Adenomatoid tumors of female genital tracts: An analysis of 195 cases / 대한산부인과학회지

OBJECTIVE: Adenomatoid tumors of female genital tracts are benign lesions derived from mesothelium, occurring most commonly during the reproductive years. The aim of this study was to evaluate the overall incidence of adenomatoid tumors in Korean women and to analyze the clinical characteristics. METHODS: One hundred and ninety five patients with adenomatoid tumors were found in a retrospective medical records review of pathologic reports for 44,984 benign uterine diseases at Cheil General Hospital, from January 1995 to April 2009. RESULTS: The overall incidence rate was 0.42% of all benign uterine disease. Among them, 149 patients received hysterectomy, and 46 patients received uterine conservative surgery. Main symptoms of the patients were pain (25.1%), bleeding (30.2%), and palpable mass (18.5%). Most common associated pathologies were leiomyoma (46.6%), adenomyosis (25.1%) and endometriosis (13.1%). Most of the diagnosis was made postoperatively. Among 46 patients with conservative treatment, 13 patients showed successful pregnancy outcome. No recurrence occurred during the follow up period. CONCLUSION: Adenomatoid tumors are associated with fibroids and tend to mimic them clinically, making pre-operative diagnosis difficult. The recurrence is rare even after conservative operation. Our data about this benign neoplasm may be helpful for counseling patients after operations.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Pregnancy outcomes of heterotopic pregnancy / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to evaluate the pregnancy outcomes of heterotopic pregnancy. METHODS: Retrospective analysis was done in 24 patients who were diagnosed as heterotopic pregnancy between January 2000 and April 2008. Patients' characteristics, risk factors, treatment methods and pregnancy outcomes were evaluated. RESULTS: A total of 24 patients were diagnosed as heterotopic pregnancy, all of these had undergone assisted reproductive technique. The mean age was 31.5 years and the mean gestational age at diagnosis was about 8 weeks. The most common etiology of infertility was tubal factor (54.2%). Four (16.7%) of the women had undergone ovulation induction, eighteen (75%) had undergone in vitro fertilization, but 2 patients (8.3%) had undergone assisted reproductive technique at other hospital and we didn't know the exact method. The most common of ectopic site was tube (75%), and 50% of ectopic sites were ruptured status at diagnosis. Three (12.5%) of 24 patients were diagnosed ectopic pregnancy after dilatation and evacuation due to missed abortion, 4 (16.7%) were diagnosed ectopic pregnancy and missed abortion, and 17 (70.8%) were diagnosed ectopic pregnancy and living intrauterine pregnancy at the time of diagnosis. Laparotomy was done in 3 patients (12.5%) and laparoscopy was done in 21 patients (87.5%). Among 17 patients who had normal intrauterine pregnancy, 12 (70.6%) delivered singletones, 2 (11.8%) delivered twins, but 3 (17.6%) patients were lost follow up. CONCLUSION: Heterotopic pregnancy should be considered in pregnant woman with abdominal pain or vaginal bleeding, although confirmed normal intrauterine pregnancy using ultrasonography at early gestational age, especially if the woman have treatment history for infertility. And early diagnosis and proper management are important.

Uterine myoma: Treatment modalities and patient preference / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to describe the clinical features of myoma, treatment options, patient preference and to identify the clinical features which affect the management of myoma. METHODS: We retrospectively analyzed medical records of 577 patients who were diagnosed as uterine myoma on ultrasound exam between January 2006 and December 2006. Patients' characteristics, treatment methods and questionnaires for patient preference were evaluated. RESULTS: The mean age was 42.3 years and 90.8% of the patients were premenopausal status. Common symptoms were pain (58.6%), bleeding (51.3%) and compression symptom (30.2%). In our study, 183 of 577 patients (31.7%) planned to have regular follow-up without treatment. Non-hormonal medical treatment was used in 27.1% and hormonal treatment was used in 41.9% of the patients. One hundred eighty-two patients underwent surgical treatment, including myomectomy (57.1%), subtotal hysterectomy (19.8%) and total hysterectomy (23.1%). Among the patients who underwent surgery, 50.6% of patients (88/174) had surgery due to compression symptom, 42.6% (126/296) due to bleeding, and 34.6% (117/338) due to pain. According to the 100 patients who answered the questionnaires, 78 patients preferred medical therapy initially, but 22 patients chose surgical treatment. When the patient was asked to choose between myomectomy and hysterectomy, 94 patients wanted myomectomy, but only 6 patients chose hysterectomy. CONCLUSIONS: Many patients diagnosed as myoma prefer medical treatment initially. Medical treatment for myoma may be considered as the first line treatment for pain and bleeding symptoms before proceeding to surgical treatment.

