The aim of this study is to determine whether or not hydrosalpinx affects pregnancy rate and implantation rate adversely in human IVF-ET program. 110 infertile couples with tubal factor undertaken IVF-ET treatment from May 1995 through April 1996 were included. Patients with tubal factor combined with other factors were excluded from this study. The hydrosalpinx group included 35 patients who had unilateral or bilateral hydrosapinx. Fifty four patients with proximal tubal occlusion without hydrosalpinx served as a control. The corrected hydrosalpinx group included 21 patients hydrosalpinx served as a control The corrected hydrosalpinx group included 21 patients who had undertaken either salpingectomy(n=5) or salpingoneostomy(n=16) before IVF-ET cycle. Controlled ovarian hyperstimulation was performed using GnRH agonist/human menopausal gonadotropin or follicular stimulation hormone(FSG). Thirty four hours after intramuscular injection of 10,000 IU human chorionic gonadotropin(hCG), trasvaginal sonography-guided oocyte retrieval was done, The cleaved embryos were transferred to the uterus on day two or three after fertilization. There was no significant difference in age(mean +/- SEM; 32.9 +/- 0.4, 32.7 +/- 0.6, 31.4 +/- 0.6), basal FSH level(7.1 +/- 0.3, 7.2 +/- 0 0.3, 7.0 +/- 0.4 mIU/ml) and estradiol on the day of hCG injection(2674 +/- 219, 3239 +/- 304, 3376 +/- 360 pg/ml) among the control, hydrosalpinix and corrected hydrosalpinx group, respectively(p > 0.05). The number of trasferred embryos(5.1 +/- 0.3, 5.6 +/- 0.3 and 5.4 +/- 0.6) were similar between the groups. The clinical pregnancy rate of 8.3% in hydrosalpingeal group was significantly lower than 25.4% of control group (p=0.057). However, in corrected hydrosalpinx group, pregnancy rate of 27.3% compared well with the control group. The implantation rate showed a similar pattern with pregnancy rate, i.e., hydrosalpingeal group had the lowest implantation rate of 2.0%, which was significantly lower than 11.6% of control group. In the corrected hydrosalpinx group, implantation rate(9.3%) recovered as that of the control group. The ectopic pregnancy rate(11.1%) of the hydrosalpingeal group was higher than that of the control group(1.7%) and was intermediate(4.5%) in corrected hydrosalpinx group(p > 0.05). In conclusion, these data show that hydrosalpinx affects the pregnancy rate adversely in IVF-ET cycyle. Thus, it is suggested that surgical correction of the hydrosalpinx before the initiation of IVF-ET cycle may be beneficial in increasing the pregnancy rate as well as decreasing the ectopic pregnancy.
Chorion ; Embryo Transfer* ; Embryonic Structures* ; Estradiol ; Family Characteristics ; Female ; Fertilization ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Injections, Intramuscular ; Oocyte Retrieval ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Ectopic ; Sterilization, Tubal ; Uterus

No abstract available.
Chronic Disease ; Glycemic Index

OBJECTIVE: The aim of this study was to evaluate the efficacy of frozen-thawed ET in poor prognosis patients such as the old age (38~44 years; OA group) and the patients who did not achieve clinical pregnancy with the first fresh ET cycle (non-pregnant patients; NP group). METHODS: Laboratory and clinical data were collected from fresh and frozen-thawed ET cycles of OA and NP group. Controlled ovarian hyperstimulation (COH) and conventional insemination or ICSI, in vitro culture and ET were performed by routine procedures. Supernumerary embryos were frozen by the slow freezing method, and frozen embryos were thawed by the rapid thawing method. Embryo development, pregnancy and implantation rates were statistically analyzed by Student t-test and chi square test. RESULTS: Mean ages were similar between fresh ET (40.0+/-1.8 years, n=206) and frozen-thawed ET (39.9+/-1.9 years, n=69) cycles in OA group. However, the clinical pregnancy and implantation rate of subsequent frozen-thawed ET significantly higher than those of fresh ET cycles (29.0% and 11.2% vs. 16.5% and 7.0%, p<0.05). In NP group, there was no difference in the mean age between fresh ET (31.2+/-2.3 years, n=40) and frozen-thawed ET (31.9+/-3.1 years, n=119) in subsequent cycles. The clinical pregnancy and implantation rates were similar between the subsequent fresh ET (42.5% and 22.6%) and the frozen-thawed ET (40.3% and 18.8%). CONCLUSION: In old age patients, higher pregnancy rate of frozen-thawed ET compared to fresh ET cycles in this study. It may be related that better uterine environments for implantation in frozen-thawed ET cycles than that of non-physiological hormonal condition in uterus of fresh COH cycles.
Embryonic Development ; Embryonic Structures ; Female ; Freezing ; Humans ; Insemination ; Pregnancy ; Pregnancy Rate ; Prognosis ; Sperm Injections, Intracytoplasmic ; Uterus

