Heterotopic pregnancy after a single embryo transfer

Heterotopic pregnancy is a rare and life-threatening condition which is defined as coexistent intrauterine and ectopic gestation. The risk of ectopic and heterotopic pregnancy is increasing due to the increased risk of multiple pregnancies with the aid of assisted reproductive technologies. However, it hardly happens in the setting of single embryo transfer, since single embryo transfer significantly reduces the incidence of multiple pregnancies. Surprisingly, we experienced a case of heterotopic pregnancy after a single embryo transfer caused by coincidental natural pregnancy during assisted reproductive technologies. An infertile woman who underwent, during her natural cycle, transfer of a single embryo that had been cryopreserved for 3 years was found to be heterotopically pregnant. After an early and successful management with laparoscopic right salpingectomy, she finally reached at full-term vaginal delivery.

Comparison of elective single cleavage-embryo transfer to elective single blastocyst-embryo transfer in human IVF-ET / 대한생식의학회지

OBJECTIVE: This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS: This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS: The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1+/-6.0, 8.2+/-4.6, and 4.2+/-3.1, respectively) compared to the eSBET group (16.7+/-7.2, 12.1+/-5.0, and 8.5+/-4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION: These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.

Comparison of elective single cleavage-embryo transfer to elective single blastocyst-embryo transfer in human IVF-ET / 대한생식의학회지

OBJECTIVE: This study was carried out to compare the clinical outcome of elective single cleavage-embryo transfer (eSCET) to that of elective single blastocyst-embryo transfer (eSBET) in human IVF-ET. METHODS: This study was a retrospective study which analyzed for 614 women who visited the Daegu Maria Clinic from August 2008 to December 2009. All were under 37 years old and had more than 8 mm of endometrial thickness on the day of hCG administration and at least one good quality embryo on day 3. The eSCETs were performed on day 3 (n=450) and the eSBETs were conducted on day 5 (n=164). RESULTS: The numbers of retrieved oocytes, fertilized oocytes, and day 3 good quality embryos were significantly lower in the eSCET group (12.1+/-6.0, 8.2+/-4.6, and 4.2+/-3.1, respectively) compared to the eSBET group (16.7+/-7.2, 12.1+/-5.0, and 8.5+/-4.5, respectively; p<0.001). However, the clinical pregnancy, implantation, on-going pregnancy, and live birth rates of the eSCET group (46.7, 46.9, 40.0, and 36.7%, respectively) were not statistically different from those of the eSBET group (51.2, 51.8, 45.1, and 43.9%, respectively; p=0.318, 0.278, 0.254, and 0.103, respectively). CONCLUSION: These results suggested that elective single embryo transfer should be performed regardless of the developmental stage to women less than 37 years old who had more than 8 mm of endometrial thickness on the hCG administration day and at least one good quality embryo on day 3 in order to reduce the twin pregnancy rate without reducing the whole pregnancy rate.

Clinical Outcome of Elective Single Embryo Transfer Compared to Elective Double Embryo Transfer Performed at the Cleavage Stage / 대한불임학회지

OBJECTIVE: This study was performed to compare the clinical outcome of elective single embryo transfer (eSET) performed at the cleavage stage to that of elective double embryo transfer (eDET). METHODS: Of the women less than 36 years old who visited Daegu Maria from January 2008 to April 2009, the only women (n=330) with more than 8 mm of endometrial thickness and at least one good quality embryo, who were treated with GnRH agonist long protocol, were included in this study. After information about complications that can arise by multiple embryo transfer, either eSET or eDET was conducted by their request (167 and 163, respectively). RESULTS: The implantation rate of eSET group was significantly higher than that of eDET group (53.9% vs. 40.2%, p<0.01). The twin pregnancy rate of eSET group was significantly lower than that of eDET group (1.1% vs. 32.3%, p<0.001). However, there were no significant differences between two groups in the clinical pregnancy (53.3% vs. 60.7%, p=0.172), ongoing pregnancy (47.3% vs. 54.6%, p=0.185) and live birth rates (44.9% vs. 50.9%, p=0.275). The number of the surplus embryos which developed to the blastocyst stage and cryopreserved at that stage was significantly higher in eSET group than that of eDET group (3.2+/-2.6 vs. 2.1+/-2.4, p<0.001). CONCLUSION: These results suggest that eSET should reduce significantly the multiple baby pregnancy without decreasing the whole pregnancy rate in women with less than 36 years old.

