OBJECTIVE: Embryo transfer is a critical step in assisted reproduction. However, the different aspects of the procedure were not fully estimated. The aim of this study is to evaluate the impact of each aspect in the procedure to success of pregnancy. METHODS: Medical records of 525 fresh IVF/ICSI cycles were reviewed retrospectively. All embryo transfers were performed under ultrasonography guidance and after removal of cervical mucus. Assessed primary variables are difficulty of procedure (easy, moderate, and difficult), presence of blood in the catheter, types of catheter (soft or hard) and physician factor, and confounding variables are age of patient, total number of oocytes, number of transferred embryos, the highest grade of embryo, endometrial thickness. Measured outcomes were clinical pregnancy (visible fetal heart beat by ultrasonography) and live-birth rate. Univariate analysis and multivariate analysis by logistic regression test were used. RESULTS: Among the variables of embryo transfer procedure, the difficulty of procedure was the only significant factor influencing both clinical pregnancy (OR: 0.402, 95% CI: 0.205-0.789, easy vs. moderately difficult) and live birth rate (OR: 0.380, 95% CI: 0.178-0.841, easy vs. moderately difficult). The difference between moderately difficult and very difficult procedure was not significant. Presence of blood was significant for live-birth rate (OR: 0.512, 95% CI: 0.267-0.980). Types of catheter and physician factor were not significant factors. CONCLUSION: The difficulty of the transfer procedure and presence of blood in catheter are significant factors influencing ART outcome.
Catheters ; Cervix Mucus ; Confounding Factors (Epidemiology) ; Embryo Transfer* ; Embryonic Structures* ; Fertilization in Vitro ; Fetal Heart ; Humans ; Live Birth ; Logistic Models ; Medical Records ; Multivariate Analysis* ; Oocytes ; Pregnancy Rate* ; Pregnancy* ; Reproduction ; Retrospective Studies ; Ultrasonography

This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the left lower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.
Poliovirus Vaccine, Oral/*adverse effects ; Poliomyelitis/*chemically induced/diagnosis/rehabilitation ; Paraplegia/*chemically induced/diagnosis/rehabilitation ; Male ; Infant ; Humans

OBJECTIVE: The purpose of this study was to determine whether intracytoplasmic sperm injection(ICSI) could overcome the defects of oocytes in IVF-ET patients with previous fertilization failure by conventional fertilization technique. Design: Retrospective study Materials and METHODS: A total of 119 ICSI cycles in 57 IVF-ET patients performed from May, 1995 to December, 1997 was enrolled. Subjects were divided into two groups: FR group included 66 ICSI cycles in 35 patients with normal sperm who underwent ICSI due to past history of failed or poor fertilization in the previous IVF-ET cycles, and OAT group included 53 ICSI cycles in 22 patients with severe oligoasthenoterato- zoospermia(OAT) which was defined as sperm concentration < 20 million/ml, mo#dlity < 30% and normal morphology < 4% by strict morphologic criteria. The outcomes of ICSI were analyzed and compared in both groups. RESULTS: The age of female patients, basal serum FSH level, and the numbers of oocytes retrieved and metaphase II oocytes were all comparable in both groups. The fertilization rate after ICSI was similar in both groups(68.7+/-25.3% vs. 67.7+/-24.5%), as were the cleavage rate of normally fertilized oocytes(93.1+/-21.4% vs. 89.3+/-21.6%), the number of embryos transferred(4,00+/-1.98 vs. 4.64+/-2.10), and cumulative embryo score(CES) indicating the quality of embryos(47.3+/-33.2 vs. 54.1+/-33.2). The implantation rate(4.3+/-10.5% vs. 3.8+/-11.0%) and the clinical pregnancy rate per cycle(15.2% vs. 13.2%) were also comparable in both groups. CONCLUSIONS: Although it has been shown that there is a higher risk of chromosomal abnormalities in oocytes from IVF-ET patients with pevious failed or poor fertilization, higher implantation and clinical pregnancy rates wer#e not observed in patients with OAT following ICSL Therefore, the functional defect of sperm such as loss of capacitation, defect of aaasome reaction, and abnormality of nucleus decondensation should be also considered in patients with previous failed or poor fertilization.
Avena ; Chromosome Aberrations ; Embryonic Structures ; Female ; Fertilization* ; Humans ; Male* ; Metaphase ; Oocytes ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic ; Spermatozoa*

