Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles / 대한생식의학회지

OBJECTIVE: Assisted reproductive technology has been associated with an increase in multiple pregnancies. The most effective strategy for reducing multiple pregnancies is single embryo transfer. Beginning in October 2015, the National Supporting Program for Infertility in South Korea has limited the number of embryos that can be transferred per in vitro fertilization (IVF) cycle depending on the patient's age. However, little is known regarding the effect of age and number of transferred embryos on the clinical outcomes of Korean patients. Thus, this study was performed to evaluate the effect of the number of transferred blastocysts on clinical outcomes. METHODS: This study was carried out in the Fertility Center of CHA Gangnam Medical Center from January 2013 to December 2014. The clinical outcomes of 514 women who underwent the transfer of one or two blastocysts on day 5 after IVF and of 721 women who underwent the transfer of one or two vitrified-warmed blastocysts were analyzed retrospectively. RESULTS: For both fresh and vitrified-warmed cycles, the clinical pregnancy rate and live birth or ongoing pregnancy rate were not significantly different between patients who underwent elective single blastocyst transfer (eSBT) and patients who underwent double blastocyst transfer (DBT), regardless of age. However, the multiple pregnancy rate was significantly lower in the eSBT group than in the DBT group. CONCLUSION: The clinical outcomes of eSBT and DBT were equivalent, but eSBT had a lower risk of multiple pregnancy and is, therefore, the best option.

Application of serum anti-Müllerian hormone levels in selecting patients with polycystic ovary syndrome for in vitro maturation treatment / 대한생식의학회지

OBJECTIVE: The purpose of this study was to identify useful clinical factors for the identification of patients with polycystic ovary syndrome (PCOS) who would benefit from in vitro maturation (IVM) treatment without exhibiting compromised pregnancy outcomes. METHODS: A retrospective cohort study was performed of 186 consecutive patients with PCOS who underwent human chorionic gonadotropin-primed IVM treatment between March 2010 and March 2014. Only the first IVM cycle of each patient was included in this study. A retrospective case-control study was subsequently conducted to compare pregnancy outcomes between IVM and conventional in vitro fertilization (IVF) cycles. RESULTS: Through logistic regression analyses, we arrived at the novel finding that serum anti-Müllerian hormone (AMH) levels and the number of fertilized oocytes in IVM were independent predictive factors for live birth with unstandardized coefficients of 0.078 (95% confidence interval [CI], 1.005-1.164; p=0.037) and 0.113 (95% CI, 1.038-1.208; p=0.003), respectively. Furthermore, these two parameters were able to discriminate patients who experienced live births from non-pregnant IVM patients using cut-off levels of 8.5 ng/mL and five fertilized oocytes, respectively. A subsequent retrospective case-control study of patients with PCOS who had serum AMH levels ≥8.5 ng/mL showed that IVM had pregnancy outcomes comparable to conventional IVF, and that no cases of ovarian hyperstimulation syndrome were observed. CONCLUSION: Serum AMH levels are a useful factor for predicting pregnancy outcomes in PCOS patients before the beginning of an IVM cycle. IVM may be an alternative to conventional IVF for PCOS patients if the patients are properly selected according to predictive factors such as serum AMH levels.

Anti-Mullerian hormone levels as a predictor of clinical pregnancy in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer cycles in patients over 40 years of age / 대한생식의학회지

OBJECTIVE: The aim of the current study was to determine the predictive value of anti-Mullerian hormone (AMH) levels for pregnancy outcomes in patients over 40 years of age who underwent in vitro fertilization or intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles. METHODS: We retrospectively analyzed the medical records of 188 women aged 40 to 44 years who underwent IVF/ICSI-fresh ET cycles due to unexplained infertility in the fertility center of CHA Gangnam Medical Center. Patients were divided into group A, with AMH levels or =1.0 ng/mL (n=91). We compared the clinical pregnancy rate (CPR) in the two groups and performed logistic regression analysis to identify factors that had a significant effect on the CPR. RESULTS: The CPR was significantly lower in group A than group B (7.2% vs. 24.2%, p or =1.90 ng/mL than in the group with AMH levels <1.90 ng/mL (p<0.001). CONCLUSION: Our study showed that AMH levels were predictive of clinical pregnancy in infertility patients over 40 years of age. Further prospective studies should be conducted to validate the predictive capability of AMH levels for the outcome of clinical pregnancy.

