Basal and Down-regulated Serum LH Levels as a Prognostic Indicator of Ovarian Response to Controlled Ovarian Hyperstimulation / 대한산부인과학회잡지

OBJECTIVE: The effect of basal day 3 luteinizing hormone (LH) and pituitary desensitized day 3 LH level on ovarian response to controlled ovarian hyperstimulation were investigated. METHODS: From January 1999 to December 2001, 445 cycles for in vitro fertilization and embryo transfer (IVF-ET) were allocated to this study. Controlled ovarian hyperstimulation (COH) was performed using long protocol of gonadotropin-releasing hormone agonist (GnRHa). All patients included in this study had blood samples drawn on cycle day 3 prior to COH and cycle day 3 after pituitary desensitization with GnRHa for measurement of FSH and LH. Infertile women were younger than 43 years old, and had normal menstrual cycle, normal day 3 FSH and LH level (<10 mIU/ml), infertility factor caused by tubal factor, mild endometriosis, unexplained infertility or mild male subfertility. The result of COH and IVF-ET were compared between low LH group and high LH group according to the level of basal LH (3 mIU/ml) and down-regulated LH (1 mIU/ml). RESULTS: The low LH groups were significantly higher FSH:LH ratio, higher dose of exogenous gonadotropin for pituitary desensitization, longer duration of gonadotropin administration. The peak estradiol, number of oocytes retrieved, number of MII oocyte, mean cumulative embryo score (MCES) were significantly lower in the low LH group than the high LH group. There were not significantly differentiation in the duration of pituitary desensitization, fertilization rate and the number of transferred embryos. The clinical pregnancy rate per cycle was not correlated with the value of basal LH concentration, but correlated with the value of down-regulated LH concentration. CONCLUSION: The lower LH activity (basal LH <3 mIU/ml, down-regulated LH <1 mIU/ml) is significantly associated with reduced ovarian response in controlled ovarian hyperstimulation after desensitization with GnRHa. These results suggest that down-regulated LH level 1 mIU/ml may be a useful predictor of the clinical pregnancy rate per cycle after controlled ovarian hyperstimulation.

Two Cases of Swyer Syndrome in Sisters / 대한산부인과학회잡지

46,XY pure gonadal dysgenesis, also known as Swyer syndrome, is a disorder of sexual differentiation. Its characteristics include a female phenotype without the somatic stigmata of Turner's syndrome, primary amenorrhea, sexual infatilism and bilateral streak gonads. Neoplasia occurs in 20-30% of individuals who have gonadal dysgenesis and Y chromosomal material. Gonadoblastoma and dysgerminoma are the most frequent tumor in phenotypic females with Y chromosome. One case was referred for palpable low abdominal mass. No other somatic abnormalities could be detected. Laparotomy revealed dysgerminoma of left ovary and mesenteric metastasis. In the course of postoperative adjuvant chemotherapy, her elder sister was diagnosed as Swyer syndrome. And karyotype of this patient was 46,XY, too. So right gonadectomy was performed thereafter. The other case visited for primary amenorrhea and delayed development of breast. Physical examination revealed no development of breast, no pubic and axillary hair. External genital organ was normal shaped. Peripheral blood karyotyping was 46,XY. Bilateral gonadectomy was performed and hormone replacement therapy was started. We report two cases of Swyer syndrome and review of literature.

De novo Fetal Chromosomal Abnormalities after Assisted Reproductive Technology / 대한산부인과학회잡지

We experienced two cases of de novo fetal chromosomal abnormalities after assisted reproductive technology (ART): One case was reciprocal translocation 46,XX,t(6;14)(p21.3;q12) after intracytoplasmic sperm injection and embryo transfer (ICSI-ET) and the other case was 46,X,iso(Xq) after in vitro fertilizaton and embryo transfer (IVF-ET), both were diagnosed prenatally by amniocentesis and postnatally cord blood culture. We report these cases with a brief review of literatures.