OBJECTIVE: The purpose of this study is to investigate the prevalence and course of autonomic nervous system related adverse effects (ARAEs) reported in patients treated with clozapine. METHOD: Ninety-one patients treated with clozapine were recruited from the Seoul National University Hospital Treatment-Resistant Schizophrenia Clinic. Medical records were reviewed for the prevalence and course of 14 ARAEs related to clozapine treatment. ARAEs with the prevalence greater than 10 % were selected and analyzed for their relationship with the demographic variables of the subjects and for the distribution of the duration of treatment and daily dosage of clozapine. RESULTS: Eighty-one(97.8%) patients experienced at least one ARAE during treatment with clozapine. The most frequent ARAE was hypersalivation, followed by constipation, tachycardia, orthostatic hypotension, nausea, diaphoresis, frequency, enuresis, vomiting, blurred vision, dry mouth, diarrhea, incontinence and urinary retention. None of the 7 selected frequent ARAEs had significant relationship with the age or sex of the subjects. Most of them developed within 8 weeks of clozapine treatment and at the dose of clozapine under 200mg/day. Among the total 248 events of ARAEs, 35 events required additional medications to alleviate the symptoms, 8 required other medical interventions, and 3 required reduction of clozapine dose. There was no case which necessitated withdrawal of clozapine therapy. CONCLUSION: The findings from this study suggest that almost all patients treated with clozapine experienced one or more ARAEs. Most of them occurred during the initial phase of treatment and managed without further medical treatment.
Autonomic Nervous System* ; Clozapine* ; Constipation ; Diarrhea ; Enuresis ; Humans ; Hypotension, Orthostatic ; Medical Records ; Mouth ; Nausea ; Prevalence ; Schizophrenia ; Seoul ; Sialorrhea ; Tachycardia ; Urinary Retention ; Vomiting

OBJECTIVE: To investigate the extent of meiotic spindle damages in cryopreserved-thawed mouse mature oocytes. METHODS: After slow freezing and ultra-rapid thawing using 1.5M dimethylsulfoxide(DMSO), mouse mature oocytes were stained by anti-alpha tubulin monoclonal antibody. The meiotic spindle and chromosomes configuration were assessed using confocal microscope. The influence of time to post-hCG oocytes retrieval (i.e. 12 hrs vs 17 hrs) was also evaluated. RESULTS: The normal meiotic spindles were observed in 89.8% of post-hCG 12 hrs group, and 80.1% of post-hCG 17 hrs group, and these were significantly lower than that of each unfreezed control. Post-hCG 12 hrs group showed a significantly higher incidence of normal meiotic spindles, compared with post-hCG 17 hrs group. CONCLUSION: The extent of meiotic spindle damages was significantly increased after cryopreservation in mouse mature oocytes. We proposed that 12 hrs interval of post-hCG oocytes retrieval may be more beneficial.
Animals ; Cryopreservation ; Dimethyl Sulfoxide ; Freezing ; Incidence ; Mice* ; Oocytes* ; Spindle Apparatus* ; Tubulin

No abstract available.
Chromosome Aberrations* ; Embryonic Structures* ; Humans ; Male* ; Preimplantation Diagnosis* ; Sperm Injections, Intracytoplasmic*

OBJECTIVE: To investigate the positive or negative effect of delaying embryo transfer(ET) one day in IVF-ET. METHODS: From May to July, 1997, a total of 64 patients was emolled in this prospective randomized case-controlled study. When the timing of oocyte retrieval was decided, random allocation of patients was made to one of the two groups: day 2 transfer or day 3 transfer. In day 3 transfer group, embryos were cultured in M3 media(Medi-Cult) for further 24 hours. RESULTS: There were no significant differences in age of patients, infertility factor, basal serum FSH level, and serum E2 level on hCG day between two poups, but number of previous IVF-ET cycles was significantly higher in day 3 transfer group(p 0.042). Number of oocytes retrieved, fertilization rate, cleavage rate, and number of embryos transferred had no significant difference, but cumulative embryo score(CES) was significantly higher in day 3 transfer group(p 0.0001). Clinical pregnancy and implantation rates were bigher in day 3 transfer group, but without significance(34.4% vs. 21.9%; 8.7% vs, 5.4%). There were also no significant differences in spontaneous miscarriage and multiple pregnancy rates. Especially in patients over 35 years of age, clinical pregnancy and implantation rates were more higher in day 3 transfer group, but without significance(41.7% vs, 8.3%; 8.5% vs. 1.6%). CONCLUSION: Considering the higher number of previous cycles in day 3 transfer group, it is at least likely that delaying ET one day may be clinically beneficial in IVF-ET, especially in patients with old age or repeated failure of previous cycles.
Abortion, Spontaneous ; Case-Control Studies ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization ; Fertilization in Vitro* ; Humans ; Infertility ; Oocyte Retrieval ; Oocytes ; Pregnancy ; Pregnancy Outcome ; Pregnancy, Multiple ; Prospective Studies ; Random Allocation

OBJECTIVE: To investigate the intluence of previous tuberculous epididymitis in infertile males with obstructive azoospermia on the outcome of sperm retrieval and intracytoplasmic sperm injection(ICSI) in IVF-ET propam. METHODS: Retrospective analysis was paformed in 26 patients with obstructive azoospermia undergoing sperm retrieval and ICSI at Seoul National University Hospital from January, 1996 to August, 1997; 12 cycles in 5 patients with tuberculous obstructive azoospermia(Group A), and 40 cycles in 21 patients with non-tuberculous obstructive azoospermia(Group B). RESULTS: There was no significant difference in the clinical pregnancy rate(PR) per fresh transfer between Groups A and B(20.0%[2/10] vs. 26.8%(11/41)). The rates of embryo implantation and clinical miscarriage were also comparable in both groups(6.3% vs. 11.1%, 50.0% vs. 9.1%). This tendencies were also similar after including five cryopreserved-thawed transfer cycles. CONCLUSION: Embryo quality and pregnancy outcome in sperm retrieval and ICSI were comparable in both the tuberculous and non-tuberculous obstructive azoospermia patients. Our results suggest that previous history of tuberculous epididymitis in patients with obstructive azoospermia does not affect the outcome of sperm retrieval and ICSI.
Abortion, Spontaneous ; Azoospermia* ; Embryo Implantation ; Embryonic Structures ; Epididymitis* ; Female ; Humans ; Male ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Seoul ; Sperm Injections, Intracytoplasmic* ; Sperm Retrieval* ; Spermatozoa*

