembryonic Pregnancy and Embryonic Pregnancy: Do Chromosomal Abnormalities Relate to Anembryonic Pregnancy? / 대한산부인과학회잡지

OBJECTIVES: Approximately 15-20% of all clinically recognized pregnancies result in spontaneous abortion between 8 and 12 weeks. In some early abortus only the extra-embryonic components of the conceptus survive, either as fragments of placenta or as empty gestational sac, and these have been termed 'anembryonic pregnancies'. Despite their common occurrences, the etiology of anembryonic conceptuses is poorly understood. The purpose of this study was to evaluate whether chromosomal abnormalities relate to a role in anembryonic pregnancy. MATERIALS AND METHODS: The study, that consisted of 143 pregnancies from chromosomally normal couples that aborted in first trimester period between January 1, 1994 and December 27, 1997, had chromosomal analysis performed on the products of conception and had ultrasonographic examination prior to spontaneous abortion. The tissue was processed and analysed using standard G-banding cytogenetic techniques with long-term cultures. RESULTS: The patient characteristics of the anembryonic pregnancy were not significantly different from those of the embryonic pregnancy. Among products of conception from embryonic pregnancies, 45% (52/115) had normal chromosomal analyses and 55% (63/115) had abnormal chromosomal analyses. Products of conception from anembryonic pregnancies resulted in 54% (15/28) of abnormal chromosome analyses and normal chromosomal analyses resulted in 46% (13/28) (p>0.05, Chi-square test). The frequency of aneuploidy and polyploidy were not different between products of conception from anembryonic pregnancy and embryonic pregnancy. Also, the gender ratio of euploid spontaneous pregnancy losses showed similar in this study. CONCLUSION: There are no differences in frequency of abnormal karyotypes in products of conception from anembryonic pregnancies compared with miscarriage after the demonstration of fetal pole. If further studies are need for the evaluation of these etiologies, and then immuno-molecular studies in early placental tissues from anembryonic pregnancy might be helpful.

Comparison of karyotypes in first trimester spontaneous fetal losses in relation to successful or failure to transvaginal ultrasonographic detection of fetal heart activity / 대한산부인과학회잡지

OBJECTIVE: Genetic defects of the zygote, such as chromosome aberration, are the most frequent cause of abnormal embryonic development and spontaneous abortion. Recent advances in ultrasonographic technology have allowed documentation of early embryonic growth and development and some studies have suggested that once fetal cardiac activity has been demonstrated at 8-10 weeks of gestation, the subsequent spontaneous abortion rate is reported to be less than 5% of pregnancies. Some authors suggested that, abortions in which fetal cardiac activity was once demonstrated, chromosomal anomalies are considered to play important roles in these abortions. But, other studies failed to reveal any relationship between occurrence of chromosomal abnormalities and ultrasonographic detection of fetal heart activity. The aim of the study was to determine the relationship of ultrasonographic detection of fetal heart activity and the abnormal karyotypes in spontaneous abortions. DESIGN: A 1-year retrospective, study. MATERIALS AND METHODS: 158 pregnancies (129 spontaneous, 29 assisted ovulatory cycles) that aborted in the first trimester between January 1,2001 and December 31, 2001, in Samsung Cheil Hospital had chromosomal analysis performed on the products of conception and had ultrasonographic examination prior to spontaneous abortion. Of these pregnancies 62 were detection of transvaginal ultrasonographic detection of fetal heart activity prior to abortion and 96 were failure to detect fetal heart activity. Fetal tissue was removed by dilatation and curettage. Cytogenetic studies were performed from cultures of dissected chorionic villi and G-sac. And then, we compared the incidence and the characteristics of abnormal karyotypes between fetal heart activity detected group (Group I) and failure to detect fetal heart activity group (Group II) prior to abortion. RESULTS: Of 158 spontaneous abortions who carrying chromosomal analysis, 98 had abnormal karyotypes. (60 trisomies, 11 polyploides, 10 mosaicism, 5 monosomies and 12 structural abnormalities). The overall incidence of chromosomal aberrations in our study group was 62.0% (98/158). Chromosomal aberrations were found in 59.7% (37/62) of abortuses in group I and 63.5% (61/96) in group II and it was insignificant statistically. The frequency of type of abnormal karyotype in both groups (Group I: 25 (40.3%) trisomies, 1 (1.6%) polyploides, 0 (0%) mosaicism, 8 (12.9%) and 3 (4.8%) monosomies, Group II: 35 (36.5%) trisomies, 10 (10.4%) polyploides, 5 (5.2%) mosaicism, 2 (2.1%) monosomies and 9 (9.4%) structural abnormalities) were insignificant statistically. When we stratified both groups and analyzed the abnormal karyotype by maternal age, those were not statistically different in both groups. CONCLUSION: In our study, chromosomal abnormalities in spontaneous abortion did not differ according to ultrasonographic detection of fetal heart activity, and the type of abnormal karyotype were not distributed differently.

Efficacy of Coculture System in the Patients with Poor Prognoses on Human IVF-ET Program / 대한불임학회지

SUMMARY: The present study was carried out to evaluate whether the coculture system of human embryos with Vero cells can improve the quality of embryo or overcome the repetitive implantation failures in order to obtain pregnancy. From January to December 1996, a total 202 cases which patients with the problems of repetitive implantation failures (group I) or those with the poor embryonic quality in their previous cycles (group II) was analysed. The quality of cocultured embryo, pregnancy, on-going and implantation rates between coculture and control groups were compared. Of 93 cases in group I, coculture was performed in 34 cases and conventional IVF for the rest. Of 109 cases in group II, 36 for coculture and 73 for conventional IVF. In group I, pregnancy, on-going and implantation rates in coculture group (14/34 (41.2%), 9/34 (26.5%), 16/81 (19.8%), respectively) were higher than those of control (11/59 (18.6%), 8/59 (13.6%), 12/152 (7.9%), respectively). There is significance in the pregnancy and implantation rates (p=0.028 and p=0.015). In group II, pregnancy, on-going and implantation rates in coculture group (8/36 (22.2%), 5/36 (13.9%), 8/87 (9.2%), respectively) were higher than those of control (5/73 (6.8%), 3/73 (4.1%), 3/158 (1.9%), respectively). Like the result of group 1, there is significance in the pregnancy and implantation rates (p=0.028 and p=0.022). Coculture system with Vero cells works well in the groups of the two indications. Although the case of 3 day-coculture was small as 15 cases in group II, 3 day-coculture improved pregnancy rate (4/15 (26.7%)). Therefore, 3 day-coculture with assisted hatching is recommended to the patients with poor embryonic quality. In conclusion, coculture system with Vero cells can be suggested as an effective method which improves pregnancy rate in those who have repetitive implantation failures or whose embryonic quality was poor in their previous cycles.