Effect of Timing of GonadotropinReleasing Hormone Agonist Administration for Ovarian Protection in Patients with Breast Cancer / 한국유방암학회지

Purpose@#This study was performed to investigate the effect of the interval between the start of gonadotropin-releasing hormone agonist (GnRHa) and the start of chemotherapy on ovarian protection in patients with breast cancer. @*Methods@#This was a prospective observational cohort study that included 136 patients with breast cancer below 40 years who received GnRHa during chemotherapy for fertility preservation. Plasma anti-Müllerian hormone (AMH) levels were measured before chemotherapy (baseline) and after chemotherapy. Subjects were divided into 3 groups according to the interval between the start of GnRHa and the start of chemotherapy for analysis: 1–6 days, 7–13 days, and ≥ 14 days. The ratio of the post-chemotherapy AMH value to the baseline AMH (pcAMH) at each time point were compared among the 3 groups.Ranked analysis of covariance was used for statistical analysis, adjusted for age, body mass index (BMI), and the existence of polycystic ovaries (PCOs). In addition, recovery of ovarian function (AMH ≥ 1 ng/mL) at 12 months was evaluated. @*Results@#The median age of the patients was 32 years. There was no difference in the baseline AMH levels among the 3 groups (mean ± standard error: 5.0 ± 0.4 ng/mL [1–6 days], 5.3 ± 0.7 ng/mL [7–13 days], and 8.1 ± 1.3 ng/mL [≥ 14 days]; p = 0.250). The pcAMH at 3, 6, 12, 24, and 36 months were not significantly different among the 3 groups (p-values were 0.332, 0.732, 0.830, 0.148, and 0.393, respectively). In multivariate analysis, young age (p = 0.024), low BMI (p = 0.013), and the existence of PCO (p = 0.015) were predictors for AMH ≥ 1 ng/mL at 12 months. @*Conclusion@#There was no difference in the ovarian protective effect according to the difference in the timing of administration of GnRHa.

Amenorrhea and Menopause in Patients with Breast Cancer after Chemotherapy / 한국유방암학회지

Early gonadotropin-releasing hormone antagonist protocol in women with polycystic ovary syndrome: A preliminary randomized trial / 대한생식의학회지

OBJECTIVE: To prospectively evaluate the efficacy and safety of a fixed early gonadotropin-releasing hormone (GnRH) antagonist protocol compared to a conventional midfollicular GnRH antagonist protocol and a long GnRH agonist protocol for in vitro fertilization (IVF) in patients with polycystic ovary syndrome (PCOS). METHODS: Randomized patients in all three groups (early antagonist, n=14; conventional antagonist, n=11; long agonist, n=11) received 21 days of oral contraceptive pill treatment prior to stimulation. The GnRH antagonist was initiated on the 1st day of stimulation in the early antagonist group and on the 6th day in the conventional antagonist group. The GnRH agonist was initiated on the 18th day of the preceding cycle. The primary endpoint was the number of oocytes retrieved, and the secondary endpoints included the rate of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and the clinical pregnancy rate. RESULTS: The median total number of oocytes was similar among the three groups (early, 16; conventional, 12; agonist, 19; p=0.111). The early GnRH antagonist protocol showed statistically non-significant associations with a higher clinical pregnancy rate (early, 50.0%; conventional, 11.1%; agonist, 22.2%; p=0.180) and lower incidence of moderate-to-severe OHSS (early, 7.7%; conventional, 18.2%; agonist, 27.3%; p=0.463), especially among subjects at high risk for OHSS (early, 12.5%; conventional, 40.0%; agonist, 50.0%; p=0.324). CONCLUSION: In PCOS patients undergoing IVF, early administration of a GnRH antagonist may possibly lead to benefits due to a reduced incidence of moderate-to-severe OHSS in high-risk subjects with a better clinical pregnancy rate per embryo transfer. Further studies with more subjects are required.