Obstetric Outcome of Unexplained Infertility Patients Following Assisted Reproductive Technology / 대한산부인과학회잡지

OBJECTIVE: This study was aimed to evaluate the obstetric and perinatal outcomes of women with unexplained infertility following assisted reproductive technology (ART). METHODS: From January 1999 to February 2002, a total of seventy-nine singleton pregnancies which progressed beyond 20 weeks gestation following embryo transfer in women finally diagnosed as unexplained infertility by diagnostic laparoscopy were enrolled in this study. The matched control was spontaneously conceived 172 singleton pregnancies. Retrospectively, we analyzed the obstetric outcome and compared gestational age at delivery, birth weight, Apgar score, and the incidence of perinatal mortality, preterm labor, preeclampsia, gestational diabetes mellitus, and oligohydramnios between two groups. RESULTS: The mean gestational duration of study group was shorter than control group (38.2 +/- 0.5 vs. 39.4 +/- 0.1 weeks, p=0.001). The incidence of gestational diabetes mellitus was significantly higher in the study group (7.6% vs. 1.2%, p=0.01). There was no significant difference in the mean birth weight (3088.1 +/- 86.1 g vs. 3243.8 +/- 37.2 g), the incidence of small for gestational age (10.1% vs. 11.6%), preeclampsia (3.8% vs. 2.3%), oligohydramnios (3.8% vs. 5.8%), preterm labor (7.6% vs. 5.2%), cesarean delivery (45.6% vs. 41.3%), and perinatal mortality (1.3% vs. 0.6%) between the two groups. CONCLUSION: The gestational duration of women with unexplained infertility after IVF-ET was shorter, but the incidence of preterm birth was not increased. And the incidence of gestational diabetes mellitus of study group was higher than that of spontaneously conceived pregnancies.

Factors Affecting Complete Fetal Loss Following Multifetal Pregnancy Reduction / 대한불임학회지

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.

Efficacy of Diagnostic Laparoscopy for TFTC (Transcervical Fallopian Tube Catheterization) in Tubal Infertility Patients / 대한불임학회지

OBJECTIVE: To evaluate whether diagnostic laparoscopy before transcervical fallopian tube catheterization (TFTC) would improve tubal recanalization rate and pregnancy rate in patients with bilateral proximal tubal blockage in hysterosalpingogram (HSG). METHODS: The retrospective study was performed in those underwent TFTC from January 1998 to December 2001. A total of 50 patients with bilateral proximal tubal blockage in HSG were subjected to TFTC sequentially using repeated HSG (rHSG), selective salpingography (SS) followed by tubal catheterization (TFTC). Each procedure was terminated once patency had been achieved without proceding to the next technique. In Group A patients (n=35, 64 tubes), diagnostic laparoscopy was performed before TFTC was taken to exclude the tube combined with peritubal adhesion or distal tubal pathology. In Group B, patients (n=15, 26 tubes) were performed TFTC without diagnostic laparoscopy. RESULTS: There were significant difference in clinical pregnancy rate (45.7% vs 15.4%, p=0.034) but no differences were found in recanalization rate (75.0% vs 73.1%) and complication rate (8.6% vs 13.3%). Although there is no signficant difference, more tubes were canalized by SS, which means tubal obstruction rather than occlusion, in Group A (25.0% vs 5.3%, p=0.069). CONCLUSION: Diagnostic laparoscopy would be effective in the selection of tube for the relatively inexpensive and less invasive TFTC or patients in need of assisted reproductive technologies. With the tubes without combined peritubal adhesion or distal tubal pathology, pregnancy rate was significantly increased.

Efficacy of Diagnostic Laparoscopy for TFTC (Transcervical Fallopian Tube Catheterization) in Tubal Infertility Patients / 대한불임학회지

