OBJECTIVE: To evaluate whether the basal serum luteinizing hormone (LH) levels in the presence of normal serum follicle stimulating hormone (FSH) are useful as a prognostic indicator of ovarian response to controlled ovarian hyperstimulation (COH). METHODS: From January 1997 to January 1999, 91 infertile women with tubal factor who had undergone in vitro fertilization and embryo transfer (IVF-ET) were enrolled in the present study. COH was performed using long protocol of gonadotropin-releasing hormone (GnRH) agonist. All patients included in this study had blood samples drawn on cycle day 2 or 3 prior to COH for measurement of basal FSH and LH. Women who had other infertility factors or high basal FSH levels (> or = 8.5 mIU/ml) were excluded from this study. The results of COH and IVF-ET were compared between two groups according to the level of basal LH (low LH group [< 3mIU/ml] vs. control group [> or = 3mIU/ml]). RESULTS: Patient's characteristics were comparable in both groups except basal LH level. The number of ampules and duration of exogenous gonadotropins required were significantly higher in the low LH group than those in the control group (p<0.001; p<0.005, respectively). The number of follicles > or = 14mm diameter on the day of human chorionic gonadotropin (hCG) injection was significantly less in the low LH group than that in the control group (p<0.001). The serum estradiol level on the day of hCG injection was also significantly lower in the low LH group, with 1115.5 +/- 380.9 pg/ml compared with 1340.6 +/- 403.0 pg/ml in the control group (p<0.005). There were significantly lower numbers in oocytes retrieved, oocytes fertilized and embryos frozen in the low LH group than those in the control group (< 0.001; < 0.001; <0.005, respectively). However, there was no difference in the fertilization rate between the two groups. The clinical pregnancy rate per cycle seemed to be lower in the low LH group, but the difference did not achieve significance (26.2% vs 39.7%). There were no differences in the miscarriage rate and multiple pregnancy rate between the two groups. CONCLUSION: This study demonstrates that the low basal LH levels ( < 3 mIU/ml) could be predictive of low ovarian response to COH and poor IVF results.
Abortion, Spontaneous ; Chorionic Gonadotropin ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Lutein* ; Luteinizing Hormone* ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple

OBJECTIVES: To investigate the effect of granulocyte colony stimulating factor (G-CSF) and granulocyte macrophage colony stimulating factor (GM-CSF) on expression of matrix metalloproteinase-2, 9 (MMP-2, 9) mRNA in mouse embryos. Materials and METHOD: From October 1997 to December 1998, morula stage mouse embryos were cultured for 48 hours with G-CSF and GM-CSF at concentrations of 0.1 pg/ml, 1 pg/ml, 10 pg/ml, 100 pg/ml, 1 ng/ml and 10 ng/ml, respectively. Embryos not treated with G-CSF or GM-CSF were served as control. Reverse transcription-polymerase chain reaction (RT-PCR) has been used to examine the expression of MMP-2, 9 mRNA in developed blastocysts. Following reverse transcription, strategically designed nested primers, optimized for specificity, were used for amplification from the cDNA equivalent of a single embryo. The products were then verified by restriction enzyme digestion and sequence analysis. Results were analyzed with Kolmogorov-Smirnov test and analysis of variance (ANOVA). The statistical significance was defined as p< 0.05. RESULTS: The relative quantities (relative volume x intensity) of MMP-2 mRNA expressed in embryos of all G-CSF treatment groups were significantly increased than in the control, especially in 10, 100 pg/ml and 1 ng/ml treatment groups. The relative quantities of MMP-2 mRNA in all GM-CSF treatment groups were also significantly increased than in the control, especially in 100 pg/ml treatment group. The relative quantities of MMP-9 mRNA of all GM-CSF treatment groups except 10 ng/ml group were significantly increased than in the control, especially 10, 100 pg/ml and 1 ng/ml treatment group. However, the relative quantity of MMP-9 mRNA was significantly increased in only 10 ng/ml G-CSF treatment group than in the control and other treatment groups. CONCLUSION: This study suggests that G-CSF and GM-CSF may increase the m-RNA expression of MMP-2 or 9 in mouse blastocysts with the concentration-specific manner.
Animals ; Blastocyst ; Colony-Stimulating Factors* ; Digestion ; DNA, Complementary ; Embryonic Structures* ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes* ; Matrix Metalloproteinase 2* ; Mice* ; Morula ; Reverse Transcription ; RNA, Messenger ; Sensitivity and Specificity ; Sequence Analysis

