OBJECTIVES: To estimate false-negative rate of cervical smears using Autopap 300 QC system in rescreening modality. METHODS: From September 1997 to December 1997, Total 26,983 cervical smears were obtained and 18,592 cervical smears were rescreened by Autopap 300 QC system with 10% review rate. The 274 cases of total 26,983 cervieal smears were confirmed histologically by colposcopic biopsy, cone biopsy and hysterectomy. The 274 cases of cervical smears, which obtained prior to pathologic diagnosis made, were evaluated based on cyto-histologic correlation and then the false negative rate were estimated. The cervical smears were reviewed, researching for the cause of false negative. RESULTS: (1) Histologic diagnosis of 274 cases include 65 cases of Low SIL, 173 cases of High SIL, 29 cases of SCC, 2 cases of adenocarcinoma in situ, and 5 cases of invasive adenocarcinoma. (2) The false negative rate were 3% (9/274). Those were 6.2%(4/65) of LSIL, 2.3% (4/173) Of HSIL, none of SCC and AIS, and 20%(5/1) of invasive adenocarcinoma. (3) The false negative cases were reviewed. The 6 cases were sampling enor and 3 cases were screening error. CONCLUSION: Using AutoPap 300 QC system in rescreening modality, The false negative rate of cervical smears were decreased, compared with our previous study.
Adenocarcinoma ; Biopsy ; Diagnosis ; Hysterectomy ; Mass Screening ; Vaginal Smears

OBJECTIVE: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. MATERIAL AND METHODS: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. RESULTS: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (> or =15 mm) was lower in the AI group (1.08+/-0.45 vs. 1.64+/-0.75) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group (10.35+/-1.74 vs. 9.23+/-1.61) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group (116.9+/-75.8 vs. 479.5+/-300.8) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed 10.6+/-1.6 mm in the endometrial thickness and 106.6+/-66.8 pg/ml in E2 concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number (1.25+/-0.5) compared to prior CC cycle. CONCLUSIONS: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.
Aromatase* ; Clomiphene* ; Endometrium ; Female ; Humans ; Infertility ; Menstrual Cycle ; Menstruation ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy, Multiple ; Prospective Studies

No abstract available.
Cervix Uteri* ; Female

OBJECTIVE: To evaluate the difference of implantation rate (IR) and clinical pregnancy rate (CPR) between two protocols of endometrial preperation in women undergoing frozen-thawed embryo transfer (FET) cycles. METHODS: This study was performed during the different time periods: A retrospective study from January 2000 to June 2001 (phase I) and a prospective study from July 2001 to March 2002 (phase II). All the patients received estradiol valerate (6 mg p.o. daily) starting from day 1 or 2 of the menstrual cycle without pituitary down regulation. Progesterone was administered around day 14 after sonographic confirmation of endometrial thickness > or = 7 mm and no growing follicle. In Group A (n=88, 99 cycles) of phase I, progesterone was administered i.m. at a dose of 50 mg daily from one day prior to thawing of pronuclear (PN) stage frozen embryo or three days prior to thawing of 6-8 cell stage frozen embryo and then each stage embryos were trasnsferred 2 days or 1 day later after thawing. In Group B (n=246, 299 cycles) of phase I, patients recieved progesterone 100 mg i.m. from one day earlier than group A; two days prior to PN embryo thawing, four days prior to of 6-8 cell embryo thawing. During the phase II, to exclude any differences in embryo transfer procedures, in Group 1 (n=23, 28 cycles) of phase II embryo was transfered by one who have used the progesterone protocol since the phase I. In Group 2 (n=122, 139 cycles) of phase II embryo was transfered by one who use the progesterone protocol from the phase II. RESULTS: When compared across the phase and group, there were no significant differences in the characteristics. During the phase I, there were significant increase in IR (14.4% vs 5.9%, p=0.001) and CPR (28.3% vs 14.5%, p=0.000) in group A. During the phases II, IR (11.8% vs 10.6%) and CPR (27.6% vs 27.3%) show no differences between two groups. CONCLUSIONS: In FET cycles, IR and CPR are increased significantly by the change of dosage and timing of progesterone administraton. And the timing is considered to be more important factor because the dosage of progesterone did not affect implantation window in previous studies. Therefore, we suggest that progesterone administration in FET cycle should begin from one day prior to PN stage embryo thawing and three days prior to 6-8 cell stage embryo thawing.
Cardiopulmonary Resuscitation ; Down-Regulation ; Embryo Transfer* ; Embryonic Structures* ; Estradiol ; Female ; Humans ; Menstrual Cycle ; Pregnancy Rate* ; Pregnancy* ; Progesterone* ; Prospective Studies ; Retrospective Studies ; Ultrasonography