A case of LEOPARD syndrome with cor triatriatum / 대한내과학회지

The LEOPARD syndrome is an acronym and serves as a mnemonic for the features of this autosomal dominant syndrome : L - lentigines (multiple), E - electrocardiographic conduction abnormalities, O - ocular hypertelorism, P - pulmonary stenosis, A - abnormalities of genitalia, R - retardation of growth, and D - deafness (sensoryneural). The main features of the syndrome are multiple lentigines in combination with congenital heart malformations. These frequently accompanied cardiac abnormalities are pulmonary stenosis, hypertrophic cardiomyopathy, and various ECG abnormalities. It is advisable to make cardiac evaluation in a patient with LEOPARD syndrome in spite of no clinical symptoms or signs, since cardiac dysfunction may be progressive or developed later. We experienced a case of this syndrome in a 31 year-old female, presenting multiple lentigines, ocular hypertelorism, and congenital cardiac abnormalities of incomplete right bundle branch block and cor triatriatum. We report the case with brief literature review.

Study on the Development of Efficient Vitrification of Human Blastocysts / 대한불임학회지

OBJECTIVE: The purpose of this study was to evaluate the survival rate of vitrified blastocyst according to the freezing vessels, equilibration time in cryoprotectant and artificial dehydration method. METHODS: Human blastocysts were vitrified after loading onto the plastic straw, open-pulled straw (OPS), electron microscopy grid (EM grid) for 1.5 min or 3 min. They also were directly plunged into LN2 within 30sec. For artificial shrinkage of blastocysts, 36 gauge fine needle was pushed at the cellular junction of the trophectoderm into the blstocoele cavity until it shrank without damage of inner cell mass. RESULTS: The survival rate of vitrified blastocysts on plastic straw, OPS, EM grid as freezing vessels were 26.7, 13.0 and 60.5%, respectively. The survival rate of EM grid was significantly higher than that of plastic straw and OPS (p<0.05). For 1.5 min equilibrium, the survival rates of early blastocyst (EB), middle blastocyst (MB) and late blastocyst (LB) were 64.4, 81.0, and 20.0% respectively. For 3 min equilibrium, the survival rates of EB, MB, and LB were 69.9, 50.0 and 57.5% respectively. The survival rates of EB and MB were significantly higher than that of LB in 1.5 min equilibrium group (p<0.05), however, the significance was not observed in 3 min equilibrium groups. In cytoplasmic shrinkage before vitrification, the survival rates of EB, MB and LB were 92.9, 100 and 75.9% respectively. The survival rate of MB was significantly higher than that of LB (p<0.05). The survival rates of vitrified blastocysts by artificial dehydration and slow-frozen blastocysts were not significantly different as 88.9 and 66.7%, respectively. CONCLUSION: This study showed that the vitrification of human blastocysts using EM grid and artificial dehydration is an effective method. Therefore, these methods would be an useful techniques for blastocyst cryopreservation.

Trial of New Protocol (Modified Luteal Long; MLL) for Improvement of Outcomes in In Vitro Fertilization and Embryo Transfer / 대한산부인과학회잡지

OBJECTIVE: To evaluate the efficacy of new protocol (Modified luteal long; MLL protocol) to improve the clinical outcomes in IVF-ET. METHODS: New protocol was applied to repeated ART failure group for 7 months (GroupI, n=106) after informed consent. Outcomes of new protocol group were evaluated and compared to conventional long protocol group (Group II, n=315) prospectively and compared to same indication group with GroupI (Group III, n=144) historical prospectively. RESULTS: There were no differences in the clinical characteristics except patient's age between GroupI and II (35.16+/-4.35 vs. 33.22+/-4.14, p<0.05). Outcomes of IVF-ET, such as numbers of retrieved oocytes, numbers of transferred embryos, numbers of 2 PN, rates of ICSI, rates of blastocyst ET, rates of fertilization, ampules of gonadotropin between GroupI & II, and GroupI & III, respectively. But the embryo quality score of GroupII was significantly higher than GroupI. There was significant increase of implantation rate (25.2 vs. 17.1%, p=0.02) in GroupII compared to GroupI, especially in 31-35 years old group. Implantation rate of less than 35 years old group and clinical pregnancy rate of 31-35 years old group in GroupII tubal factor patients were significantly higher than GroupI tubal factor patients. Clinical pregnancy rate (47.2 vs. 12.8%, p=0.001) and implantation rate (15.2 vs. 5.5%, p=0.009) of GroupI was significantly higher than GroupIII, especially in 36-40 years old group. Implantation rates of ES factor patients (especially in 36-40 years old) and unknown factor patients (especially less than 35 years old), and clinical pregnancy rate of ES factor patients (especially in 36-40 years old) were significantly higher in GroupI than III. CONCLUSION: These results suggest that new protocol may play some role in the increase of endometrial receptivity. Further investigation, including molecular research work will be needed to clarify the factors concerned in the increase of implantation rate.