OBJECTIVES: To examine the in vitro interactions of blastocyst attachment using type I collagen. MATERIALS AND METHODS: ICR mice were used and follicular growth was stimulated by pregnant mare serum gonadotropin and human chorionic gonadotropin. On day 4 of pregnancy, the uteri were removed and blastocysts were flushed. Mixtures of 1mL sterile water, 0.5mL DMEM, 2mL type collagen solution and 0.5mL 0.1M NaOH were prepared and transferred to an incubator where the collagen solution polymerized. Blastocysts were transferred to dishes previously coated with type I collagen. CMRL 1066 was used as the basic culture medium. It was supplemented with 1mM glutamine and 1mM sodium pyruvate plus 50 IU/ml penicillin and 50 mg/ml streptomycin. During the first 4 days the culture medium was supplemented with 20% fetal calf serum and thereafter with 20% heat inactivated human cord serum. All blastocysts were initially cultured for 2 days without media change. After 2 days, fresh medium was renewed daily. The stages of embryo growth were examined and recorded everyday under a dissecting microscope and classified according to the standard in vivo criteria set forth by Witschi. RESULTS: By 48h, nearly all blastocysts had attached to the surface of collagen pad. Following adhesion to the collagen pad, the blastocysts maintained their 3-dimensional integrity in contrast to control. The embryos in collagen pad were not flattening and kept polarity and spherical shape during culture. The polar trophoblast invaded the type I collagen downward unlike the horizontal growth in control. In the developmental stage of mouse blastocyst, there were significant differences between control and type I collagen group during day 4 and 5 culture. CONCLUSION: Blastocyst development was better in type I collagen group than control. Therefore, in vitro culture study using type I collagen could provide improved model for the establishment of blastocyst implantation study.
Animals ; Blastocyst ; Chorionic Gonadotropin ; Collagen ; Collagen Type I* ; Embryo Implantation ; Embryonic Structures* ; Female ; Glutamine ; Gonadotropins ; Hot Temperature ; Humans ; Incubators ; Mice* ; Mice, Inbred ICR ; Penicillins ; Polymers ; Pregnancy ; Pyruvic Acid ; Sodium ; Streptomycin ; Trophoblasts ; Uterus ; Water

BACKGROUND: The technique using target-controlled infusion (TCI) with propofol produces safe intraoperative sedation during regional anesthesia with rapid recovery and high patient satisfaction. The objective of this study was to define the blood propofol concentration necessary for conscious sedation in regional anesthesia patients according to age. METHODS: Sixty patients scheduled to undergo regional anesthesia were allocated into one of three groups according to age, such as group 1 (n = 20): 16 24 yr, group 2 (n = 20): 30 39 yr, group 3 (n = 20): 40 55 yr. Thirty minutes after performing regional anesthesia, TCI of propofol started at a target plasma level of 1 microgram/ml adjusted in steps of 0.2 microgram/ml to maintain a sedation level 3 on a 5-point sedation scale. RESULTS: The mean target concentration was 0.9 microgram/ml (group 1), 0.8 microgram/ml (group 2), 0.7 microgram/ml (group 3). The mean propofol consumption was 38.5 microgram/kg/min (group 1), 34.3 microgram/kg/min (group 2), and 30.8 microgram/kg/min (group 3). The recovery time was significantly delayed in group 3 (2.8 min) compared to group 1 (1.5 min) and group 2 (1.8 min). CONCLUSIONS: TCI of propofol within at 0.7 0.9 microgram/ml blood concentration range produces safe intraoperative sedation during regional anesthesia with rapid induction, rapid recovery and high patient satisfaction without severe complications in 16 55 yr old patients.
Anesthesia, Conduction* ; Conscious Sedation* ; Humans ; Patient Satisfaction ; Plasma ; Propofol*

