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.

Effects of Y Chromosome Microdeletion on the Outcome of in vitro Fertilization / 대한불임학회지

OBJECTIVE: To determine whether the presence of Y-chromosome microdeletion affects the outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. METHODS: Fourteen couples with microdeletion in azoospermic factor (AZF)c region who attempted IVF/ICSI or cryopreserved and thawed embryo transfer cycles were enrolled. All of the men showed severe oligoasthenoteratoazoospermia (OATS) or azoospermia. As a control, 12 couples with OATS or azoospermia and having normal Y-chromosome were included. Both groups were divided into two subgroups by sperm source used in ICSI such as those who underwent testicular sperm extraction (TESE) and those used ejaculate sperm. We retrospectively analyzed our database in respect to the IVF outcomes. The outcome measures were mean number of good quality embryos, fertilization rates, implantation rates, beta-hCG positive rates, early pregnancy loss and live birth rates. RESULTS: Mean number of good quality embryos, implantation rates, beta-hCG positive rates, early pregnancy loss rates and live birth rates were not significantly different between Y-chromosome microdeletion and control groups. But, fertilization rates in the Y-chromosome microdeletion group (61.1%) was significantly lower than that of control group (79.8%, p=0.003). Also, the subgroup underwent TESE and having AZFc microdeletion showed significantly lower fertilization rates (52.9%) than the subgroup underwent TESE and having normal Y-chromosome (79.5%, p=0.008). Otherwise, in the subgroups used ejaculate sperm, fertilization rates were showed tendency toward lower in couples having Y-chromosome microdeletion than couples with normal Y-chromosome. (65.5% versus 79.9%, p=0.082). But, there was no significance statistically. CONCLUSIONS: In IVF/ICSI cycles using TESE sperm, presence of Y-chromosome microdeletion may adversely affect to fertilization ability of injected sperm. But, in cases of ejaculate sperm available for ICSI, IVF outcome was not affected by presence of Y-chromosome AZFc microdeletion. However, more larger scaled prospective study was needed to support our results.

Successful Pregnancy after Paclitaxel-Cisplatin Chemotherapy in Invasive Squamous Cell Carcinoma of Cervix During Pregnancy: A Case Report and Review of the Literature / 대한산부인과학회잡지

Paclitaxel-Cisplatin based chemotherapy in invasive squamous cell carcinoma of cervix during pregnancy has not been reported previously. A woman was diagnosed with stage II b invasive squamous cell carcinoma of cervix during pregnancy at 27 weeks gestational age. She was treated with two cycles of paclitaxel and cisplatin during pregnancy. At 36 weeks, she underwent a classical cesarean section and bilateral paraaortic lymphadenectomy. One additional cycles of chemotherapy and radiotherapy were given. She developed a recurrence within 6 months of surgery. The infant has normal growth and development at 4.3 months of age. This is the first reported case of paclitaxel-cisplatin use in cervical cancer during pregnancy.

A Clinical Report of Pregnancy Induced Hypertension according to the Severity / 대한주산의학회잡지

The aim of present study was to establish the baseline data for pregnancy induced hypertension (PIH). From November 2000 through October 2001, a total of 212 women diagnosed as PIH and delivered at Samsung Cheil Hospital were included in this study. We reviewed the obstetric and neonatal records, then analyzed the incidence, maternal complications, and neonatal outcomes according to the severity of PIH. The incidence of PIH was 2.6% (mild and severe form was 59% and 41%, respectively). In maternal age, parity, number of fetus (singletone or multiple pregnancy), and gestational diabetus, there was no significant different incidence between mild and severe form of PIH. But, the women with severe PIH delivered more frequently at 21~28 and 33~36 gestational weeks than in mild form (p<0.05). Among fetuses with intrauterine growth restriction (IUGR), a group with birth weight below the population 5 percentile was more frequent in severe than in mild form of PIH (p0.05). As to maternal, fetal and neonatal complications of PIH, maternal anemia, preterm labor, and IUGR were more frequently founded in severe form of PIH than in mild. We could not found significant different frequency in other complication (disseminated intravascular coagulation, abruptio placenta, pulmonary edema, low apgar score, meconium stained, respiratory distress syndrome, and intracranial hemorrhage) between mild and severe form of PIH.

Is Transient Bradycardia Following Cordocentesis Associated with Adverse Pregnancy Outcome? / 대한산부인과학회잡지

OBJECTIVE: To evaluate the association between transient bradycardia following cordocentesis and adverse pregnancy outcome. METHODS: 117 cordocentesis was performed at Samsung Cheil hospital and women's healthcare center, between January 1, 2000, and December 31, 2002. Clinically significant bradycardia was defined as a drop in the heart rate to less than 120 bpm. The adverse outcome included major anomaly, chromosomal abnormality, intrauterine growth restriction, preterm birth, and intrauterine fetal death. RESULTS: Bradycardia following cordocentesis was observed in 13 cases (11.1 per cent). The fetal heart rate before (149.2 +/- 0.7 bpm) and after (144.7 +/- 2.8 bpm) cordocenteis was significantly different. The adverse outcome rate was 50.0 per cent (6/12) in cases with bradycardia and 27.7 per cent (26/94) in those without bradycardia (RR=2.6, P=NS). CONCLUSION: Our result is that the association between transient bradycardia following cordocentesis and adverse pregnancy isn't statistically significant, even though adverse outcome is more frequent in pateints with bradycaredia. Therefore, patient with bradycardia following cordocentesis need periodic fetal surveillance.

Is Transient Bradycardia Following Cordocentesis Associated with Adverse Pregnancy Outcome? / 대한산부인과학회잡지

OBJECTIVE: To evaluate the association between transient bradycardia following cordocentesis and adverse pregnancy outcome. METHODS: 117 cordocentesis was performed at Samsung Cheil hospital and women's healthcare center, between January 1, 2000, and December 31, 2002. Clinically significant bradycardia was defined as a drop in the heart rate to less than 120 bpm. The adverse outcome included major anomaly, chromosomal abnormality, intrauterine growth restriction, preterm birth, and intrauterine fetal death. RESULTS: Bradycardia following cordocentesis was observed in 13 cases (11.1 per cent). The fetal heart rate before (149.2 +/- 0.7 bpm) and after (144.7 +/- 2.8 bpm) cordocenteis was significantly different. The adverse outcome rate was 50.0 per cent (6/12) in cases with bradycardia and 27.7 per cent (26/94) in those without bradycardia (RR=2.6, P=NS). CONCLUSION: Our result is that the association between transient bradycardia following cordocentesis and adverse pregnancy isn't statistically significant, even though adverse outcome is more frequent in pateints with bradycaredia. Therefore, patient with bradycardia following cordocentesis need periodic fetal surveillance.