Genetic Polymorphism of CYP2D6 and Clomiphene Concentrations in Infertile Patients with Ovulatory Dysfunction Treated with Clomiphene Citrate

CYP2D6 is primarily responsible for the metabolism of clomiphene citrate (CC). The purpose of the present study was to investigate the relationship between CYP2D6 genotypes, concentrations of CC and its major metabolites and drug response in infertility patients. We studied 42 patients with ovulatory dysfunction treated with only CC. Patients received a dose of 100 mg/day CC on days 3-7 of the menstrual cycle. CYP2D6 genotyping and measurement of CC and the major metabolite concentrations were performed. Patients were categorized into CC responders or non-responders according to one cycle response for the ovulation. Thirty-two patients were CC responders and 10 patients were non-responders with 1 cycle treatment. The CC concentrations were highly variable within the same group, but non-responders revealed significantly lower (E)-clomiphene concentration and a trend of decreased concentrations of active metabolites compared to the responders. Nine patients with intermediate metabolizer phenotype were all responders. We confirmed that the CC and the metabolite concentrations were different according to the ovulation status. However, our results do not provide evidence for the contribution of CYP2D6 polymorphism to either drug response or CC concentrations.

Effect of Fragment Removal on Development of Human Fragmented Embryos in IVF-ET Program / 대한불임학회지

OBJECTIVE: To investigate the beneficial effect of fragment removal on the subsequent cell division and clinical outcome of the fragmented human embryos. METHODS: A prospective study was performed in Hanna Women's Clinic and Mizmedi Hospital. Sixty couples undergoing In vitro fertilization-embryo transfer (IVF-ET) program were participated in the present study. The microsurgical fragment removal was performed in 106 fragmented embryos of 29 patients before the transfer. As a control group, 122 fragmented embryos of 31 patients were transferred without the fragment removal. Effects of fragment removal on morphological changes and clinical outcomes of fragmented embryos were investigated. RESULTS: Mean morphological grade (G2.79) of fragmented embryos was significantly improved after the fragment removal (G1.63, p<0.001). Most of the fragmented embryos did not show a regeneration of fragments after the fragment removal during the subsequent development, and a beneficial effect of fragment removal on the development of the fragment removed embryos was observed. Implantation and pregnancy rates of fragment removed embryos were 12.3% and 31.3%, whereas the rates of control group embryos were 6.6% and 22.5%, respectively. There was no statistical significance in the rates between the two groups because of the low number of trials. CONCLUSION: Microsurgical fragment removal improved the subsequent development as well as the morphological grade of fragmented embryos. The fragment removal may be beneficial for neighboring blastomeres by repairing the intercellular communication and removing the secretion of the potential toxic materials by fragments.

A Case of Hyperreactio Luteinalis in Normal Pregnancy / 대한산부인과학회잡지

We report a case of hyperreactio luteinalis in a patient with normal singleton pregna-ncy. In the 10th week of gestation, the patient developed lower abdominal pain accompanied by abdominal distension. Ultrasonography revealed bilateral ovarian cysts. Right salpingo-oophorectomy was performed due to torsion of right ovarian cyst. The pathologic diagnosis was corpus luteal cyst. Any signs of maternal virilization were not seen. The patient deliv-ered a normal male infant at 39th week of gestation. As hyperreactio luteinalis is a benign condition in itself with normal spontaneous remission after delivery, the conservative man-agement may be appropriate.

A Case of Small Cell Carcinoma of the Ovary / 대한부인종양콜포스코피학회잡지

Small cell carcinoma of the ovary has been identified as a specific histopathologic entity. The first II cases were reported by Dickersin et a1, 1982, Since then only 80 cases were reported in literature. This rare and highly aggresive melignancy primarily affeets ehildren and young women(10-40) and grows rapidly, with hypercalcemia occuring frequently. Abscence of effective treatment results in early mortality. Recently we have experienced one case of primary sma11 cell carcinoma of the ovary, which is presented with a brief review of the literature.