Short Coasting of One or Two Days by Withholding Both Gonadotropins and GnRH Agonist Prevents Ovarian Hyperstimulation Syndrome without Compromising the Outcome / 대한불임학회지

OBJECTIVE: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome. METHOD: Thirty-seven women who had been coasted during COH for IVF were coasted when > or =20 follicles > 15 mm with serum E2 level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E2 level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E2 levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. RESULTS: The mean serum E2 level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E2 level was 43% in one day coasting group and 15% (1st day) and 81% (2nd day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3 (8.1%) patients. CONCLUSIONS: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.

Learning Curve of Laparoscopic Myomectomy / 대한산부인과학회잡지

OBJECTIVE: To evaluate the effectiveness and feasibility of laparoscopic myomectomy compared to open myomectomy METHODS: A retrospective study of 85 cases of myomectomy was performed. Twenty six cases of open myomectomy (group I) and 59 cases of laparoscopic myomectomy (group II) were done by one main surgeon from 1996 to 2002 in the department of OBGYN at Moonhwa Hospital. Group II was divided into two subgroups, group IIA and group IIB. Group IIA included 17 cases of laparoscopic myomectomy done from 1996 to 1998 during learning period. Group IIB included 42 cases of laparoscopic myomectomy performed from 1999 to 2002 after learning period. RESULTS: There were no significant differences in age, parity, the number of myoma, and the size of myoma between groups I and II. The intensity of postoperative pain and febrile morbidity were significantly lower in group II than in group I (P<0.05). Mean operation time was significantly shorter in group I than in group II. However, after completing the learning curve, no significant difference was found in the operation time between group I and group IIB. Blood loss was significantly decreased in group II compared to group I (P<0.05). CONCLUSION: The learning curve for lasparoscopic myomectomy needed 17 cases and laparoscopic myomectomy could be an excellent minimally invasive method as an alternative of open myomectomy after learning curve.

Effects of Metformin on Clomiphene-resistant Infertile Women with Polycystic Ovary Syndrome / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the efficacy of metformin for ovualtion induction and pregnancy in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). METHODS: From March 2001 to March 2002, 19 patients with PCOS who had at least two consecutive cycles of anovulation in response to CC treatment up to 250 mg/day at the Infertility Center of Moon Hwa Hospital were enrolled in this study. The participants were required to have tubal patency on hysterosalpingography and their husbands were required to have normal semen analysis. The mean age was 30.5 +/- 3.6 years, the body weight 62.7 +/- 10.1 kg, the duration of infertility 3.7 +/- 2.1 years and the BMI 24.7 +/- 3.6 kg/m2. For 19 patients, a total of 75 cycles were treated with 1) CC+gonadotropin (group 1; 24 cycles), 2) CC+metformin (group 2; 29 cycles), or 3) CC+gonadotropin+metformin (group 3; 22 cycles). As for gonadotropin, highly purified-follicle stimulating hormone (HP-FSH) or/and hMG were used from the 3rd day of CC treatment. In the first cycle, metformin (1,500 mg/day) was administered during 1-28 days of menstrual cycle. Metformin was discontinued when a pregnancy was confirmed. RESULTS: Among 19 patients, 17 patients were ovulated (89.5%) and 7 patients (36.8%) were pregnant. Of a total of 75 cycles, 51 cycles (68.0%) were ovulated successfully with one of three treatment methods. Metformin treatment had similar ovulation rate compared to gonadotropin treatment. There was no significant difference in ovulation rate among the three groups (70.8% vs 58.6% vs 63.7%). However, the pregnancy rate was significantly higher in group 3 (18.2%, 4 cycles) compared to group 1 (8.3%, 2 cycles) and group 2 (6.9%, 2 cycles). Of pregnant cycles, all 2 cycles from group 1 were spontaneously aborted. One cycle in group 2 and one cycle in group 3 were spontaneously aborted and all other pregnant cycles were normally delivered. CONCLUSION: With the combination therapy of metformin, the improvement in pregnancy rate among CC-resistant PCOS infertile women might be expected.

Successful correction of posthysterectomy vaginal vault prolapse by repair of fascial defects and by using uterosacral ligament suspension / 대한산부인과학회잡지

OBJECTIVE: To report the method and efficacy of the site specific-defects repair in the endopelvic fascia and uterosacral ligament suspension for the correction of posthysterectomy vaginal vault prolapse. METHODS: This study was performed in 3 patients with posthyterectomy vaginal vault prolapse who underwent the surgery for the reconstruction of endopelvic fascia and the correction of vault prolapsed vagina by using uterosacral ligament suspension at the department of Obstetrics and Gynecology in Moon-Hwa Hospital. Among them, 1 patient was treated by laparotomy, and 2 patients were treated by laparoscope. RESULTS: The age of patients ranged from 49 to 67 years. The mean operation time was 111 minutes (105-120 minutes). The status of postoperative vagina was normal in all 3 patients, who were discharged 9 days after operation without symptoms. No complication or recurrence were found in them despite long-term follow-up for 24 months, 12 months, 7 months, respectively after operation. One patient has been treated with HRT therapy. CONCLUSION: The reconstruction of the defect of endopelvic fascia and uterosacral ligament fixation may be very safe, effective, and functional in the correction of vaginal vault prolapse. This study reports the treatment of vaginal vault prolapse using uterosacral ligament within Korea for the first time.