OBJECTIVE: To evaluate whether diagnostic laparoscopy before transcervical fallopian tube catheterization (TFTC) would improve tubal recanalization rate and pregnancy rate in patients with bilateral proximal tubal blockage in hysterosalpingogram (HSG). METHODS: The retrospective study was performed in those underwent TFTC from January 1998 to December 2001. A total of 50 patients with bilateral proximal tubal blockage in HSG were subjected to TFTC sequentially using repeated HSG (rHSG), selective salpingography (SS) followed by tubal catheterization (TFTC). Each procedure was terminated once patency had been achieved without proceding to the next technique. In Group A patients (n=35, 64 tubes), diagnostic laparoscopy was performed before TFTC was taken to exclude the tube combined with peritubal adhesion or distal tubal pathology. In Group B, patients (n=15, 26 tubes) were performed TFTC without diagnostic laparoscopy. RESULTS: There were significant difference in clinical pregnancy rate (45.7% vs 15.4%, p=0.034) but no differences were found in recanalization rate (75.0% vs 73.1%) and complication rate (8.6% vs 13.3%). Although there is no signficant difference, more tubes were canalized by SS, which means tubal obstruction rather than occlusion, in Group A (25.0% vs 5.3%, p=0.069). CONCLUSION: Diagnostic laparoscopy would be effective in the selection of tube for the relatively inexpensive and less invasive TFTC or patients in need of assisted reproductive technologies. With the tubes without combined peritubal adhesion or distal tubal pathology, pregnancy rate was significantly increased.

Obstetric outcome in women with a history of recurrent miscarriage / 대한산부인과학회잡지

OBJECTIVE: To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. METHODS: From 1 June 1998 to 30 June 2000, 82 patients who attended infertility & current miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. RESULTS: The etiology of recurrent miscarriage was immunologic factor (36.6%), unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%) and chromosomal abnormality (5.6%). The rate of preterm delivery (11%) and incidence of pregnancy induced hypertention (8.5%) were significantly higher than those of control group (3.2% and 2.5% respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. CONCLUSION: The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.

The efficacy of prophylactic intravenous albumin in clinical progress in patients with severe ovarian hyperstimulation syndrome who needed hospitalization / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the efficacy of prophylactic intravenous albumin in patients with severe ovarian hyperstimulation syndrome (OHSS) who needed hospitalization. METHODS: From January, 1995 to December, 2000, 86 women who underwent COH for IVF-ET were hospitalized for the management of severe OHSS in Samsung Cheil hospital. Among them, twenty one patients were treated with prophylactic intravenous albumin at the day of ovum retrieval, and 65 were not. We analysed clinical symptoms, signs, and hospital courses in the records of 86 patients retrospectively. We compared above variables of prophylactic albumin used group (n=21) with those of non-used group (n=65). RESULTS: Among the indices of ovarian response to ovarian stimulation, serum estradiol (E2) level at the day of hCG injection was significantly higher in prophylactic albumin used group (5805.2+/-1604.4 pg/ml) than non-used group (4125.2+/-1921.5 pg/ml, P<0.05). But the variables which indicate clinical progress (number and amount of paracentesis, amount of used albumin after hospitalization, duration of symptoms, hospital days) showed less severe tendency in prophylactic albumin used group but was not significantly different between two groups. CONCLUSION: Our results indicates that the use of prophylactic intravenous albumin in patients who have risk of severe OHSS had some advantages in favorable clinical progress.

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.

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.

Outcome of Preimplantation Genetic Diagnosis for Chromosome Aneuploidy and Genetic Disease / 대한불임학회지

OBJECTIVES: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. MATERIALS AND METHODS: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6~10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. RESULTS: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced embryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). CONCLUSIONS: PGD by using FISH or PCR is useful to get normal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

Outcome of Preimplantation Genetic Diagnosis for Chromosome Aneuploidy and Genetic Disease / 대한불임학회지

OBJECTIVES: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. MATERIALS AND METHODS: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6~10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. RESULTS: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced embryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). CONCLUSIONS: PGD by using FISH or PCR is useful to get normal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

Ovarian Response and Pregnancy Rate according to Basal FSH concentration in Controlled Ovarian Hyperstimulation and Clomiphene Citrate stimulated cycle for ART / 대한산부인과학회잡지

