Effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase compared with GnRH agonist long protocol in non-obese and obese patients with polycystic ovary syndrome undergoing IVF/ICSI / 대한생식의학회지

OBJECTIVE: To evaluate the effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase (MDP-EL) in comparison with standard GnRH agonist luteal long protocol (LP) in each non-obese and obese polycystic ovary syndrome (PCOS) women undergoing IVF. METHODS: Two hundred eleven infertile women with PCOS were recruited and randomized to undergo either GnRH antagonist MDP-EL (antagonist group) or standard GnRH agonist luteal LP (agonist group). IVF cycle outcomes were compared between the two groups. RESULTS: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the antagonist group than in the agonist group. Incidence of severe ovarian hyperstimulation syndrome was significantly lower in the antagonist group. However, IVF and pregnancy outcomes were similar in the two groups. When all subjects were divided into non-obese and obese subgroups, in non-obese PCOS subgroup, IVF and pregnancy outcomes were comparable in the antagonist and agonist groups but total dose and days of rhFSH were also significantly fewer in the antagonist group. Similar findings were also observed in obese PCOS subgroup. CONCLUSION: GnRH antagonist MDP-EL is at least as effective as GnRH agonist LP and may be a more patient-friendly alternative in controlled ovarian stimulation for PCOS patients undergoing IVF, independent of body mass index.

Comparison of follitropin beta administered by a pen device with follitropin beta administered by a conventional syringe in patients undergoing IVF-ET / 대한생식의학회지

OBJECTIVE: To compare the effectiveness and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin beta solution in patients undergoing IVF-ET. METHODS: GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). RESULTS: There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin beta. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. CONCLUSION: The pen device for self-administration of follitropin beta is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin beta when compared with the conventional syringe.

Comparison of follitropin beta administered by a pen device with follitropin beta administered by a conventional syringe in patients undergoing IVF-ET / 대한생식의학회지

OBJECTIVE: To compare the effectiveness and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin beta solution in patients undergoing IVF-ET. METHODS: GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). RESULTS: There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin beta. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. CONCLUSION: The pen device for self-administration of follitropin beta is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin beta when compared with the conventional syringe.

A large advanced seminoma in an older woman with androgen insensitivity syndrome / 대한생식의학회지

A 58-year-old woman who presented with inguinal hernia for the first time was diagnosed as seminoma and complete androgen insensitivity syndrome (CAIS). The patient received a late diagnosis, and therefore she could not take a proper management. CAIS is a rare X-linked recessive disease with an XY karyotype that is caused by androgen receptor defects. It usually present with primary amenorrhea or inguinal hernia. The risk of malignant transformation of undescended testis increases with age, thus gonadectomy should be performed after puberty. We present a case of large advanced seminoma in a woman with CAIS who was neglected and diagnosed lately.

Effects of Drospirenone (2 mg) with 17beta-estradiol (1 mg) on Blood Pressure, Body Weight, and Lipid Profiles in Postmenopausal Korean Woman / 대한폐경학회지

OBJECTIVES: The objective of the present study was to determine the effects of the widely used combination hormone therapy, drospirenone and 17beta-estradiol on the blood pressure, body weight, lipid profiles, and major side effects in postmenopausal Korean women. METHODS: Four hundred seventeen menopausal patients who were being treated with drospirenone/17beta-estradiol at the Asan Medical Center between December 2007 and October 2010 underwent a retrospective chart review. One hundred twenty-five patients were divided into 2 groups based on blood pressure, as follows: group 1 (normal blood pressure, n = 76); and group 2 (stage 1 hypertension and pre-hypertension, n = 49). The systolic and diastolic blood pressure and the body weight were checked before the treatment, and 1, 2, 3, 6, 9, 12, 18 and 24 months after taking the medication. RESULTS: The median days of administration were 279. The combination of drospirenone and 17beta-estradiol had a blood pressure-lowering effect in groups 1 and 2. However, the body weight did not show a statistically significant change. Only the level of triglycerides decreased with time and the change was statistically significant. The low density lipoprotein (LDL)-cholesterol and triglycerides levels had a statistically significant decrease 18 months after the medication. The most common reasons for discontinuouing medication were vaginal spotting (28%), fear of side effects (27%), and ineffectiveness (26%). CONCLUSION: The combination of drospirenone/17beta-estradiol caused a decrease in systolic and diastolic blood pressure and the body weight showed no statistically significant decrease. Furthermore, triglycerides showed statistically significant decrease and there were no severe side effects of the medication reported.

GnRH antagonist multiple dose protocol with oral contraceptive pill pretreatment in poor responders undergoing IVF/ICSI / 대한생식의학회지

OBJECTIVE: To investigate the effectiveness of GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment in poor responders undergoing IVF/ICSI, compared with GnRH antagonist MDP without OCP pretreatment and GnRH agonist low-dose long protocol (LP). METHODS: A total of 120 poor responders were randomized into three groups according to controlled ovarian stimulation (COS) options; GnRH antagonist MDP after OCP pretreatment (group 1), GnRH antagonist MDP without OCP pretreatment (group 2) or GnRH agonist luteal low-dose LP without OCP pretreatment (group 3). Patients allocated in group 1 were pretreated with OCP for 21days in the cycle preceding COS, and ovarian stimulation using recombinant human FSH (rhFSH) was started 5 days after discontinuation of OCP. RESULTS: There were no differences in patients' characteristics among three groups. Total dose and days of rhFSH used for COS were significantly higher in group 3 than in group 1 or 2. The numbers of mature oocytes, fertilized oocytes and grade I, II embryos were significantly lower in group 2 than in group 1 or 3. There were no significant differences in the clinical pregnancy rate and implantation rate among three groups. CONCLUSION: GnRH antagonist MDP with OCP pretreatment is at least as effective as GnRH agonist low-dose LP in poor responders and can benefit the poor responders by reducing the amount and duration of FSH required for follicular maturation.

