Comparison of Clinical Efficacy between a Single Administration of Long-Acting Gonadotrophin-Releasing Hormone Agonist (GnRHa) and Daily Administrations of Short-Acting GnRHa in In Vitro Fertilization-Embryo Transfer Cycles

This study was aimed to evaluate the efficacy of a single administration of long-acting gonadotrophin-releasing hormone agonist (GnRHa) as compared with daily administrations of short-acting GnRHa in controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) cycles. The mean dosage of recombinant follicle-stimulating hormone (rFSH) required for COH (2,354.5+/-244.2 vs. 2,012.5+/-626.1 IU) and the rFSH dosage per retrieved oocyte (336.7+/-230.4 vs. 292.1+/-540.4 IU) were significantly higher in the long-acting GnRHa group (N= 22) than those in the short-acting GnRHa group (N=28) (p<0.05). However, the mean number of visit to the hospital that was required before ovum pick-up (3.3+/-0.5 vs. 22.2+/-2.0) and the frequency of injecting GnRHa and rFSH (12.8+/-1.2 vs. 33.5+/- 3.5) were significantly decreased in the long-acting GnRHa group (p<0.0001). The clinical pregnancy rate, implantation rate, and early pregnancy loss rate were not significantly different between the 2 groups. So, we suggest that a single administration of long-acting GnRHa is a useful alternative for improving patient's convenience with clinical outcomes comparable to daily administrations of short-acting GnRHa in COH for IVF-ET cycles.

The Preconceptional Level of Peripheral Natural Killer Cells which was Expected to Bring Successful Treatment Outcome using Low-dose Intravenous Gamma Immunoglobulin (IVIg) Infusion in Patients with Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVES: We aimed to investigate the clinical effect of low-dose intravenous immunoglobulin treatment in unexplained recurrent spontaneous aborters (RSA) with elevated peripheral CD56+ natural killer (NK) cell levels and to determine the pre-conceptional NK cell percentage predictive of subsequent successful pregnancy outcome. MATERIALS AND METHODS: Sixty four cases of unexplained recurrent miscarriage with elevated peripheral NK cells (>15%) were received low dose IVIg infusion at the dosage of 400 mg/Kg/month after confirmation of gestational sac and continued until 20 weeks. The patients were divided into two groups according to the pregnancy outcome: Group I was success of treatment defined as live birth at or after 25 gestational weeks and Group II was failure of treatment. The preconceptional levels of the peripheral blood NK cells were compared between two groups. RESULTS: Fifty-three pregnancies resulted in live births after 25 weeks and 11 resulted in abortion (Overall success rate of IVIG treatment was 82.8%). Preconceptional CD56+ NK cell percentage in group II (27.4+/-1.9%) was higher than those in group I (22.3+/-0.8%). By using ROC curve, optimal discrimination between success and failure of treatment was achieved with < or = 27% of preconceptional NK cell percentage. CONCLUSION: In RSA patients with elevated NK cells, we suggest that preconceptional peripheral blood CD56+ NK cell level could be a useful marker for predicting successful treatment outcome of low-dose IVIg infusion.

Aberrant Expression of Transforming Growth Factor-beta1 in Endometrium of Infertile Women During the Window of Implantation / 대한산부인과학회잡지