A healthy delivery of twins by assisted reproduction followed by preimplantation genetic screening in a woman with X-linked dominant incontinentia pigmenti / 대한생식의학회지

The purpose of this study is to report a successful twin pregnancy and delivery in a female patient with X-linked dominant incontinentia pigmenti (IP) who underwent assisted reproductive technology followed by preimplantation genetic screening (PGS). A 29-year-old female with IP had a previous history of recurrent spontaneous abortion. A molecular analysis revealed the patient had a de novo mutation, 1308_1309insCCCCTTG(p.Ala438ProfsTer26), in the inhibitor of the kappa B kinase gamma gene located in the Xq28 region. IVF/ICSI and PGS was performed, in which male embryos were sexed using array-based comparative genomic hybridization (aCGH). After IVF/ICSI and PGS using aCGH on seven embryos, two euploid male blastocysts were transferred with a 50% probability of a viable male pregnancy. The dizygotic twin pregnancy was confirmed and the amniocentesis results of each twin were normal with regard to the mutation found in the mother. The patient delivered healthy twin babies during the 37th week of gestation. This case shows the beneficial role of PGS in achieving a successful pregnancy through euploid male embryo gender selection in a woman with X-linked dominant IP with a history of multiple male miscarriages.

Correlation between Expression of Glucose Transporters in Granulosa Cells and Oocyte Quality in Women with Polycystic Ovary Syndrome

BACKGROUND: The glucose transporters (GLUTs) exhibit different tissue-specific expression. This study aimed to investigate the types of GLUTs expressed in human granulosa cells (GCs) obtained from women with polycystic ovary syndrome (PCOS) and their relationship with insulin resistance (IR) and the outcomes of in vitro maturation (IVM) of immature oocytes. METHODS: Expression of GLUTs was evaluated in GCs from women with PCOS with or without IR. Thirty-six women with PCOS undergoing an IVM program were included. Differential gene expression between the insulin sensitive (IS) and IR group was measured by reverse transcription polymerase chain reaction. RESULTS: Expression of GLUTs 1, 3, 5, 8, and 13 was constitutive, whereas expression of GLUTs 2 and 7 was not observed in human GCs. The remaining GLUTs, 4, 6, 9, 10, 11, and 12, were differentially expressed among patients according to metabolic status, such as insulin sensitivity. A higher number of GCs from patients with IR (92%) expressed GLUT6 than GCs from IS PCOS patients (46.3%). Logistic regression showed that expression of GLUTs 9, 11, and 12 correlates with rates of IVM at 48 hours, fertilization, and implantation, respectively. CONCLUSION: This is the first report describing the expression pattern of all 13 members of the GLUT family in human GCs. Results of the present study suggest that patients' insulin sensitivity regulates GLUT expression in GCs in PCOS patients, and this may control oocyte quality for IVM and subsequent processes such as fertilization and implantation in patients taking part in an in vitro fertilization program.

Clinical manifestations and risk factors of severe ovarian hyperstimulation syndrome by IVF-ET / 대한산부인과학회지

OBJECTIVE: The aim of this study is to determine the incidence, clinical predictors, clinical manifestations of severe ovarian hyperstimulation syndrome in a large group. METHODS: A retrospective analysis of all IVF-ET cycles was performed from January 2005 to October 2007. We analysed incidence of severe OHSS and clinical manifestation. We assessed transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes as the predictive factors comparing severe OHSS group and control group. Chi-square test and Student's t-test were used. Pleural effusion group was assessed identically. RESULTS: 6,292 IVF-ET cycles were undertaken in which 133 cycles of severe OHSS was developed (incidence: 2.11%). Patients age, transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes were high in severe OHSS group and lately developed OHSS patients were all pregnant. 43.6% of severe OHSS were diagnosed polycystic ovarian syndrome. Pleural effusion was develop in 28 patients (incidence : 0.45%) and there were no predictive factor of pleural efusion. CONCLUSIONS: The incidence of severe OHSS was 2.11%. The protocol of controlled ovarian hyperstimulation did not affect the incidence of severe OHSS. Transvaginal number of follicles on hCG, serum estradiol, numbers of oocytes, PCOS, pregnancy were meaningful risk factors. There were no predicting factor for the pleural effusion of severe OHSS.

Risk factors for ectopic pregnancy after fresh non-donor in vitro fertilization and embryo transfer / 대한산부인과학회지