OBJECTIVE: To estimate the efficacy of recombinant human follicle stimulating hormone (rFSH) versus highly purified urinary human FSH (uFSH) in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET). METHODS: From 1 January 2001 to 31 August 2001, A total of 254 cycles from 241 patients who attended infertility clinic at Samsung cheil hospital was enrolled in this study. With pituitary down regulation using GnRH agonist by short protocol, rFSH (Puregon(R), Organon, Netherlands) was administered in 131 cycles and uFSH (Metrodin-HP(R), Serono, Switzerland) was administered in 123 cycles. We analyzed ovarian response, pregnancy rate, live birth rate, oocyte quality and embryo quality. RESULTS: The clinical characteristics of two groups were not different. Total FSH dosages (1322.3+/-526.2 IU versus 2124.4+/-881.9 IU, p<0.001) and dosages per retrieved oocyte (90.6+/-36.0 IU versus 138.0+/-57.2 IU, p<0.001) were significantly lower in rFSH group than uFSH group. Clinical pregnancy rate and live birth rate of two groups were not significantly different. The rate of good quality oocyte (Grade I and II) from retrieved oocytes was higher in rFSH group (68.2% versus 64.8%, p=0.024), but after preincubating oocytes for 4 to 6 hours and removing cumulus cells in intracytoplasmic sperm injection (ICSI) cycles, nuclear maturity of oocytes were not significantly different. The quality of transferred embryos were not significantly different too. CONCLUSION: rFSH offered more effective ovarian response in COH and better quality of retrieved oocytes, compared with uFSH.
Cumulus Cells ; Down-Regulation ; Embryo Transfer ; Embryonic Structures* ; Female ; Fertilization in Vitro ; Follicle Stimulating Hormone, Human* ; Gonadotropin-Releasing Hormone ; Humans* ; Infertility ; Live Birth ; Oocytes* ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic ; Urofollitropin

OBJECTIVE: It has been suggestes that various mechanism of fetal loss are associated with anticardiolipin(ACA) and humoral immunity in the patients with recurrent spontaneous abortion. Thus we have investigated the relationship between ACA and chromosomal anomaly to know the clinical impact of ACA to early fetal loss as comparing to the chromosomal anomaly in the patients of recurrent spontaneous abortions. MATERIALS AND METHODS: Patients(n=88) with a history of recurrent spontaneous abortion (2 or more) between January 1, 1994 and June 30, 1999 were included in this study. Quantitative measurement of serum ACA was performed by ELISA and chromosomal analysis of chorionic villi obtained from aborted conceptuses was done by using standard G-banding technique. RESULTS: The incidence rate of ACA positive was 27%(24/88) and that of chromosomal abnormality was 57%(50/88). The incidence rate of abnormal karyotype was 54% (13/24) in ACA positive. Among 24 ACA positive, 10 had IgG-ACA positive, 10 had IgM-ACA positive and 4 had both types of ACA. The incidence rate of chromosomal anomalies was 30% (3/10) in IgG-ACA positive, 90%(9/10) in IgM-ACA positive and there was significant difference between these two groups (p=0.02). The incidence rate of chromosomal trisomy was 59% (23/37) in ACA negative, 62% (8/13) in ACA positive and there was no significance between two groups. CONCLUSIONS: The significantly low incidence of chromosomal abnormalities in conceptal products of patients with IgG-ACA comparing that of patients with IgM-ACA suggests that this isotype of antibody have influence on the genesis of spontaneous abortions in genetically normal pregnancy. In further studies, additional trials are mandatory for obtaining a definitive conclusions about relationship between pathologic changes of conceptal products and pathophysiologic effects of IgG-ACA.
Abnormal Karyotype ; Abortion, Spontaneous ; Antibodies, Anticardiolipin* ; Chorionic Villi ; Chromosome Aberrations ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunity, Humoral ; Incidence ; Pregnancy ; Trisomy