OBJECTIVE: TGF-beta1 is a polypeptide which stimulates the growth of some mesenchymal cell types and inhibits the growth of epithelial cell types. Several studies have reported that TGF-beta1 is present in the endometrial tissue and it is also involved in a variety of physiological processes such as the implantation of the embryo into the endometrium. However, the expression of endometrial TGF-beta1 have not been well established in infertile women with endometriosis or hydrosalpinx having impaired endometrial receptivity. Therefore, the aim of this study was to determine the expression of endometrial TGF-beta1 in infertile women and to compare it with that of fertile women during the window of implantation. MATERIALS AND METHODS: Endometrial biopsies were performed during the window of implantation from 10 normal fertile women and 15 infertile women (5 unexplained infertility, 5 endometriosis and 5 tubal disease with hydrosalpinx). We performed immunohistochemistry using paraffin-embedded endometrial tissues. The staining intensity of TGF-beta1-immunostained section was assessed by semi-quantitative histologic score (H-score=Sum[Pi x (i +1)]; i: intensity 0-3, Pi: %cells for each given intensity) of 100 cells. RESULTS: In normal fertile women, the staining intensity of TGF-beta1 in the glandular epithelium was higher than that of stromal cells. But the stromal cells showed an irregularly distributed positivity. In infertile women, their expression patterns were similar to those in fertile women. There was no statistically significant difference in the staining intensity of TGF-beta1 between the glandular epithelium and stromal cell of women with unexplained infertility and that of fertile women. However, the staining intensity of TGF-beta1 in the glandular epithelium and stromal cell of women with endometriosis or hydrosalpinx were significantly higher (p<0.01) than those in fertile women. CONCLUSION: This study demonstrated that increased expression of endometrial TGF-beta1 in women with endometriosis or hydrosalpinx during the window of implantation may cause endometrial dysfunction during the implantation process such as endometrial-embryonic interactions and endometrial proteolytic activity.

Comparative Analysis of Pregnancy Outcomes after In Vitro Fertilization with Intracytoplasmic Sperm Injection (IVF-ICSI) between Obstructive and Non-obstructive Azoospermia / 대한불임학회지

OBJECTIVE: To compare the pregnancy outcomes after in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) between obstrucvtive and non-obstrucvtive azoospermia. METHODS: From January 1994 to December 2002, 524 patients with obstructive azoospermia (886 cycles) and 163 patients with non-obstructive azoospermia (277 cycles) were included in this study. Microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) in obstructive azoospermia and TESE in non-obstructive azoospermia were perfomed to retrieve sperm, which was used for ICSI and then fertilized embryos were transferred. The results of ICSI-fertlization rate (FR), clinical pregnancy rate (CPR), clinical abortion rate (CAR) and delivery rate (DR)- were statistically analysed in obstructive versus non-obstructive azoospermia. RESULTS: There were no differences in the number of retrieved oocytes, injected oocytes for ICSI and oocyte maturation rate. FR was significantly higher in obstructive than non-obstructive azoospermia (71.7% vs. 61.1%, p<0.001). There was no difference in CPR per embryo transfer cycle. After pregnancy was established, however, CAR was significantly higher in non-obstructive than obstructive azoospermia (25.6% vs. 12.5%, p=0.004). DR per clinical pregnancy cycle was significantly higher in obstructive than non-obstructive azoospermia (78.0% vs. 64.4%, p=0.012). In the karyotype ananlysis of abortus, abnormal karyotypes were found in 75.0% (6/8) of obstructive and 55.6% (5/9) of non-obstructive azoospermia. CONCLUSION: Our data show significantly higher FR in obstructive than non-obstructive azoospermia. Though there was no differrence in CPR, CAR was significantly higher in non-obstructive than obstructive azoospermia. The abortion may be related to the abnormal karyotype of embryo, but further investigations are necessary to elucidate the cause of clinical abortion in azoospermia.

Study on the Insulin Resistance According to Obesity in the Patients with Polycystic Ovarian Syndrome / 대한산부인과학회잡지

OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a heterogenous dysfunctional endocrinologic disorder with unknown etiology, clinically characterized by obesity, chronic anovulation, masculinization and infertility. Recently, the association between polycystic ovarian syndrome and insulin resistance have been brought up and insulin resistance is one of the most important factor related to the development of obesity. However, not all polycystic ovarian syndrome patients are obese, it would give a clue to understanding pathophysiology of obesity and PCOS if insulin resistance could be classified according to the degree of obesity in PCOS. Thus, we performed this prospective study to know the relationship between insulin resistance and obesity in the patients with PCOS. METHODS: Fourty eight polycystic ovary patients were included at Samsung Cheil Hospital from April to October 2002. These patients were grouped according to obeseness. HOMA index was used to evaluate insulin resistance calculated by using fasting blood sugar and serum insulin level. RESULTS: Twenty patients (41%) were classified as obese group, twenty eight patients (59%) had normal body mass index. Increased insulin resistance was observed in the patients with polycystic ovarian syndrome. And it was significantly higher in the obese patients compared to the patients with normal body mass index (6.8+/-2.8 vs. 2.7+/-0.9, t-test, p<0.01). CONCLUSION: For increased insulin resistance, immediate management would be needed in the patients of polycystic ovarian syndrome, especially combined with obesity.