OBJECTIVE: To compare the pregnancy outcomes of transvaginal multifetal pregnancy reduction (MFPR) according to the gestational period when the procedure was performed METHODS: From January l995 to February 1998, total 27 patients with multiple pregnancy were included in this study. The patients were grouped to early MFPR group (<8 weeks, n=16) and delayed MFPR group (>8 weeks, n=ll) according to the gestational age that MFPRs were performed. All MFPRs were performed by transvaginal sonography-guided fetal aspiration or mechanical trauma. The complete pregnancy loss rate before 24 weeks of gestation, spontaneous loss of embryo, procedure-related complication, gestational age at delivery, and pregnancy complication were compared between the two groups. Statistical analysis of data was performed using Students t-test and Fishers exact test as appropriate. Statistical significance was defined as p<0.05. RESULTS: There was no significant difference in the complete pregnancy loss rate between the early MFPR group (6.3%) and the delayed MFPR group (27.3%). The incidence of partial spontaneous loss of embryo in the two groups were not differed significantly (6.3% vs. 18.2%). The procedure-related complication of the delayed MFPR group (36.4%) seemed to be higher than that of the early MFPR group (6.3%), however there was no statistical difference (p=0, 07). Especially, all 3 patients in whom the MFPR was performed after 10 weeks suffered from the procedure-related complication. The mean gestational age at delivery of the two groups were not differed significantly (36.3+2.8 weeks vs. 37.0+1.3 weeks). There was also no significant difference in the mean birth weights of the two groups (2378.8+563.7 gm vs. 2427.1+436.2 gm). CONCLUSION: Although there was no statistically significant difference, the early transvaginal MFPR might be a safe and useful method without significant adverse complications compared to the delayed MFPR.
Birth Weight ; Embryonic Structures ; Female ; Gestational Age ; Humans ; Incidence ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Pregnancy Reduction, Multifetal* ; Pregnancy, Multiple

It is well known that the clinical test for responsibility of accurate fertilization capacity in male partners is very important to diagnose and treat the infertility. However, it has been reported that the traditional semen analysis cannot accurately predict fertilization and pregnancy potential. The present study was performed to evaluate the acrosomal reaction to ionophore challenge (ARIC) test as a prognostic indicator for fertilization of sperm and oocyte in an in vitro fertilization and embryo transfer (IVF-ET) program. From March 1996 to Februry 1997, 30 couples undergoing IVF program were allocated to this study group. All female partners in the study group were 35 years old or less and their serum level of basal follicle stimulating hormone (FSH) and estradiol (E2) were normal. All the male partners have normal parameters of semen analysis. The ARIC tests were performed on the day of ovum pick up and in vitro insemination in all the male partners. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone (GnRH) agonist was used in all couples for IVF-ET. The acrosomal reaction with 10microliter of 10% DMSO was induced spontaneously in 10.1+/-9.8%, and acrosomal reaction with calcium ionophore A 23187 was induced in 27.4+/-18.1%, and the ARIC value was 17.4+/-16.2%. There were no significant correlation between the ARIC value and the fertilization rate (r2=0.044, p=0.268). There were also no significant correlation between the ARIC value and the percentage of the grade I, II embryos (r2=0.046, p=0.261). On the basis of above results, it was suggested that ARIC test might not be a useful prognostic indicator for fertilization in IVF-ET in male partners with normal parameters of conventional semen analysis. We guessed that IVF-ET could be performed to the patients primarily without universal appilcation of ARIC test to all male partenrs, and if fertilization failure occurs, the microassisted fertilization (MAF) such as intracytoplsmic sperm injection (ICSI) might be used as an alternative mode of treatment with acceptable success rate.
Acrosome Reaction* ; Acrosome* ; Adult ; Calcimycin ; Calcium ; Dimethyl Sulfoxide ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Family Characteristics ; Female ; Fertilization ; Fertilization in Vitro* ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Humans ; Infertility ; Insemination ; Male ; Oocytes ; Ovum ; Pregnancy ; Semen Analysis ; Spermatozoa

