Clinical trial comparing recombinant human chorionic gonadotropin (hCG) to urinary hCG for induction of final follicular maturation in IVF-ET / 대한산부인과학회지

OBJECT: Human chorionic gonadotropin (hCG) is used to induce final follicular maturation in women undergoing controlled ovarian hyperstimulation (COH). Urinary preparations are associated with a number of disadvantages including an uncontrolled source, batch-to-batch variability and lack of purity. We performed this study to compare the efficacy of recombinant hCG and urinary hCG for induction of final follicular maturation in women undergoing IVF-ET. METHODS: Prospective trial was performed on a total of 84 IVF cycles carried out in 84 infertile women with tubal and peritoneal factor. Patients were randomized 1:1 to 250 microgram of recombinant hCG subcutaneous injection or 10,000 IU of urinary hCG intramuscular injection after completing recombinant human follicle stimulating hormone (FSH) stimulation. Oocyte pickup was scheduled 36 hours after hCG administration and embryos were transferred 3 days after oocyte pickup. We measured the efficacy points including the number of retrieved and fertilized oocytes, quality of oocytes and embryos, and clinical pregnancy rate. RESULTS: Serum progesterone and hCG level on post-hCG day 5 were significantly higher in the recombinant hCG group (p<0.01, p<0.05). There were no significant differences in outcome including the number of retrieved oocytes, quality of oocytes and embryos, clinical pregnancy rate between the two preparations. The incidence of injection-site reactions such as pain, itching, and bruising were significantly lower in the recombinant hCG group (p<0.01, p<0.01 and p<0.05). CONCLUSIONS: For triggering ovulation, recombinant hCG seems to have significant advantages compared with urinary hCG in terms of luteal progesterone and local tolerance.

The effect of oligohydramnios on the adverse perinatal outcome and clinical characteristics in uncomplicated term pregnancies / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the effect of the isolated oligohydramnios on the perinatal outcome in uncomplicated term pregnancies. METHODS: We used data from Jan 2002 to Dec 2005 in all uncomplicated pregnancies between 37 and 41weeks and 6 days of gestation with a singleton fetus, underwent monitoring with serial determination of AFI. Oligohydramnios was defined by ultrasonographic determination of AFI < or =5 cm. Exclusion criteria were PROM, maternal medical complications and fetal anomalies detected by prenatal ultrasound. We investigated the mode of delivery, birth weight, birth weight <10th percentile, 1 and 5 min Apgar score, umbilical cord pH and base excess, and meconium stained amniotic fluid (MSAF). We also assessed the predictive value of obstetric factors associated with adverse perinatal outcome. We used statistics analysis by Chi-square test, independent-samples T test using SPSS 14.0 V. RESULTS: 2,491 patients met our inclusion criteria. Oligohydramnios was diagnosed in 8.63% (215/2,491). There was significantly difference in cesarean section for fetal distress between those with oligohydramnios vs. normal AFI (43.8% vs.4.1%). Patients with oligohydramnios had significantly lower SGA (15.3% vs. 5.7%), lower Apgar score at 1 min<7 (7.9% vs. 3.3%), and higher rate of MSAF (31.2% vs. 18.4%) than those with normal AFI. There were musculoskeletal abnormalities in 10/215 (4.6%) and urogenital abnomralites in 53/215 (24.6%). CONCLUSION: Isolated oligohydramnios in uncomplicated term pregnancies is associated with an increased adverse perinatal outcome. Nulliparity, advanced maternal age, MSAF, SGA, and lower BPP were significantly associated with the adverse perinatal outcomes.