Chromosomal Analysis of Aborted Conceptuses among Anembryonic Pregnancy and Embryonic Pregnancy: Do Chromosomal Abnormalities Relate to Anembryonic Pregnancy? / 대한산부인과학회잡지

OBJECTIVES: Approximately 15-20% of all clinically recognized pregnancies result in spontaneous abortion between 8 and 12 weeks. In some early abortus only the extra-embryonic components of the conceptus survive, either as fragments of placenta or as empty gestational sac, and these have been termed 'anembryonic pregnancies'. Despite their common occurrences, the etiology of anembryonic conceptuses is poorly understood. The purpose of this study was to evaluate whether chromosomal abnormalities relate to a role in anembryonic pregnancy. MATERIALS AND METHODS: The study, that consisted of 143 pregnancies from chromosomally normal couples that aborted in first trimester period between January 1, 1994 and December 27, 1997, had chromosomal analysis performed on the products of conception and had ultrasonographic examination prior to spontaneous abortion. The tissue was processed and analysed using standard G-banding cytogenetic techniques with long-term cultures. RESULTS: The patient characteristics of the anembryonic pregnancy were not significantly different from those of the embryonic pregnancy. Among products of conception from embryonic pregnancies, 45% (52/115) had normal chromosomal analyses and 55% (63/115) had abnormal chromosomal analyses. Products of conception from anembryonic pregnancies resulted in 54% (15/28) of abnormal chromosome analyses and normal chromosomal analyses resulted in 46% (13/28) (p>0.05, Chi-square test). The frequency of aneuploidy and polyploidy were not different between products of conception from anembryonic pregnancy and embryonic pregnancy. Also, the gender ratio of euploid spontaneous pregnancy losses showed similar in this study. CONCLUSION: There are no differences in frequency of abnormal karyotypes in products of conception from anembryonic pregnancies compared with miscarriage after the demonstration of fetal pole. If further studies are need for the evaluation of these etiologies, and then immuno-molecular studies in early placental tissues from anembryonic pregnancy might be helpful.

Recombinant Human Follicle Stimulating Hormone (rFSH) versus Highly Purified Urinary FSH (uFSH): Oocyte and Embryo Quality / 대한산부인과학회잡지

OBJECTIVE: To estimate the efficacy of recombinant human follicle stimulating hormone (rFSH) versus highly purified urinary human FSH (uFSH) in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET). METHODS: From 1 January 2001 to 31 August 2001, A total of 254 cycles from 241 patients who attended infertility clinic at Samsung cheil hospital was enrolled in this study. With pituitary down regulation using GnRH agonist by short protocol, rFSH (Puregon(R), Organon, Netherlands) was administered in 131 cycles and uFSH (Metrodin-HP(R), Serono, Switzerland) was administered in 123 cycles. We analyzed ovarian response, pregnancy rate, live birth rate, oocyte quality and embryo quality. RESULTS: The clinical characteristics of two groups were not different. Total FSH dosages (1322.3+/-526.2 IU versus 2124.4+/-881.9 IU, p<0.001) and dosages per retrieved oocyte (90.6+/-36.0 IU versus 138.0+/-57.2 IU, p<0.001) were significantly lower in rFSH group than uFSH group. Clinical pregnancy rate and live birth rate of two groups were not significantly different. The rate of good quality oocyte (Grade I and II) from retrieved oocytes was higher in rFSH group (68.2% versus 64.8%, p=0.024), but after preincubating oocytes for 4 to 6 hours and removing cumulus cells in intracytoplasmic sperm injection (ICSI) cycles, nuclear maturity of oocytes were not significantly different. The quality of transferred embryos were not significantly different too. CONCLUSION: rFSH offered more effective ovarian response in COH and better quality of retrieved oocytes, compared with uFSH.