Clinical outcomes of frozen embryo transfer cycles after freeze-all policy to prevent ovarian hyperstimulation syndrome

OBJECTIVE: To compare the clinical pregnancy rate (CPR) and ongoing pregnancy rate (OPR) in frozen embryo transfers (FETs) following either freeze-all policy to prevent ovarian hyperstimulation syndrome (OHSS; freeze-all group) or excess embryo cryopreservation after fresh embryo transfer (surplus group). METHODS: The freeze-all group comprised 44 FET cycles performed in 25 women between 2010 and 2016. The surplus group comprised 53 FET cycles performed in 47 women during the same period. The cumulative CPR and OPR according to duration of cryopreservation (interval between cryopreservation and FET) was estimated using Kaplan-Meier plots. Cox regression analysis was used for identifying factor to affect to cryopreservation duration in cycles with pregnancy. RESULTS: In day 2–4 transfer cycles, the crude CPR (40% vs. 18.2%) and OPR (20% vs. 4.5%) were similar between the 2 groups. In day 5 transfer, the crude CPR (33.3% vs. 38.7%) and OPR (33.3% vs. 29%) were also similar between the 2 groups. The cumulative CPR (100% vs. 47.5%) and OPR (100% vs. 33.3%) in day 2–4 transfer as well as the cumulative CPR (46.7% vs. 100%) and OPR (46.7% and 74.8%) in day 5 transfer were also similar between the 2 groups. The median duration of cryopreservation was significantly shorter in the freeze-all group than in the surplus group (19.8 vs. 36.9 weeks, P=0.04). Previous history of delivery was the only factor associated with a shorter cryopreservation duration in cycles with pregnancy (hazard ratio, 0.18; 95% confidence interval, 0.05–0.65; P=0.01). CONCLUSION: Freezing embryos to prevent OHSS and transferring the frozen embryos later may guarantee an acceptable reproductive outcome.

Major Disease Prevalence and Menstrual Characteristics in Infertile Female Korean Smokers

We investigated the prevalence of smoking and factors associated with smoking in infertile Korean women. Smoking status, education, occupation, personal habits, past medical history, current illness, stress level, and menstrual characteristics were collected from self-report questionnaires. The Beck Depression Inventory (BDI) was used to assess the degree of depression. Data on the causes of infertility and levels of six reproductive hormones were collected from medical records. Among 785 women less than 42 years of age, the prevalence of current, secondhand, past, and never smokers were 12.7%, 45.7%, 0.9%, and 40.6%, respectively. Primary infertility was more frequent in secondhand smokers. Causes of infertility were similar among current, secondhand, and never smokers. Current smokers were less educated (P < 0.001) and more likely to consume alcohol than secondhand or never smokers (P < 0.001). Secondhand smokers slept less than current smokers (P = 0.041). Among several major diseases, only the prevalence of diabetes mellitus (4.0%) was significantly higher in current smokers than in secondhand smokers (0.0%, P = 0.002) or never smokers (0.6%, P = 0.031). The self-reported prevalence of depression, and the degree of depression were similar among women with different smoking statuses. There were no differences in menstrual characteristics or serum levels of six reproductive hormones between current, secondhand, and never smokers, even after excluding women with polycystic ovary syndrome. In conclusion, education/employment status, alcohol drinking, and the prevalence of primary infertility and diabetes mellitus were significantly different according to smoking status among infertile women.

Ospemifene: A Novel Option for the Treatment of Vulvovaginal Atrophy

Ospemifene—a third-generation selective estrogen receptor modulator approved by the Food and Drug Administration in 2013—is an oral medication for the treatment of dyspareunia. In postmenopausal women with vulvovaginal atrophy, ospemifene significantly improves the structure and pH levels of the vagina, reducing dyspareunia. It is available as a 60-mg tablet; hence, women who may have had prior difficulty with vaginal administration or on-demand use of nonprescription lubricants and moisturizers would likely prefer this form of treatment. Preclinical studies demonstrated that ospemifene has an estrogen agonist action on the bone, reducing the cell proliferation of ductal carcinoma in an in situ model. Studies evaluating the safety of treatment for up to 52 weeks have shown that ospemifene is a safe medication with minimal impact on the endometrium. Further studies with larger number of subjects are necessary to better conclude its effects and long-term safety.

Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma

OBJECTIVE: To estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors. METHODS: One hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, 82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL. CONCLUSION: The incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.