OBJECTIVES: Recently, recombinant FSH (rFSH) has been manufactured using a Chinese hamster ovary cell line transfected with the gene encoding human FSH. Both rFSH and urinary gonadotropin (uFSH) could be used for controlled ovarian hyperstimulation (COH). However, uFSH implies a number of disadvantages, such as batch-to-batch inconsistency, no absolute source control, dependence on large amounts of urine, low specific activity, and low purity. The purpose of this study was to evaluate the efficacy of rFSH in human IVF-ET program. MATERIALS AND METHODS: A total of 508 infertile women was enrolled in this study. They are classified into rFSH group (n=177) or uFSH group (n=331), and all of them were matched by age and cause of infertility in same period. The Puregon(R) (Organon, Holland) was used as rFSH, and the Metrodin-HP(R) (Serono, Switzeland) and Humegon(R) (Organon, Holland) was used as uFSH. We subdivided the patients into three age groups. The outcomes of IVF-ET program were analyzed using the statistical package for social sciences (SPSS). RESULTS: There was no significant differences in the level of estradiol on hCG injection day, the numbers of retrieved oocytes, matured oocytes, fertilized oocytes, transferred embryos, frozen embryos between the two groups. The total dose (IU) of gonadotropin for COH was significantly lower in the rFSH group compared to uFSH group (1339+/-5491.1 vs 2527.8+/-1075.2 IU, p<0.001). Clinical pregnancy rate per embryo transfer in the rFSH group showed increasing tendency, compared to the uFSH group, but there was no statistical significance (35.2% vs 29.3%). Our results demonstrated that the relative efficiency of rFSH compared with uFSH is higher in older patients. CONCLUSIONS: The ovarian stimulatory effect and clinical outcome of recombinant FSH was similar to that of the urinary gonadotropin. The IVF-ET cycles with significantly lower dose of gonadotropin in rFSH group showed comparable results. Therefore, we suggest that recombinant FSH is more potent and effective than urinary gonadotropin.
Animals ; Cell Line ; Cricetinae ; Cricetulus ; Embryo Transfer ; Embryonic Structures ; Estradiol ; Female ; Follicle Stimulating Hormone, Human* ; Gonadotropins ; Humans* ; Infertility ; Oocytes ; Ovary ; Pregnancy Rate ; Social Sciences

OBJECTIVE: To investigate whether polymorphisms of gene encoding CYP1B1 is associated with the risk of endometriosis in Korean women. METHODS: We investigated 199 patients with histopathologically confirmed endometriosis rAFS stage III/IV and 183 control group women who were surgically proven to have no endometriosis. The genetic distribution of four different CYP1B1 polymorphisms at G119-T, G432-C, T449-C, and A453-G were analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism of PCR products. RESULTS: We found no overall association between each individual CYP1B1 genotype and the risk of endometriosis. The odds ratio of genotype GG/GC+GG/TC+TT/AA compared to GG/CC/CC/AA (reference) was calculated as 2.06 with a 95% confidence interval of 1.003~4.216. CONCLUSIONS: This results suggest that CYP1B1 genetic polymorphism may be associated with development of endometriosis in Korean women.
Endometriosis* ; Female ; Genotype ; Humans ; Odds Ratio ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length