Expression of EGF mRNA and protein in eutopic and ectopic endometrial tissues of patients with endometriosis / 대한산부인과학회지

OBJECTIVE: This study was performed to investigate the expression of EGF mRNA and protein in eutopic and ectopic endometrial tissues of the patients with endometriosis and in eutopic endometrial tissues of the patients without endometriosis. METHODS: Study group was composed of 34 women with endometriosis taking surgical treatment at the Department of Obstetrics and Gynecology, Asan Medical Center, from October 2004 to December 2005. Control group consisted of 14 women who had undergone surgical treatment for cervical intraepithelial neoplasia or benign gynecologic conditions other than endometriosis during the same period. Eutopic endometrial tissues of both groups and ectopic endometrial tissues of study group were collected during the operations. Real time reverse transcriptase-polymerase chain reaction (RT-PCR) was used to quantify EGF mRNA of these tissues. Western blot analysis was performed to ascertain the expression of EGF protein. RESULTS: The expressions of EGF mRNA were significantly lower in both eutopic (P<0.01) and ectopic (P<0.01) endometrial tissues of the women with endometriosis than in eutopic endometrial tissues of control group. The expressions of EGF protein were shown to be lower in both eutopic and ectopic endometrial tissues of the women with endometriosis than in eutopic endometrial tissues of control group. CONCLUSION: We found some correlations between the lower expression of EGF in endometrial tissues and the development of endometriosis. In addition, the change or defect of some factors in the eutopic endometrium might play an important role in the development of endometriosis.

Effects of rosiglitazone on ovarian stromal blood flow, ovarian stimulation and outcome in patients with polycystic ovary syndrome undergoing in vitro fertilization / 대한산부인과학회지

OBJECTIVE: We investigated to evaluate the effects of rosiglitazone on intraovarian stromal blood flow, ovarian response to stimulation, and in vitro fertilization-embryo transfer (IVF-ET) outcome in polycystic ovary syndrome (PCOS) patients. METHODS: Forty-six infertile women, 24 to 36 years of age, with only tubal factor and PCOS, were randomized into either rosiglitazone (n=23) or placebo (n=23) treatment group. A rosiglitazone of 4 mg once daily was started on day 1 of the cycle prior to gonadotropin releasing hormone (GnRH) agonist suppression, and continued to the day of human chorionic gonadotropin (hCG) injection in study group. For a control Group, placebo was administered during the same period. Each of the 2 groups consisted of 23 cycles of IVF-ET. Transvaginal color Doppler analyses (resistance index (RI) and pulsatility index (PI)) were performed to assess the intraovarian stromal blood flow in all participants on the starting days of rosiglitazone or placebo (RI0, PI0), GnRH agonist administration (RI1, PI1) and ovarian stimulation (RI2, PI2). RESULTS: There were no significant differences in age, body mass index (BMI), infertiliy duration, endocrine profile, fasting and 2-hour glucose levels after a 75 gm glucose load, RI0 and PI0 values of ovarian stromal artery between two groups. RI1 and PI1 values were higher in study group, but the differences were not statistically significant. RI2 and PI2 values in study group were significantly higher than in control group (0.60+/-0.04 versus 0.56+/-0.03; P or =14 mm in diameter on the day of hCG injection and the number of retrieved oocytes were significantly lower in study group. The number of retrieved oocytes was significantly higher in study group. The clinical pregnancy rate was higher in study group but it did not make statistical significance. CONCLUSIONS: Rosiglitazone therapy could reduce the intraovarian stromal blood flow and appeared to be beneficial in improving response to ovulation induction and IVF outcomes in PCOS patients.

Malignant Mixed Mullerian Tumor of the Uterus: Retrospective Study of 26 cases / 대한산부인과학회지

OBJECTIVE: To review the clinicopathological characteristics and prognosis of patients with malignant mixed Mullerian tumor (MMMT) of the uterus. METHODS: Retrospective clinical study was done on 26 patients diagnosed with the MMMT of the uterus at our hospital from Janurary, 1994 to December, 2004. Demographic data, pathologic findings, stages, treatment, prognosis and survival time were reviewed. RESULTS: The median age of patients was 59 years. Most of the patients (76.9%) were in the postmenopausal state. The most common symptom was vaginal bleeding (65.4%). There were 17 patients (65.4%) with stage I, 3 patients (11.6%) with stage II, 4 patients (15.4%) with stage III, 2 patients (7.6%) with stage IV disease in this study. Of the hysterectomy specimens, 4 (15.4%) of them were heterologous tumors, 22 (84.6%) of them were homologous tumors. Overall 5 year survival rate of all stages was 60% and the patients with advanced stages (III, IV) showed poorer prognosis than the patients with early stages (I, II) (P=0.001). Myometrial invasion depth was also significant prognostic factor (P<0.001). CONCLUSION: The MMMT of the uterus is a highly malignant tumor and the significant prognostic factor is the FIGO stage and myometrial invasion depth.