The efficacy of prophylactic intravenous albumin in clinical progress in patients with severe ovarian hyperstimulation syndrome who needed hospitalization / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study is to evaluate the efficacy of prophylactic intravenous albumin in patients with severe ovarian hyperstimulation syndrome (OHSS) who needed hospitalization. METHODS: From January, 1995 to December, 2000, 86 women who underwent COH for IVF-ET were hospitalized for the management of severe OHSS in Samsung Cheil hospital. Among them, twenty one patients were treated with prophylactic intravenous albumin at the day of ovum retrieval, and 65 were not. We analysed clinical symptoms, signs, and hospital courses in the records of 86 patients retrospectively. We compared above variables of prophylactic albumin used group (n=21) with those of non-used group (n=65). RESULTS: Among the indices of ovarian response to ovarian stimulation, serum estradiol (E2) level at the day of hCG injection was significantly higher in prophylactic albumin used group (5805.2+/-1604.4 pg/ml) than non-used group (4125.2+/-1921.5 pg/ml, P<0.05). But the variables which indicate clinical progress (number and amount of paracentesis, amount of used albumin after hospitalization, duration of symptoms, hospital days) showed less severe tendency in prophylactic albumin used group but was not significantly different between two groups. CONCLUSION: Our results indicates that the use of prophylactic intravenous albumin in patients who have risk of severe OHSS had some advantages in favorable clinical progress.

Outcome of Preimplantation Genetic Diagnosis for Chromosome Aneuploidy and Genetic Disease / 대한불임학회지

OBJECTIVES: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. MATERIALS AND METHODS: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6~10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. RESULTS: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced embryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). CONCLUSIONS: PGD by using FISH or PCR is useful to get normal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

Outcome of Preimplantation Genetic Diagnosis for Chromosome Aneuploidy and Genetic Disease / 대한불임학회지

OBJECTIVES: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. MATERIALS AND METHODS: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6~10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. RESULTS: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced embryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). CONCLUSIONS: PGD by using FISH or PCR is useful to get normal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

Obstetric outcome in women with a history of recurrent miscarriage / 대한산부인과학회잡지

OBJECTIVE: To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. METHODS: From 1 June 1998 to 30 June 2000, 82 patients who attended infertility & current miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. RESULTS: The etiology of recurrent miscarriage was immunologic factor (36.6%), unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%) and chromosomal abnormality (5.6%). The rate of preterm delivery (11%) and incidence of pregnancy induced hypertention (8.5%) were significantly higher than those of control group (3.2% and 2.5% respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. CONCLUSION: The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.

Ovarian Response and Pregnancy Rate according to Basal FSH concentration in Controlled Ovarian Hyperstimulation and Clomiphene Citrate stimulated cycle for ART / 대한산부인과학회잡지

OBJECTIVE: To evaluate whether elevation of basal FSH predict poor ovarian response and lowered pregnancy rate in women undergoing controlled ovarian hyperstimulation (COH) and Clomiphene Citrate stimulated cycle (CC cycle) for assisted reproductive technologies (ART). METERIALS AND METHODS: From January 1999 to December 1999, total 1067 COH cycles and 119 CC cycles from 1033 patients were included in this study. At each cycle, on cycle day 2 or 3, basal FSH was measured before GnRH agonist starting. FSH value (mIU/ml) was 2 nd IRP 78/549 standard. We divided COH and CC cycles into 4 groups according to elevated basal FSH concentration, respectively. i) Normal (Basal FSH OR =20 mIU/ml): Group D (n=35), Group IV (n=34). Retrospectively, we obtained mean total ampules of gonadotropin, mean serum E2 concenturation on hCG day, mean number of retrieved oocyte, mean number of embryo transferred, mean number of good embryo, cancellation rate, clinical pregnancy rate and live birth rate. RESULTS: Ovarian response by elevation of basal FSH decreased more significantly in COH cycles than CC cycles. In COH cycles, ovarian response of Group B, C and D decreased significantly (P<0.001). In CC cycles, ovarian response of Group IV decreased significantly (P<0.01). Including cycles only under 35 years old, COH cycles with mildly elevated basal FSH had poor ovarian response (P<0.01), but the clinical pregnancy rate (28.3%) and live birth rate (24.2%) did not decrease, compared with normal FSH Group (27.5%, 23.1% respectively). In cycles with markedly elevated basal FSH, clinical pregnancy rate (5.9%) and live birth rate (2.9%) of CC cycles were equal to that of COH cycles (5.7%, 2.9%, respectively). CONCLUSION: Mildly elevated basal FSH does not predict poor outcome in ART. Poor prognosis conferred by mildly elevated basal FSH may be overcome by maximizing stimulation protocol. Therefore other stimulation protocol for poor ovarian response may be effective in mildly elevated basal FSH cycles. In cycles with moderately to severe elevated basal FSH, lowered pregnancy rate was mainly due to quantitative and qualitative decrease in ovarian response. In cycles with markedly elevated basal FSH, CC stimulated cycle was more cost effective with good compliance.