A case of primary bilateral adrenal lymphoma with adrenal insufficiency / 대한내과학회지

Adrenal gland is an uncommon primary site in non-Hodgkin's malignant lymphoma and reports of primary bilateral adrenal lymphoma with its functional impairment are extremely rare. Only 15 cases were reported during past 50 years, and 11 of them expired within 6 months after diagnosis.A woman came to emergency room with lethargy, abdominal pain and diarrhea. Bilateral adrenal enlargement was found on a previous abdominal sonogram. Under the impression of acute adrenal insufficiency, intravenous hydrocortisone and vigorous saline infusion were given immediately. Later, the endocrine function tests revealed primary hypoadrenalism. The 1st CHOP chemotherapy was administered after tissue diagnosis. This report describes the clinical, radiologic, and pathologic findings in a 58-year-old woman with adrenal insufficiency due to primary bilateral adrenal lymphoma with the review of previous literatures.

Study on the Vitrification of Haman Blastocysts: II. Effect of Vitrification on the Implantation and the Pregnancy of Haman Blastocysts / 대한불임학회지

OBJECTIVE: This study was conducted to investigate the effect of vitrification on the implantation the pregnancy of human blastocysts. METHOD: The transfer of the frozen-thawed blastocysts by the slow freezing or vitrification was performed between January 1998 and July 1999. The zygotes derives from IVF were cocultured with cumulus cells in YS medium containing 20% hFF for 5days. Two or three of the best balstocysts produced on day 5 were transferred into the uterus, and then supernumerary blastocysts were randomly divided into two groups. One was frozen by slow freezing and the other was frozen by vitrification method. The slow freezing procedure was performed in two steps (5% glycerol and 9% glycerol + 0.2 M sucrose for 10 min, respectively) using programmed freezer (-2degrees C/min to -7degrees C, 0.3degrees C and plunged into LN2). The blastocysts frozen by slow freezing were thawed at 36degrees C then removed glycerol in 7 steps. The vitrification procedure was performed in three steps (10% glycerol for 5 min, 10% glycerol + 20% ethylene glycol for 5 min, 25% glycerol + 25% ethylene glycol and directly LN2 within 1 min). The blastocysts frozen by vitrification were thawed at 20degrees C water then removed cryoprotectant in 3 steps. In each group, thawed blastocysts were cocultured with cumulus cells in YS medium containing 20% hFF for 18h and transferred into the uterus. The implantation rate was evaluated per transferred blastocysts and the pregnancy rate was evaluated per transfers. RESULTS: The survival rate of vitrified group (74.5%) was higher than slow freezing group (68.0%), but not significant. When 98 thawed blastocysts of vitrification were transferred in 40 cycles, 19 pregnancies (clinical pregnancy rate; 47.5%) were established. One miscarriage occurred in the eighth week of pregnancy (ongoing pregnancy rate; 45.0%). 7 pregnancies were ongoing, 11 pregnancies went to term, and 16 healthy infants were born. The Implantation rate was 31.6%. These results were higher than those obtained by the slow freezing (clinical pregnancy rate; 40.3%, ongoing pregnancy rate; 32.5% and implantation rate; 25.3%), but not significant. CONCLUSION: Vitrification is a simple, quick and economical method when compared to slow freezing. It will be chosen as a good method of human embryo freezing in IVF-ET programs.