Drug Induced Sleep Endoscopy for Poor-Responder to Uvulopalatopharyngoplasty in Patient with Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate drug-induced sleep endoscopy (DISE) findings in patients with persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP) surgery. SUBJECTS AND METHOD: Patients were included in this study if they had a postoperative DISE evaluation as well as pre- and postoperative polysomnography. DISE findings included the obstructive sites (velum, oropharyngeal lateral walls, tongue base, and epiglottis), and the obstructive patterns of velopharynx (anteroposterior, lateral, and concentric). RESULTS: A total of 77 patients were included in this study. Poor-responder patients to UPPP (n=50) and well-responder patients to UPPP (n=27) were similar with regard to age, gender, body mass index, preoperative AHI, and minimal O2 saturation. In our analysis of DISE findings on poor-responder, velopharynx was the most common obstruction site (100%), followed by oropharynx (88%), tongue base (70%), and epiglottis (44%). Results showed that most patients (n=49) had multiple obstructive sites. No significant differences according to position dependency and REM dependency were found in obstructive sites. However, severe OSA patients had tongue base obstruction more frequently than the moderate OSA patients did. The obstructive pattern of velopharynx usually showed concentric configuration (70%, 35 of 50). CONCLUSION: Our results suggest that the preoperative DISE may be a useful method for determination of the personalized surgery to OSA patients because of its more precise information to upper airway obstruction.

The effect of aromatase inhibitor letrozole incorporated in gonadotrophin-releasing hormone antagonist multiple dose protocol in poor responders undergoing in vitro fertilization

OBJECTIVE: To evaluate whether letrozole incorporated in a gonadotrophin-releasing hormone (GnRH) antagonist multiple dose protocol (MDP) improved controlled ovarian stimulation (COS) and in vitro fertilization (IVF) results in poor responders who underwent IVF treatment. METHODS: In this retrospective cohort study, a total of 103 consecutive IVF cycles that were performed during either the letrozole/GnRH antagonist MDP cycles (letrozole group, n=46) or the standard GnRH antagonist MDP cycles (control group, n=57) were included in 103 poor responders. COS results and IVF 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 letrozole group than in the control group. Duration of GnRH antagonist administered was also shorter in the letrozole group. The number of oocytes retrieved was significantly higher in the letrozole group. However, clinical pregnancy rate per cycle initiated, clinical pregnancy rate per embryo transfer, embryo implantation rate and miscarriage rate were similar in the two groups. CONCLUSION: The letrozole incorporated in GnRH antagonist MDP may be more effective because it results comparable pregnancy outcomes with shorter duration and smaller dose of rhFSH, when compared with the standard GnRH antagonist MDP.

The effect of LH Receptor in the Pregnancy of Poor Responders / 대한불임학회지

OBJECTIVES: To investigate the effect of LH receptor in folliculogenesis, we confirm the expression level of LH receptor (LH-R) mRNA in human granulosa cells (GCs) and its expression levels were analyzed by comparison to embryo developmental rate and pregnancy rate. MATERIALS AND METHODS: GCs were obtained at the time of oocyte retrieval from the patients undergoing IVF-ET program. The patients were divided into two groups: Group I (n=20) is poor responder (retrieved oocyte(s)3ea). After the extraction of total RNA, semiquantitative RT-PCR was performed and the expression level of LH-R mRNA was normalized by beta-actin. Statistical analysis was performed by using Chi(2) test, Student's t-test and Pearson correlation. RESULTS: In Group II, the relative values of LH-R mRNA (0.680 vs. 0.463, p<0.005) and pregnancy rate (54.7% vs. 23.1%, p<0.05) were significantly higher than in Group I. Number of retrieved oocyte(s) was gradually increased when the expression of LH-R mRNA was increased (p<0.05). But the quality of retrieved oocyte and transferred embryo were not related with the expression of LH-R mRNA. When the pregnancy rate was compared with FSH only group and FSH combined with hMG group in the ovarian stimulation protocol, FSH combined with hMG group was significantly higher than FSH only group in Group I (37.5% vs. 0%), and the expression of LH-R mRNA was significantly higher in hMG combined group than FSH only group (p<0.05). CONCLUSION: Expression level of LH-R mRNA has important role in ovarian function related with the response to gonadotrophin in human folliculogenesis. Furthermore these data might provide the evidence that additional use of hMG is helpful to poor responders.

Comparison of EffectiveNESS between Recombinant Follicle Stimulating Hormone and Human Menopausal Gonadotrophin Administration in those with Diminished Ovarian Reserve.

The study was carried out to compare the effectiveness of recombinant follicle stimulating hormone (recombinant FSH) and human menopausal gonadotrophin (HMG) in those with diminished ovarian reserve. A total of 106 ovarian stimulation cycles from 88 poor responders were included in this study. Either recombinant FHS or HMG was administered in order to stimulate the ovary for each cycle. The pregnancy rate of the recombinant FSH group (22.5%) was higher than that of the HMG group (9.1%). The cancellation rate of the recombinant FSH group (10.0%) was lower than that of the HMG group (19.7%). In in vitro fertilisation-embryo transfer (IVF-ET) cycles, the fertilisation rate of the recombinant FSH group (62.8%) was higher than that of the HMG group (51.8%). The pregnancy rate and the implantation rate of the recombinant FSH group (23.0 and 9.1%, respectively) were higher than those of the HMG group (13.6 and 5.9%, respectively). Although this did not achieve statistical significance, only the recombinant FSH group achieved pregnancies using gamete intrafallopian transfer (GIFT). In conclusion, recombinant FSH is probably more effective than HMG in improving the IVF and pregnancy rate in poor responders.