Ovarian Response and Pregnancy Rate according to Basal FSH concentration in Controlled Ovarian Hyperstimulation and Clomiphene Citrate stimulated cycle for ART / 대한산부인과학회잡지

OBJECTIVE: To evaluate whether elevation of basal FSH predict poor ovarian response and lowered pregnancy rate in women undergoing controlled ovarian hyperstimulation (COH) and Clomiphene Citrate stimulated cycle (CC cycle) for assisted reproductive technologies (ART). METERIALS AND METHODS: From January 1999 to December 1999, total 1067 COH cycles and 119 CC cycles from 1033 patients were included in this study. At each cycle, on cycle day 2 or 3, basal FSH was measured before GnRH agonist starting. FSH value (mIU/ml) was 2 nd IRP 78/549 standard. We divided COH and CC cycles into 4 groups according to elevated basal FSH concentration, respectively. i) Normal (Basal FSH OR =20 mIU/ml): Group D (n=35), Group IV (n=34). Retrospectively, we obtained mean total ampules of gonadotropin, mean serum E2 concenturation on hCG day, mean number of retrieved oocyte, mean number of embryo transferred, mean number of good embryo, cancellation rate, clinical pregnancy rate and live birth rate. RESULTS: Ovarian response by elevation of basal FSH decreased more significantly in COH cycles than CC cycles. In COH cycles, ovarian response of Group B, C and D decreased significantly (P<0.001). In CC cycles, ovarian response of Group IV decreased significantly (P<0.01). Including cycles only under 35 years old, COH cycles with mildly elevated basal FSH had poor ovarian response (P<0.01), but the clinical pregnancy rate (28.3%) and live birth rate (24.2%) did not decrease, compared with normal FSH Group (27.5%, 23.1% respectively). In cycles with markedly elevated basal FSH, clinical pregnancy rate (5.9%) and live birth rate (2.9%) of CC cycles were equal to that of COH cycles (5.7%, 2.9%, respectively). CONCLUSION: Mildly elevated basal FSH does not predict poor outcome in ART. Poor prognosis conferred by mildly elevated basal FSH may be overcome by maximizing stimulation protocol. Therefore other stimulation protocol for poor ovarian response may be effective in mildly elevated basal FSH cycles. In cycles with moderately to severe elevated basal FSH, lowered pregnancy rate was mainly due to quantitative and qualitative decrease in ovarian response. In cycles with markedly elevated basal FSH, CC stimulated cycle was more cost effective with good compliance.

Expression of leukemia inhibitory factor in endometrium of infertile women during the window of implantation / 대한산부인과학회잡지

OBJECTIVE: To determine the expression of endometrial leukemia inhibitory factor (LIF) in infertile women and to compare it with that of fertile women during the window of implantation METHODS: Endometrial biopsies were performed during the window of implantation from 10 normal fertile and 15 infertile women (5 unexplained infertility, 5 endometriosis and 5 tubal disease with hydrosalpinx). We performed immunohistochemistry using paraffin-embedded endometrial tissues. RESULTS: In fertile and infertile women, the staining intensities of LIF in the glandular epithelium were significantly higher (p<0.01) than those of stromal cells. There was no significantly difference in the expression of LIF between the glandular epithelium of infertile women with endometriosis or hydrosalpinx and those of fertile women. However, the staining intensities of LIF in the glandular epithelium of unexplained infertility patients were significantly lower (p<0.01) than those in fertile women. The staining intensities of LIF in stromal cell of women with unexplained infertility, endometriosis and hydrosalpinx were similar to those in fertile women. CONCLUSIONS: This study demonstrated that the glandular epithelial cells are more important sites of LIF secretion than stromal cells. The expression of endometrial LIF may be decreased in women with unexplained infertility during the window of implantation. Therefore, this result suggest that abnormalities of LIF expression in infertile women may underlie endometrial dysfunction in the adhesive phase of implantation.