OBJECTIVE: To investigate the association of the muscle contraction with gating of the sensory input at central and peripheral levels according to the intensity of muscle contraction and location of the muscles, somatosensory evoked potentials (SSEPs) studies were evaluated at different levels of isometric contraction in the different muscles. METHOD: Median nerve SSEPs were recorded at Erb's point and scalp in the ten healthy adult subjects with isometric contraction of ipsilateral abductor pollicis brevis (APB), ipsilateral abductor digiti minimi (ADM) and contralateral APB. Median nerve SSEPs were recorded in each of these conditions during precontraction, weak contraction, strong contraction and 4 minutes after contraction. RESULTS: 1) N9 amplitudes of median SSEPs recorded at Erb's point were augumented during weak contraction and these amplitude augumentations were statistically significant in the ipsilateral APB contraction (p<0.05). 2) N20 amplitudes recorded at scalp were inhibited during strong isometric contraction and these amplitude inhibitions were statistically significant in the ipsilateral APB contraction (p<0.05). 3) The latencies of N9 and N20 potentials were not significantly changed during isometric contraction. CONCLUSION: Therefore peripheral nervous system as well as central nervous system is responsible for gating, so the subject should be asked for the best relaxation possible for higher reliability of SSEPs.
Adult ; Central Nervous System ; Evoked Potentials, Somatosensory* ; Humans ; Isometric Contraction ; Median Nerve ; Muscle Contraction* ; Muscles ; Peripheral Nervous System ; Relaxation ; Scalp

Much attention has been paid to the insertion of central venous catheter(CVC) but their removal is a subject discussed rarely. After removal of a central venous catheter, rare but potentially life-threatening, transient cardiopulmonary collapse or neurological dysfunction had developed. The failure to appreciate these complications may be a significant factor in their high mortality. Early recognition and treatment may be made possible by a high index of suspicion. In this report, the clinical courses of two patients with central venous catheter removal distress syndrome are reviewed. Also guidelines for safe removal of CVC are formulated. An awareness of potential CVC removal complications is most important for their prevention and timely treatment. CVCs should be removed with the same degree of meticulous attention to detail that accompanies their insertion. Medical personnel should be reminded that removal of the catheter is an integral component of CVC management.
Catheters ; Central Venous Catheters* ; Humans ; Mortality

OBJECTIVE: The aim of study was to evaluate the efficacy of medical and/or laparoscopic surgical treatment for improvement of reproductive outcome of in vitro fertilization and embryo transfer (IVF-ET) in the patients with endometriosis. METHODS: 296 IVF-ET cycles except 18 cycles of cancelled embryo-transfer (unfertilization; 16 cycles, high risk of ovarian hyperstimulation syndrome; 2 cycles) in 191 infertile women with endometriosis from January 1, 1995 to December 31, 1998 were included in this study. All women's ages were < or = 35 and the factor for infetility was endometriosis only and day 3 follicle stumulating hormone (FSH) level of all the cycles was < or = 10 mIU/ml in this study. All the baseline study about infertility was done before initiating treatment of infertility. The stage of endometriosis was recorded during diagnostic laparoscopy by WHO critera. Medical treatment (GnRH agonist or danazole) or laparoscopic surgery was done independently or combinedly by the physician's decision according to the disease entity and symptoms. Short or long protocols were used for controlled ovarian hyperstimulation and 3 day embryos were transferred (maximally 4 embryos) by standard procedures in our institute. We classified the cases as 4 groups : group 1 (without pre-treatment, 80 cycles), goup 2 (laparoscopic surgery only, 37 cycles), group 3 (medication only, 140 cycles), group IV (combined pre-treatment, 39 cycles). RESULTS: The mean age (years old, mean +/- SEM) was 31.5 +/- 0.3 (group 1), 31.6 +/- 0.5 (group 2), 31.5 +/- 0.2 (group 3), 31.7 +/- 0.4 (group 4) respectively. The duration of infertility (months) was 57.7 +/- 3.3, 64.5 +/- 4.8, 59.1 +/- 1.9, 52.0 +/- 3.7 respectively among groups. The viable pregnancy rate (over 28 gestational weeks, VPR) was 12.5 % (10/80) in goup 1, 13.5 % (5/37) in goup 2, 14.3 % (20/140) in group 3, 30.8 % (12/39) in group 4 and there was statistically significant difference between group 1 and group 4 (P=0.03, Chi square test). The total used gonadotropins (ampules) for controlled ovarian hyperstimulation were 28.2 +/- 0.6.
Embryo Transfer ; Embryonic Structures ; Endometriosis* ; Female ; Fertilization in Vitro ; Gonadotropins ; Humans ; Infertility ; Laparoscopy* ; Ovarian Hyperstimulation Syndrome ; Pregnancy Rate* ; Pregnancy*

