Current status of assisted reproductive technology in Korea, 2009.

Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical pregnancy rate per cycle with embryo transfer. When comparing with international registry data, clinical pregnancy rate per transfer from fresh IVF cycles including ICSI (34.1%,) was comparable to clinical pregnancy rate per transfer in European Society for Human Reproduction and Embryology report was 32.5% though lower than 45.0% for USA data. There was no remarkable difference in status of assisted reproductive technology in Korea between the current report and the data reported in 2008. The age of women trying to get pregnant was reconfirmed to be the most important factor that may have impact on success of ART treatment.

Juvenile cystic adenomyoma in a 19-year-old woman: a case report with a proposal for new diagnostic criteria.

We report a case of a cystic adenomyoma in a 19-year-old nullipara who presented with severe dysmenorrhea and pelvic pain. Preoperative magnetic resonance imaging showed a 3-cm well-circumscribed mass with a 2.1-cm cystic cavity in the myometrium of the left fundus. The tumor, including the cyst, was excised via laparoscopy with a part of the normal myometrium using a modified myomectomy method. On histologic examination, the cystic cavity was lined by endometrial tissue composed of endometrial epithelium and stroma. After 12 months of postoperative follow-up, the patient had significant improvement of dysmenorrhea.

Clinical significance of serum albumin level in pregnancy-related hypertension.

AIM: To evaluate the usefulness of serum albumin level as a marker of severity in pregnancy-related hypertension. METHODS: Of 454 patients with pregnancy-related hypertension who were admitted to Kyungpook National University Hospital between May 1999 and April 2008, the medical records and laboratory tests of 354 patients who met the inclusion criteria for the current study were reviewed. A comparison of the characteristics of each hypertension group and the correlation between serum albumin levels and the time to delivery, 24-h urine protein, and/or pregnancy outcomes were statistically analyzed using SPSS 12.0 (SPSS Korea, Korea). RESULTS: Serum albumin level had a negative correlation with 24-h urine protein (Pearson's correlation coefficient = -0.481) and a positive correlation with time to delivery (= 0.389). Serum albumin ≤3.0 g/dL was highly associated with severe proteinuria (>2 g/day). There were significant differences in maternal or perinatal morbidity as a function of serum albumin level. If serum albumin level fell below 2.5 g/dL, the risks of ascites, hemolysis elevated liver enzyme low platelet (HELLP) syndrome and perinatal mortality significantly increased (odds ratio [OR] and 95% confidence interval [CI]: 3.5 [1.5-8.1], 12 [3.1-45], and 6.1 [1.7-22], respectively). CONCLUSION: Serum albumin level in pregnancy-related hypertension is a significant determinant of disease severity and may be considered as a useful marker for predicting time to delivery, severe proteinuria, and pregnancy outcomes.

Umbilical cord blood amino-terminal pro-brain natriuretic peptide levels according to the mode of delivery.

PURPOSE: To evaluate cord blood amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels according to the mode of delivery. METHOD: Between 1 March and 31 May 2007, 106 blood samples were drawn from the umbilical vein at the time of delivery. Eighty-four NT-proBNP levels [63 term (34 cesarean sections and 29 vaginal deliveries) and 21 preterm births] were analyzed with respect to gestational age, birth weight, Apgar score, newborn gender, and cord blood pH. RESULTS: There was no statistical significance on comparison of the mean NT-proBNP values between the cesarean and vaginal delivery groups (801.9+/-537.7 vs. 724.3+/-542.4 pg/ml, respectively; P=0.572). The correlation of NT-proBNP with gestational age, birth weight, and cord blood pH was -0.616, -0.585, and -0.202, respectively. The mean values for NT-proBNP levels were compared according to the newborn gender (male vs. female; P=0.926), and Apgar score at 1 min [>6 (N=71) vs.

Relationship between the length of the uterine cavity and clinical pregnancy rates after in vitro fertilization or intracytoplasmic sperm injection.

In this prospective clinical study involving 354 IVF-intracytoplasmic sperm injection cycles, we determined the influence of the length of the uterine cavity on clinical pregnancy rates. Our data showed that clinical pregnancy and implantation rates are associated positively with an increased length of the uterine cavity.

Effect of different ingredients in traditional Korean medicine for human uterine leiomyoma on normal myometrial and leiomyomal smooth muscle cell proliferation.

Crude water extracts of 13 traditional Korean medicinal ingredients used for leiomyomal treatment were prepared and used to treat human uterine normal myometrial and leiomyomal cell cultures. All the ingredients inhibited proliferation and altered the morphology of both myometrial and leiomyomal cells. Among the 13 ingredients, n-hexane-, chloroform-, and ethylacetate-soluble fractions were extracted from seven ingredients that potently inhibited cell proliferation in their water extract form. Among these, the ethylacetate-fraction of Phlomis umbrosa and Spatholobus suberectus, and the chloroform-fraction of Curcuma zedoaria and S. suberectus inhibited leiomyomal cell proliferation significantly compared to myometrial cell proliferation. Similarly, immunohistochemical analysis showed the inhibition of transforming growth factor-beta receptor 2 in leiomyomal tissue after treatment with the fractions of the ingredients. Moreover, the chloroform-fraction of C. zedoaria was subfractionated by open column chromatography. Two of the eight subfractions (fractions 6 and 7) potently inhibited cell proliferation in leiomyoma compared to myometrium. Further study will be performed with the goal of isolating specific compounds from two effective subfractions of C. zedoaria, ethylacetate-fraction of P. umbrosa, and the ethylacetate and chloroform-fractions of S. suberectus. The present study may be helpful in developing an alternative remedy to leiomyoma with minimal side-effects compared to the current treatments.

Effects of isolating methods (mechanical or enzymatical) on structure of pre-antral follicles in mouse.

PURPOSE: This study was conducted to evaluate the stable and effective isolating method of pre-antral follicles from ovary by means of mechanical or enzymatical method in mice. METHODS: Mouse (ICR, 3-4 weeks old) ovarian pre-antral follicles of 70-130 microm (A: < or = 90; B: 91-110; C: 111-130 microm) in diameter were isolated by mechanical method (group I) using syringe needles or by enzymatical method (group II) using 600 IU collagenase and DNase and cultured individually in 20 microL droplet of media under mineral oil on culture dish for 8 days. RESULTS: On 8th day after culture, disruption rate (84.4 +/- 18.8% vs. 9.4 +/- 18.8%) was significantly higher (p < 0.05) in group II than in group I. Survival rate (88.0 +/- 28.9% vs. 0%) was significantly higher (p < 0.0000) in group I than in group II. There were no differences in the survival rate among different initial sized pre-antral follicles in group I (A: 86.7 +/- 12.5%, B: 100%, C: 69.2 +/- 30.0%, NS) or group II (A: 0%, B: 0%, C: 0%, NS), respectively. CONCLUSIONS: In conclusion, compared to mechanical dissection, enzymatical isolation of pre-antral follicles resulted in higher follicular disruption rate. Survival rate was not affected by different initial sizes of pre-antral follicles in mice.