The Effect of Exocelomic Fluid in the First Trimester Pregnancy on Trophoblast Cell Proliferation in Vitro / 대한산부인과학회잡지

OBJECTIVE: To investigate the effect of exocelomic fluid in first trimester pregnancy on trophoblast cell proliferation in vitro. METHODS: The coelomic fluid was obtained from women with apparently normal pregnancies (n=9) and women presenting with missed abortion (n=22). The concentrations of cytokines in coelomic fluid were determined by two steps sandwich ELISA. The detection limits were the 4 pg/ml for IFN-gamma, 1 pg/ml for TNF-alpha, 2 pg/ml for IL-6 and 5 pg/ml for IL-10, respectively. The data are presented as mean+/-SEM. Statistical analysis was performed by Mann-Whitney U test. Trophoblast cell (Jeg-3 choriocarcinoma cell line) proliferation in vitro was determined using colorimetric immunoassay, based on the measurement of BrdU incorporation using DNA synthesis. The optical absorbance of the samples at 450 nm was measured using an ELISA reader. The data are presented as absorbance in the samples (mean+/-SEM). Statistical analysis was performed using regression analysis and t-test. RESULS: Th-2 type cytokines are present to some extent and IL-6, one of Th-1 type cytokines, also exists in the coelomic fluid from the missed abortion. Coelomic fluids from the majority of normal pregnancies inhibited trophoblast proliferation in vitro significantly higher than fluids from the missed abortion. CONCLUSION: These data showed that exocoelomic fluids may have a unique immune privilege surrounding developing embryo in the early pregnancy. Further studies are required to determine the goowth factors in coelomic fluids from normal pregnancies and missed abortion, and to evaluate the influence on the development of early pregnancy complications.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

The clinical significance of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with pelvic pain and endometriosis / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of laparoscopic uterosacral nerve ablation (LUNA) in infertile women with chronic pelvic pain and endometriosis. METHOD: Prospective randomized study was performed in 20 infertile women with endometriosis and chronic pelvic pain, who had undergone of laparoscopic uterosacral nerve ablation at Samsung Cheil hospital between April and September, 1998. Statistical analysis was perfomed using by DBSTAT (ver. 2.0). RESULT: The pelvic pain score of pre-operation was 3.72+/-1.07 (mean+/-SD) and it was significantly decreased to 1.83+/-0.85 at 1 month later and 1.93+/-0.92, 1.69+/-0.60, 1.56+/-0.62, 1.56+/-0.81 each in second, third, fourth and fifth month after operation. There was no correlation between pelvic pain and stage of endometriosis. Pregnancy rate was 65% after LUNA (twelve deliveries, one pregnancy is ongoing at IUP 24 weeks). CONCLUSION: Laparoscopic uterosacral nerve ablation would be effective for infertile women with endometriosis and pelvic pain.

Chromosome Analysis of Abortuses in Recurrent Spontaneous Aborters with Serum Anticardiolipin Antibodies / 대한산부인과학회잡지