OBJECTIVE: To investigate whether frozen-thawed testicular sperm obtained from men with azoospermia could serve as an efficacious sperm source for intracytoplasmic sperm injection (ICSI) by comparing to the results of ICSI using fresh testicular sperm. METHODS: From January 1997 to March 1999, 41 patients with azoospermia who underwent ICSIs using fresh and/or frozen-thawed testicular sperm were included in the study. In 23 patients of 41, fresh testicular sperm was left after ICSI and therefore remaining testicular sperm was frozen and frozen testicular sperm was used in next ICSI cycles. The results of ICSI were compared in frozen-thawed testicular sperm (frozen-thawed group, 30 cycles) versus fresh testicular sperm (fresh group, 39 cycles). RESULTS: The number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate were comparable in the frozen-thawed and fresh groups. There were also no differences in the miscarriage rate and multiple pregnancy rate between the two groups. In patient group with obstructive azoospermia, there were no significant differences in the number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate between the two groups. In patient group with non-obstructive azoospermia, all parameters of results of ICSI were comparable in both groups. In each non-obstructive azoospermic patient group with mixed motile/immotile sperm and patient group with only immotile sperm, there were also no significant differences in the number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate between the frozen-thawed and fresh groups. CONCLUSION: Our data demonstrate that using frozen-thawed and fresh testicular sperm gives rise to comparable results after ICSI irrespective of the status of sperm in patients with obstructive or non-obstructive azoospermia.
Abortion, Spontaneous ; Azoospermia* ; Embryonic Structures ; Female ; Fertilization ; Humans ; Male ; Oocytes ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Sperm Injections, Intracytoplasmic* ; Spermatozoa*

BACKGROUND: Middle cerebral artery (MCA) steno-occlusive disease is known to be more common in Eastern than in Western, however, clinical characteristics have not been well documented. We aimed to find clinical characteristics of isolated MCA disease comparing with other MCA steno-occlusive disease. METHODS: Patients with lesion in M1 portion of MCA divided into three groups by angiographic finding ; isolated MCA stenosis (IMCAS, n=39), isolated MCA occlusion (IMCAO, n=29), and multiple (ICA, BA or VA) steno-occlusion involving MCA (Combined, n=48). Patients with evidence of cardioembolic MCA occlusion and Moyamoya disease were excluded. We analyzed clinical features, neuroimaging findings, and prognosis retrospectively. RESULTS: MRI showed large deep (36%), small deep (26%), cortical (21%), and mixed (cortical & deep, 15%) infarct in IMCAS group ; mixed (38%), large deep (21%), small deep (17%), and cortical (17%) infarct in IMCAO group ; large deep (31%), cortical (23%), small deep (17%), and no lesion (17%) in Combined group. Site of MCA steno-occlusion on angiogram was middle (44%), distal (39%), and proximal (18%) in IMCAS group ; proximal (48%), middle (35%), and distal (17%) in IMCAO group ; middle (42%), proximal (31%), and distal (27%) in Combined group. Patient's neurologic status, assessed by NIHSS, during first 7 days was 'not changed' or 'worsening' (>93%) in all 3 groups. Neurologic outcome at 3 months later was improving (65%) in IMCAS group by modified Rankin scale. CONCLUSIONS: Isolated MCA stenotic disease was not significantly different from iso-lated MCA occlusion group or Combined group in clinical features, neuroimaging findings, and prognosis.
Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery* ; Moyamoya Disease ; Neuroimaging ; Prognosis ; Retrospective Studies

No abstract available.
Humans ; Pregnancy, Twin*

No abstract available.
Abscess* ; Drainage*