The Discordance of Intra-twin Birth Weight by Infantile Gender and Birth Order in Korea; 2008-2013 / 대한주산의학회잡지

PURPOSE: To investigate the incidence of intra-twin birth weight discordance and its association with infantile gender and birth order. METHODS: We used the data of birth from 2008 to 2013 of Korea Statistics (38,140 pairs of twins). Adjusted logistic regression analyses were performed to describe the birth weight discordance (> or =25%) according to infantile gender and birth order (twin A: 1st, twin B: 2nd). Birth weight discordance was calculated as 100 x (birth weight difference/birth weight of the heavier twin). RESULTS: Twin A (mean 2.431 kg) was heavier than twin B (mean 2.359 kg), and the weight difference was 0.281 kg on average. Overall incidence of birth weight discordance was 8.3 percent. The incidence of discordance was 8.8 percent among unlike-sexed pairs and 8.0 percent among like-sexed pairs. Twins with birth weight A> or =B (10.2 percent) showed higher incidence of discordance than twins with birth weight A or =B) as compared to like-sexed twins (female-female) with birth weight (A

A third stage pelvic organ prolapse due to cervical swelling during labor: A case report / 대한산부인과학회지

Pelvic organ prolapse complicating pregnancy is a rare clinical condition and its incidence is one in 10,000~15,000 deliveries. It is associated with multiparity, low socioeconomic status, inadequate perinatal care, maternal malnutrition, previous abdominal surgery, and weakness of pelvic muscular and connective tissue. It can cause cervical dystocia, which leads to cervical laceration, uterine rupture, maternal and fetal death. We experienced a case, first in Korea, of cervical swelling that developed during labor, prolapsed beyond the vaginal introitus and thus obstructed the birth canal. The patient underwent cesarean section and subsequently received MgSO4 topical therapy and resulted in complete resolution. We report this case with a brief review of literature.

Second trimester listeriosis followed by fetal death in utero (FDIU): A case report / 대한산부인과학회지

Listeriosis is an infectious disease caused by Listeria monocytogenes, a gram positive, facultatively anaerobic bacterium. Listeriosis occurs primarily in newborn infants, elderly patients, immunocompromised patients and pregnant women. One third of the patients are pregnant women, and complications of this disease include miscarriage, stillbirth and preterm labor. We experienced a case of listeriosis in a singleton pregnancy at 23rd week of gestation that presented with fever, chill, lower abdominal pain, backache, and eventually resulted in fetal death in utero. Autopsy results of the stillborn baby, as well as blood and amniotic fluid culture of the mother confirmed Listeria monocytogenes infection. Proper antibiotics therapy thereafter led to clear recovery of the infected mother. We report this case with a brief review of literature.

The Anatomical Properties of Size of Abdominal Aorta in Korean Normal Adult Populations

PURPOSE: The diameter of the abdominal aorta is an important criterion for making the diagnosis of abdominal aortic aneurysm. But the diagnostic criteria for the aortic diameters and the aneurysms are based on western people' s data, and there is scant data on this for Koreans. In this study, we measured a normal range of the abdominal aortic diameter of Korean adults and we classified the diameters according to age, gender and the body mass index (BMI). METHODS: The data is based on 496 patients (male: 281, female: 215) who had no evidence of vascular disease on abdominal multi detector computed tomography exams that were been done between October through December of year 2007 at our hospital. The abdominal aorta was measured at the smallest outer diameter of the infrarenal aorta and the upper bifurcation level. The age of the patients was from 20 to 70 years-old and the patients were divided into 6 groups by age. The patients were also divided into three groups according to their BMI (the low weight, normal weight and over weight groups). We computed the average and standard deviation of the aortic dimensions from each group. RESULTS: The average diameter at the infrarenal aorta was 18.32 mm and that at the upper bifurcation level was 17.25 mm. The males' average aortic diameter at the infrarenal aorta and at the upper bifurcation level was 19.23 mm and 18.10 mm, respectively, and those values for the females were 17.09 mm and 16.20 mm, respectively. In both the males and females, the diameter increased with increasing patient age (P<01). For the BMI, the diameter was larger for the higher BMI group. CONCLUSION: For the normal Korean population, the diameter of the abdominal aorta increases with aging and with an increased BMI, but the changes were relatively smaller as compared with the western normal range. More studies are needed to determine Koreans' normal range of the diameter of the abdominal aorta and this data can be applied to the diagnosis and treatment of abdominal aortic aneurysm.