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.

Clinical correlation of basal FSH level and IVF-ET outcome / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the value of basal follicular stimulating hormone level on clinical outcome in women undergoing IVF-ET. METHOD: A descriptive and retrospective study of 730 cycles of IVF-ET chosen from 2002 to 2004 in CHA fertility center. RESULTS: Basal FSH screening appeared to be a fairly informative predictor of achiving pregnancy especially in GnRH agonist long protocol in women undergoing IVF-ET. In addition, basal FSH level shows significant difference compared ongoing pregnancy with early abortion group in GnRH antagonist group. CONCLUSION: Therefore, we were able to predict the ovarian response and IVF-ET outcome using FSH level. Furthermore, this information allow more precise counseling for patients.

Clinical evaluation of ultrasound-guided embryo transfer / 대한산부인과학회지

OBJECTIVE: Clinical evaluation of the efficacy of ultrasound-guided embryo transfer (ET) comparing with embryo transfer without ultrasound guidance (Non-US). METHODS: From January 2003 to April 2003, we examined the efficacy of ultrasound-guided embryo transfer (ET) on clinical outcome from in-vitro fertilization (IVF-ET) cycle. One hundred thirty patients were prospectively randomized into two groups: 69 patients had ultrasound-guided ET (US) and 61 patients had clinical touch embryo transfer without ultrasound guidance (Non-US). RESULTS: There were no statistically significant differences between the two groups with respect to age, cause of infertility, and the characteristics of the IVF cycle. The pregnany rate (42.0%: 40.9%, p=0.9043) and implantation rate (26.6%: 23.1%; p=0.5057) were similar in both groups. CONCLUSION: There was no significant improvement in pregnancy and implantation rates, following the use of ultrasound guidance during ET, but ultrasound assistance would suggest that decrease in cervical and uterine trauma, decrease in the total duration of ET time, and increase in the easy transfer rate can play a positive role in embryo transfer.