Uterine anomalies have been reported in 4% of women with infertility and in up to 15% of those with recurrent abortion. One of the major intrauterine disorder associated with infertility and recurrent abortions is intrauterine septum, The reproductive outcome of 41 patients of intrauterine septum (7 complete, 34 incomplete) with repeated abortions or infertility was assessed after the uterine septotomy. 5 of 7 patients with comlete uterine septum undergone uterine septotomy (3; hysteroscopic metroplasty, 2; abdominal metroplasty) had total 6 pregnancies and all of them had live biths. 28 patients with incomplete uterine septum got the hysteroscopic intrauterine septotomy and the viable pregnancy rate was 62% (3 ongoing pregnancies, 13 live biths of total 26 pregnancies). 6 patients with incomplete uterine septum had not the operation and 5 patients had 5 live births after total 6 pregnancies with 1 spontaneus abortion. Even though, the number of cases were small, the live birth rate in the group of septotomy of the patients of complete uterine septum (100%, 6/6) was higher than that in the group of not-done (50%, 1/2). The live birth rate in the group of not-done of the patients with incomplete uterine septum (83%, 5/6) was higher than that in the group of hysteroscopic uterine septotomy (62%, 16/26), but 5 of 6 had short uterine septal length (<1 cm), 1 had 1.5 cm septal length in the group of not-done. All the patients with successful pregnancy outcome had no other co-factors at the diagnostic laparoscopy, but the 5 primary infertility patients with no live birth even after treatment (all were with incomplete septum; 3 undergone hysteroscopic septotomy, 2 not-done with one abortion) had other co-factors such as endometriosis, peritoneal or tubal facor. In conclusion, hysteroscopic uterine septotomy would be useful for the patients with habitutal abortion or infertility and more advanced managemnet protocols should be applied to the patients having other co-factors if there was no pregnancy even after the uterine septotomy.
Abortion, Habitual* ; Endometriosis ; Female ; Humans ; Hysteroscopy* ; Infertility* ; Laparoscopy ; Live Birth ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

OBJECTIVE: It is well known that fresh blastocyst transfer results in better pregnancy outcomes with a smaller number of transferred embryos compared with cleavage stage embryo transfer. However, in terms of frozen-thawed blastocyst transfer, only a few studies are available. We aimed to evaluate clinical outcomes of frozen-thawed embryo transfer (FET) with blastocysts. METHODS: Retrospective analysis of FET cycles with blastocysts (B-FET) between Jan 2007 and June 2009 was performed. Age-matched FET cycles with cleavage stage embryos (C-FET) during the same period were collected as controls. A total of 58 B-FET cycles were compared with 172 C-FET cycles and also compared with those of post-thaw extended culture blastocysts from frozen pronuclear stage embryos (22 cycles). RESULTS: There was no difference in the patient characteristics of each group. The embryos' survival rates after thawing were comparable (>90%) and there was no difference in the implantation rate or clinical and ongoing pregnancy rate among the three groups. CONCLUSION: In FET, blastocyst transfers may not present better pregnancy outcomes than cleavage stage embryo transfers. A further large-scale prospective study is needed.
Blastocyst ; Embryo Transfer ; Embryonic Structures ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Survival Rate