OBJECTIVE: The purposes of this study are to evaluate the obstetric outcome in pregnancies resulting from oocyte donation and to assess the factors related to the obstetric complications. METHODS: The obstetric outcome in pregnancies from the oocyte donation (n=37) was compared with that in pregnancies from conventional IVF program (n=137) in our IVF center between January 1995 and December 2000. Control group was selected by age, parity, and order of gestation matched to the study group. Pregnancy induced hypertension (PIH) was defined as blood pressure >140/90 mmHg on two or more occasions at least 6 hours apart with or without proteinuria after 20 weeks of gestation and not associated with chronic hypertension. Small for gestational age (SGA) was defined as birth weight below tenth percentile for gestational weeks. The data was analyzed using the Statistical Package for Social Sciences (SPSS). RESULTS: Early pregnancy loss rates were 37.8% (14/37) and 23.4% (32/137) in study and control group, respectively (P>0.05). PIH related factors such as mean age, parity and order of gestation were not significantly different among the two groups. However, the incidence of PIH in oocyte donation group (30.0%, 6/20) was significantly higher than control group (8.8%,9/102). There was no significant difference in the incidence of SGA between the two groups. When oocyte donation group was stratified by relationship of oocyte donor to infertile patient (sibling versus non-sibling), the incidence of early pregnancy loss and PIH was significantly higher (chi square test, P<0.05) in non-sibling group (42.3%, 11/26; 38.5%, 5/13) than in control group (23.4%, 32/137; 8.8%, 9/102). CONCLUSION: The incidence of PIH was significantly higher in pregnancies after oocyte donation. Notably, the pregnancies from non-sibling oocyte donors had much higher incidence of early pregnancy loss and PIH than pregnancies from sibling oocyte donors or control group. Therefore, the occurrence of early pregnancy loss and PIH may be related to other factors than age, parity or multiple pregnancy.
Birth Weight ; Blood Pressure ; Female ; Gestational Age ; Humans ; Hypertension ; Hypertension, Pregnancy-Induced ; Incidence ; Oocyte Donation* ; Oocytes* ; Parity ; Pregnancy ; Pregnancy, Multiple ; Primary Ovarian Insufficiency* ; Proteinuria ; Siblings ; Social Sciences ; Tissue Donors

OBJECTIVE: To estimate the difference in gene expression related to carcinogenesis between HPV 16 positive squamous cell carcinoma and HPV 16 positive adenocarcinoma of cervix. METHODS: We used cDNA microarray technology to identify alterations in gene expression of human cervical cancers. Gene expression of three cell lines, CaSki and SiHa (HPV 16 positive squamous cell carcinoma) and HeLa (HPV 16 positive adenocarcinoma) were compared with HT3 (HPV 16 negative squamous cell carcinoma). The microarray contains twin spots for 344 cancer-associated genes. RESULTS: The analysis showed several interesting findings: (1) In all three squamous cell lines, CD4, CSF1, MMP15 and TNFR6 were increased, whereas SLC3A2 were decreased, (2) Only in adenocarcinoma cell line HeLa, CDC25A, CDK2, CDK9, IL2, PF4, MAD, FCER2, MAP4K1 and MS4A1 were increased, and PLAU, IL8, IL9R and ATK were decreased. (3) In both squamous cell carcinoma cell lines CaSki and SiHa, 61 genes which belong to chemokine, cell cycle, growth factor, interleukin, adhesion molecule, protein kinase and TNF were increased, whereas 10 genes which are associated with apoptosis and cytokine were increased only in SiHa, and 97 genes which are associated with a variety of cell functions were increased only in CaSki. CONCLUSION: We suggest that there might be common, but also different carcinogenic mechanisms involved in HPV 16 related cervical cancers according to the histologic subtypes and different tumors.
Adenocarcinoma ; Apoptosis ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Cycle ; Cell Line* ; Cervix Uteri ; DNA, Complementary* ; Female ; Gene Expression ; Human papillomavirus 16 ; Humans ; Interleukin-2 ; Interleukin-8 ; Interleukins ; Oligonucleotide Array Sequence Analysis* ; Protein Kinases ; Uterine Cervical Neoplasms*