OBJECTIVE: It has been suggestes that various mechanism of fetal loss are associated with anticardiolipin(ACA) and humoral immunity in the patients with recurrent spontaneous abortion. Thus we have investigated the relationship between ACA and chromosomal anomaly to know the clinical impact of ACA to early fetal loss as comparing to the chromosomal anomaly in the patients of recurrent spontaneous abortions. MATERIALS AND METHODS: Patients(n=88) with a history of recurrent spontaneous abortion (2 or more) between January 1, 1994 and June 30, 1999 were included in this study. Quantitative measurement of serum ACA was performed by ELISA and chromosomal analysis of chorionic villi obtained from aborted conceptuses was done by using standard G-banding technique. RESULTS: The incidence rate of ACA positive was 27%(24/88) and that of chromosomal abnormality was 57%(50/88). The incidence rate of abnormal karyotype was 54% (13/24) in ACA positive. Among 24 ACA positive, 10 had IgG-ACA positive, 10 had IgM-ACA positive and 4 had both types of ACA. The incidence rate of chromosomal anomalies was 30% (3/10) in IgG-ACA positive, 90%(9/10) in IgM-ACA positive and there was significant difference between these two groups (p=0.02). The incidence rate of chromosomal trisomy was 59% (23/37) in ACA negative, 62% (8/13) in ACA positive and there was no significance between two groups. CONCLUSIONS: The significantly low incidence of chromosomal abnormalities in conceptal products of patients with IgG-ACA comparing that of patients with IgM-ACA suggests that this isotype of antibody have influence on the genesis of spontaneous abortions in genetically normal pregnancy. In further studies, additional trials are mandatory for obtaining a definitive conclusions about relationship between pathologic changes of conceptal products and pathophysiologic effects of IgG-ACA.

Three cases of successful pregnancy outcome after intensive care in the patients with complete uterine septum, cervical duplication and longitudinal vaginal septum / 대한산부인과학회잡지

Three cases of successful pregnancy outcome after intensive care in the patients with rare mullerian anomaly of complete uterine septum, hypoplastic cervical duplication and longitudinal vaginal septum in infertility clinic are reported. These presented three cases are the reports of supporting the embryologic hypothesis of bidirectional mullerian development which fusion and resorption begins at the isthmus and proceeds simultaneously in both the cranial and caudal directions rather than the classical views of unidirectional(caudal to cranial) mullerian development. Thus, we present here three cases of rare mullerian anomaly and their pregnancy outcomes in an attempt to alert gynecologist to the possible occurrence of such a malformation. In 2 cases, successful pregnancy outcomes were achieved after abdominal or hysteroscopic uterine septotomy before pregnancy and in the last case, successful pregnancy outcome intensive obstetric care was achieved even under uncorrected uterine anomaly and complete removal of uterine septum resulted in uneventful postoperative courses at the same time of cesarean section.

The incidence of fetal chromosomal abnormalities in recurrent miscarriage couples with balanced translocation / 대한산부인과학회잡지

OBJECTIVES: The most common chromosomal abnormality contributing to recurrent abortion is the balanced chromosomal translocation. However the exact incidence of fetal losses are still unknown. The objectives of this study were to evaluate the incidence of fetal chromosomal abnormalities and outcome of pregnancy in recurrent miscarriage couples with balanced translocation. DESIGN: A retrospective analysis of recurrent spontaneous abortion patients with balanced chromosomal translocation. MATERIALS AND METHODS: Cytogenetic analysis was performed in 56 couples with history of recurrent abortions from 1995 to 1999. The use of high resolution banding technique and fluorescent in situ hybridization (FISH) in the chromosomal analysis has made the precise evaluation of chromosome aberrations. RESULTS: Among 56 couples, 42 patients had reciprocal translocation and 14 had Robertsonian translocation. Chromosomal aberrations were more frequent in women (36 cases) than in men (20 cases). Prenatal cytogenetic analyses were carried out in 14 subsequent pregnancies for carrier couples with balanced translocation. The fetal karyotypes showed that 5 cases (35.7%) was normal, 8 (57.1%) were balanced translocation, and 1 (7.1%) was unbalanced translocations. And cytogenetic analyses were done on 15 subsequent chorionic villi samples of abortuses for carrier couples with balanced translocations. Fourteen of fifteen abortuses (93.3%) were abnormal karyotype. CONCLUSIONS: Although the incidence of chromosomal imbalance in the fetuses was relatively low in prenatal cytogenetic analysis, individuals with balanced translocations are predisposed to giving birth to malformed offsprings with chromosomal imbalance (partial trisomy or monosomy). Therefore we recommend preimplantation genetic diagnosis (PGD) for recurrent abortions with balanced translocation and preventing the birth of offspring with chromosomal abnormalities.