OBJECTIVE: To evaluate whether elevation of basal FSH predict poor ovarian response and lowered pregnancy rate in women undergoing controlled ovarian hyperstimulation (COH) and Clomiphene Citrate stimulated cycle (CC cycle) for assisted reproductive technologies (ART). METERIALS AND METHODS: From January 1999 to December 1999, total 1067 COH cycles and 119 CC cycles from 1033 patients were included in this study. At each cycle, on cycle day 2 or 3, basal FSH was measured before GnRH agonist starting. FSH value (mIU/ml) was 2 nd IRP 78/549 standard. We divided COH and CC cycles into 4 groups according to elevated basal FSH concentration, respectively. i) Normal (Basal FSH OR =20 mIU/ml): Group D (n=35), Group IV (n=34). Retrospectively, we obtained mean total ampules of gonadotropin, mean serum E2 concenturation on hCG day, mean number of retrieved oocyte, mean number of embryo transferred, mean number of good embryo, cancellation rate, clinical pregnancy rate and live birth rate. RESULTS: Ovarian response by elevation of basal FSH decreased more significantly in COH cycles than CC cycles. In COH cycles, ovarian response of Group B, C and D decreased significantly (P<0.001). In CC cycles, ovarian response of Group IV decreased significantly (P<0.01). Including cycles only under 35 years old, COH cycles with mildly elevated basal FSH had poor ovarian response (P<0.01), but the clinical pregnancy rate (28.3%) and live birth rate (24.2%) did not decrease, compared with normal FSH Group (27.5%, 23.1% respectively). In cycles with markedly elevated basal FSH, clinical pregnancy rate (5.9%) and live birth rate (2.9%) of CC cycles were equal to that of COH cycles (5.7%, 2.9%, respectively). CONCLUSION: Mildly elevated basal FSH does not predict poor outcome in ART. Poor prognosis conferred by mildly elevated basal FSH may be overcome by maximizing stimulation protocol. Therefore other stimulation protocol for poor ovarian response may be effective in mildly elevated basal FSH cycles. In cycles with moderately to severe elevated basal FSH, lowered pregnancy rate was mainly due to quantitative and qualitative decrease in ovarian response. In cycles with markedly elevated basal FSH, CC stimulated cycle was more cost effective with good compliance.

Ovarian Response and Pregnancy Rate according to Basal FSH concentration in Controlled Ovarian Hyperstimulation and Clomiphene Citrate stimulated cycle for ART / 대한산부인과학회잡지

OBJECTIVE: To evaluate whether elevation of basal FSH predict poor ovarian response and lowered pregnancy rate in women undergoing controlled ovarian hyperstimulation (COH) and Clomiphene Citrate stimulated cycle (CC cycle) for assisted reproductive technologies (ART). METERIALS AND METHODS: From January 1999 to December 1999, total 1067 COH cycles and 119 CC cycles from 1033 patients were included in this study. At each cycle, on cycle day 2 or 3, basal FSH was measured before GnRH agonist starting. FSH value (mIU/ml) was 2 nd IRP 78/549 standard. We divided COH and CC cycles into 4 groups according to elevated basal FSH concentration, respectively. i) Normal (Basal FSH OR =20 mIU/ml): Group D (n=35), Group IV (n=34). Retrospectively, we obtained mean total ampules of gonadotropin, mean serum E2 concenturation on hCG day, mean number of retrieved oocyte, mean number of embryo transferred, mean number of good embryo, cancellation rate, clinical pregnancy rate and live birth rate. RESULTS: Ovarian response by elevation of basal FSH decreased more significantly in COH cycles than CC cycles. In COH cycles, ovarian response of Group B, C and D decreased significantly (P<0.001). In CC cycles, ovarian response of Group IV decreased significantly (P<0.01). Including cycles only under 35 years old, COH cycles with mildly elevated basal FSH had poor ovarian response (P<0.01), but the clinical pregnancy rate (28.3%) and live birth rate (24.2%) did not decrease, compared with normal FSH Group (27.5%, 23.1% respectively). In cycles with markedly elevated basal FSH, clinical pregnancy rate (5.9%) and live birth rate (2.9%) of CC cycles were equal to that of COH cycles (5.7%, 2.9%, respectively). CONCLUSION: Mildly elevated basal FSH does not predict poor outcome in ART. Poor prognosis conferred by mildly elevated basal FSH may be overcome by maximizing stimulation protocol. Therefore other stimulation protocol for poor ovarian response may be effective in mildly elevated basal FSH cycles. In cycles with moderately to severe elevated basal FSH, lowered pregnancy rate was mainly due to quantitative and qualitative decrease in ovarian response. In cycles with markedly elevated basal FSH, CC stimulated cycle was more cost effective with good compliance.

Expression of leukemia inhibitory factor in endometrium of infertile women during the window of implantation / 대한산부인과학회잡지

OBJECTIVE: To determine the expression of endometrial leukemia inhibitory factor (LIF) in infertile women and to compare it with that of fertile women during the window of implantation METHODS: Endometrial biopsies were performed during the window of implantation from 10 normal fertile and 15 infertile women (5 unexplained infertility, 5 endometriosis and 5 tubal disease with hydrosalpinx). We performed immunohistochemistry using paraffin-embedded endometrial tissues. RESULTS: In fertile and infertile women, the staining intensities of LIF in the glandular epithelium were significantly higher (p<0.01) than those of stromal cells. There was no significantly difference in the expression of LIF between the glandular epithelium of infertile women with endometriosis or hydrosalpinx and those of fertile women. However, the staining intensities of LIF in the glandular epithelium of unexplained infertility patients were significantly lower (p<0.01) than those in fertile women. The staining intensities of LIF in stromal cell of women with unexplained infertility, endometriosis and hydrosalpinx were similar to those in fertile women. CONCLUSIONS: This study demonstrated that the glandular epithelial cells are more important sites of LIF secretion than stromal cells. The expression of endometrial LIF may be decreased in women with unexplained infertility during the window of implantation. Therefore, this result suggest that abnormalities of LIF expression in infertile women may underlie endometrial dysfunction in the adhesive phase of implantation.