OBJECTIVE: To estimate the efficacy of low-dose aspirin and prednisolone supplementation in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET). METHODS: From 1 July 2001 to 31 July 2002, A total of 306 cycles from 306 patients who attended infertility clinic at Samsung Cheil Hospital was enrolled in this study. With pituitary desensitization in a short gonadotrophin-releasing hormone (GnRH) agonist protocol, recombinant FSH (Puregon, Organon, Netherlands) was administered for ovarian stimulation, until the largest follicle had a mean diameter > 18 mm and at least two other follicles with a diameter of 16 mm. In study group (128 cycles), low dose aspirin (100 mg/day) and prednisolone (5 mg/day) were administered from COH starting day to post-oocyte retrieval 12th day. The COH protocol of control group (178 cycles) was same as study group, except no additional supplementation. Retrospectively, we analysed ovarian response and outcome of IVF cycles. RESULTS: The demographic characteristics of two groups were not different. E2 on hCG day (2408.3+/-1375.4 pg/ml vs 2232.3+/-1305.1 pg/ml: p=0.261), number of retrieved oocytes (13.1+/-9.1 vs 12.5+/-8.8: p=0.680), number of good embryos transferred (3.0+/-2.5 vs 2.9+/-2.0) were not different significantly between two groups. hCG positive rate (52.3% vs 43.3%: p=0.116), biochemical pregnancy rate (23.9% vs 15.6%: p=0.224), clinical pregnancy rate (39.8% vs 36.5%: p=0.629), and clinical abortion rate (10.4% vs 6.5%: p=0.392) were not different significantly either. hCG positive rate (56.1% vs 44.7%: p=0.079) shows a increasing tendency in study group, younger than 35 years old. In study group, older than 36 years old or basal FSH > 10 mIU/ml, there were no significant improvement of ovarian response and prgnancy rate. CONCLUSION: Low dose aspirin and prednisolone supplementation in routine IVF patients shows no significant improvement in ovarian response, pregnancy rate, and implantation rate. Also, in poor ovarian responder, this supplementation shows no benefits.
Abortion, Induced ; Adult ; Aspirin* ; Embryo Transfer ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Infertility ; Oocytes ; Ovulation Induction ; Prednisolone* ; Pregnancy Rate ; Retrospective Studies

OBJECTIVES: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. MATERIALS AND METHODS: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6~10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. RESULTS: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced embryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). CONCLUSIONS: PGD by using FISH or PCR is useful to get normal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.
Abortion, Habitual ; Abortion, Induced ; Abortion, Spontaneous ; Amniocentesis ; Aneuploidy* ; Biopsy ; Blastomeres ; Child ; Chromosome Aberrations ; Diagnosis ; Embryonic Structures ; Exons ; Female ; Humans ; Mass Screening ; Morula ; Muscular Atrophy, Spinal ; Muscular Dystrophy, Duchenne ; Parturition ; Polymerase Chain Reaction ; Pregnancy ; Pregnancy Rate ; Preimplantation Diagnosis* ; Prenatal Diagnosis ; Prostaglandins D ; Sex Chromosomes ; Sperm Injections, Intracytoplasmic