OBJECTIVE: To find risk factors for ectopic pregnancy among women who conceived after fresh non-donor in vitro fertilization and embryo transfer (IVF-ET). METHODS: A total of 2,326 cycles conceived after fresh non-donor IVF-ET between January 2002 and December 2005 were studied with regard to patient factors, and factors related to the ART procedures through review of their medical chart. Risk factors in ectopic pregnancy were assessed by using chi-square test and multivariate logistic regression analysis. RESULTS: Of 2,326 pregnancies of fresh non-donor IVF-ET cycles, 135 (5.8%) were ectopic pregnancies. Most of ectopic pregnancies were tubal type (79 cases, 58.5%) and combined type (40 cases, 29.6%). Most of ectopic pregnancies (87.4%) were treated by laparoscopic surgery. In comparison with clinical pregnancy group, estradiol level checked on human chorionic gonadotrophin (hCG) injection day for final follicular maturation and mean number of oocytes retrived were higher in ectopic group. respectively, (2,228.9 vs. 1,906.9 pg/ml, p=0.022; 13.8 vs. 11.6, p=0.001). In univariate analysis, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.20-2.35) and, decreased among women with male factor infertility (OR 0.7, 95% CI 0.47-0.94) and use of intracytoplasmic sperm injection (ICSI) (OR 0.7, 95% CI 0.50-0.98). However, in multivariate logistic regression analysis, only tubal factor was an independent predictor for ectopic pregnancy. CONCLUSIONS: Tubal factor infertility is the main risk factor for ectopic pregnancy following fresh non-donor IVF-ET.

A case of abdominal pregnancy on abdominal scar following in vitro fertilization and embryo transfer in a patient with bilateral tubal obstruction / 대한산부인과학회지

Abdominal pregnancy is a rare event following in vitro fertilization and embryo transfer. In case of early abdominal pregnancy, it is difficult to diagnose and treat early because of nonspecific symptoms. The abdominal pregnancy in a woman with tubal obstruction is very exceptional and an abdominal pregnancy on abdominal scar have not been reported. We reported the first abdominal pregnancy on abdominal scar following in vitro fertilization and embryo transfer in a woman with unilateral salpingectomy and contralateral tubal obstruction.

The role of transvaginal sonography at early pregnancy in prediction of placenta previa / 대한산부인과학회지

OBJECTIVE: Ultrasonography was used to determine not only the size but also the shape and site of gestational sac (GS) in early pregnancy. This study was performed to evaluate the role of transvaginal ultrasonography to predict placenta previa in early pregnancy, and analyze the correlation of the GS location with pregnancy outcomes. METHODS: From 1995 to 2007, medical records of pregnant women who had diagnosed placenta previa at Kangnam St. Mary's Hospital and Our Lady of Mercy Hospital were reviewed retrospectively. 71 patients with placenta previa had transvaginal ultrasonographic evidences within 7 weeks of gestation. As a control group, randomized sampling among pregnant women without placenta previa was performed, and 102 patients were selected and reviewed. Data was analyzed with SPSS version 11.0 statistically. RESULTS: 23.9% of GS (n=17) were found in lower 1/3 of the uterine cavity, 31.0% (n=22) were in middle 1/3, while 45.1% (n=32) were in upper 1/3. The distribution of GS in placenta previa patients leans to the lower in uterine cavity compared to normal pregnancies significantly (P=0.000). The relationship between the location of GS and differential diagnosis of placental previa was not statistically significant. CONCLUSION: Our results show that there would be higher risk for placenta previa, preterm labor, and early delivery when ultrasonographic finding of GS within 7 weeks of gestation reveals lower implantation in uterine cavity.

The comparison of intravenous anesthesia with fentanyl versus alfentanill during oocyte retrieval for in vitro fertilization / 대한마취과학회지

BACKGROUND: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. METHODS: The patients were designed to receive alfentanil (group A, n = 70) or fentanyl (group F, n = 70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 microgram/kg in group A or fentanyl 1.5 microgram/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. RESULTS: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. CONCLUSIONS: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully.

The comparison of intravenous anesthesia with fentanyl versus alfentanill during oocyte retrieval for in vitro fertilization / 대한마취과학회지

BACKGROUND: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. METHODS: The patients were designed to receive alfentanil (group A, n = 70) or fentanyl (group F, n = 70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 microgram/kg in group A or fentanyl 1.5 microgram/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. RESULTS: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. CONCLUSIONS: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully.

Cases of Transarterial embolization in Arteriovenous Malformation of Uterus / 대한산부인과학회지

Uterine arteriovenous malformations are very rare but potentially life-threatening lesions. These lesions may be congenital or acquired, but especially in patients with a history of infection, curettage, abortion, pelvic surgery or cancer. Ultimate treatment depends on the patients desire for fertility. Embolization therapy is effective method in reproductive age patients of. We have experienced two clinical cases of arteriovenous malformation of uterus, which is presented with a brief review of literature.

Simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer / 대한산부인과학회지

A case of simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer is presented. On the 22 days after ET, the patient complained of low abdominal pain and vaginal spotting for one day and was suspected of left tubal pregnancy by transvaginal ultrasonography. However, laparoscopy revealed the bilateral tubal pregnancy and laparoscopic bilateral salpingectomy was performed. This unusual type of ectopic pregnancy must be kept in mind when evaluating a patient suspected of a possible early abnormal gestation after assisted reproductive technologies. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube during surgery.