Molecular Analysis of the Y Chromosome in a 46,XY Female Phenotype

This is a case report of 46,XY female phenotype (46,XY karyotype, no pubic hair, blind vagina and absence of uterus)in an 18-year-old patient. To confirm whether a Y chromosome has a structural abnormality, fluorescent in situ hybridization (FISH) with the chromosome X/Y cocktail probe was simultaneously performed, and the six loci [PABY, RPS4Y(sy16, sy17), ZFY, DYS14] on the short arm, one locus (DYZ3) on the centromere and one locus (DYZ1) on the long arm were amplified by polymerase chain reaction (PCR). The probes used FISH hybridized to centromere of the X chromosome and heterochromatin region (Yq12) of the Y chromosome, and all PCR related Y chromosome showed positive band like normal male. From the results obtained, it seemed that the Y chromosome from the 46,XY female was structurely normal. Especially, the SRY gene has been equated with the mammalian testis-determining factor, and absence or point mutation in the SRY gene causes XY female. To detect the point mutations of SRY sequencesn, single-strand conformation polymorphism (SSCP) assay was used. Our results confirm that this patient has no mutation in the SRY gene on the Y chromosome.

Clinical Efficacy of Intravenous Immunoglobulin for the Prevention of Recurrent Spontaneous Abortion / 대한산부인과학회잡지

The aim of this study was to evaluate the efficacy of intravenous immunoglobulin treatment for recurrent spontaneous abortion. Immunologic causes in either alloimmune or autoimmune type have been suggested for more than 80% of these patients. Various immunotherapy including paternal leukocyte transfusion has been used, but there is controversy on its efficacy and side-effects. The proposed immunomodulatory mechanism of intravenous immunoglobulin includes passive transfer of blocking or anti-idiotype antibody, blockade of Fc receptors, enhancement of supressor T-cell function, down regulation of B cell function. In this study, we used intravenous immunoglobulin for the prevention of spontaneous abortion. Five patients with a history of two or more spontaneous abortions were enrolled in this study. Other etiologic factors such as anatomical, chromosomal, hormonal factors were excluded. Three of them were positive for anti-cardiolipin antibody (ACA). When the pregnancy was diagnosed at about five weeks of gestation, 30 g intravenous immunoglobulin was administered and continued up to 28 weeks with three weeks. Ongoing pregnancy beyond 20 weeks was considered successful. Four among five patients (80%) was successful in maintaining pregnancy now ongoing 20, 31, 33, 39 weeks. One patient with ACA positive had abartion due to anembryonic pregnancy. No adverse reaction was observed during the treatment. From these preliminary data, it is suggested that intravenous immunoglobulin treatment may be effective in maintaining pregnancy in patients with unexplained recurrent spontaneous abortion, Further studies are needed to clarify the its immunomodulatory mechanism and establish a more simplified protocol limiting the use at certain critical period of time.

A Case of Successful Pregnancy in a Woman with Anti-M Isoimmunization after Intravenous Immunoglobulin Therapy / 대한산부인과학회잡지

Although severe hemolytic diseases of the newborn triggered by anti-M are very rare, anti-M alloantibodies have been known to be associated with a cause of multipie intrauterine death. Serological and hematological investigations have been reported on a woman who experienced four multiple intrauterine deaths due to anti-M. The mothers blood type was of group A, NN and the husbands cells were of group B, MN. In the serological examination at 9th week's gestation of the fifth pregnancy, anti-M antibodies were identified in her serum. The antibodies comprised IgM saline agglutinin at a titer of 16 at 4 degrees C and IgG agglutinin reacted in an indirect antiglobulin technique at a titer of 4 at 37 degrees C. She underwent high-dose immunoglobulin infusion therapy on a monthly program from 3rd month gestation and a total of 6 times of intravenous immunoglobulin was given. The anti-M titer did not rise during the pregnancy. She delivered a live girl by cesarean section at the 37th week because of a failure of induction. The childs blood type was of group O, MN. The child was discharged and developed normally.