OBJECTIVE: To evaluate the outcome of pregnancy in kidney transplanted women, and correlate this with the time of transplantation to conception. MATERIAL AND METHODS: We analyzed the outcome of 31 pregnancies from 21 allograft recipients at Kangnam St. Mary's Hospital, Catholic Medical Center from January 1990 through December 2000. For each reported pregnancy we reviewed obstetrical, medical and pediatric records. For children follow-up and for those whose obstetric procedures were taken in other hospitals, we did a questionarie and telephone interviews. RESULTS: Of the 31 pregnancies followed by us, there were 23 live-born offspring delivered by 21 mothers and 8 stillborn/abortuses, including five artificial abortuses. The mean gestational age at delivery was 36.18+/-0.6 weeks and the mean birth weight of the offspring was 2,525+/-137gm. Only 43.4% was delivered after 37weeks of gestation. Preterm delivery rate (delivered before 37weeks of gestation) was 56.5%. Common obstetric complications were intrauterine growth restriction (39.1%) preterm labor (35%), premature rupture of membrane (30%), preeclampsia (30%), and maternal complications were deterioration of renal function (5%) and rejection of allograft (18%) after delivery. Mean interval from transplantation to pregnancy was 4.7 years. Twelve pregnancies occurred within the first 2 years of transplantation, while 19 pregnancies occurred after that period. No difference was noted in neonatal body weight between 2 groups (p=0.824). There was no difference in mean interval from transplantation to pregnancy in the delivery group (5.21+/-0.9 years) vs. the abortion group (4.57+/-1.1 years) (p=0.207). All women continued with her medication during pregnancy, based on cyclosporine and/or azathioprine and steroids. No congenital anomaly was noted in the newborn. When follow up lately, one boy with neurofibromatosis and a girl with recurrent hematuria were noted. CONCLUSION: Although pregnancy in renal allograft patient is hazardous, good outcome can be expected if function of the allograft is good before conception.
Allografts ; Azathioprine ; Birth Weight ; Body Weight ; Child ; Cyclosporine ; Female ; Fertilization ; Follow-Up Studies ; Gestational Age ; Hematuria ; Humans ; Infant, Newborn ; Interviews as Topic ; Kidney ; Kidney Transplantation* ; Male ; Membranes ; Mothers ; Neurofibromatoses ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Rupture ; Steroids

PURPOSE: To evaluate the utility of signal intensity differences between in- and opposed-phase MRI and the lipid peak ratio in in-vivo proton MR spectroscopy of the gallbladder as diagnostic tools for measuring the lipid content of gallbladder bile. MATERIALS AND METHODS: Twenty-six normal volunteers underwent MR imaging (FMPSPGR) and in-vivo proton MR spectroscopy of the gallbladder. In all cases the results of liver function tests were normal, as were cholesterol levels, and ultrasonography of the gaubladder revealed nothing unusual. For MRI and MRS a 1.5T unit (Signa Horizon; GE Medical Systems, Milwaukee, U.S.A.) was used. In-phase and opposed-phase coronal-section MR images(FMPSPGR; TR=125 msec, TE=1.8, 4.2 msec) of the gallbladder were obtained, and differences in signal intensity thus determined. For proton MR spectroscopy of the gallbladder, a localized proton STEAM sequence was employed. A single voxel of 1-8 cm3 was placed at the center of the gallbladder cavity, peak areas at 0.8-1.6 ppm (lipid), 2.0-2.4 ppm, 3.2-3.4 ppm, 3.9-4.1 ppm, and 5.2-5.4 ppm were measured by proton MRS and the relative peak area ratios of peak 0.8-1.6 ppm/other peaks were calculated. The degree of correlation between signal intensity differences at MRI and the relative peak area ratio of lipid in proton MRS was estimated using the p-value and Pearson's correlation coefficient. RESULTS: Signal intensity differences ranged from 11.3 to 43.4% (mean, 26+/-8.9%), and the range of lipid peak area ratio at MRS was 0.10-0.97 (mean, 0.66+/-0.21). There was significant correlation between the two measured values (p=0.014, Pearson's correlation coefficient=0.478). CONCLUSION: In normal cystic bile, signal intensity differences at in- and opposed-phase MRI and relative lipid peak area ratios at MRS varied, though both methods could be used diagnostically for measuring the lipid contents of body tissue.
Bile* ; Cholesterol ; Gallbladder* ; Healthy Volunteers ; Liver Function Tests ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy* ; Protons* ; Steam ; Ultrasonography