OBJECTIVE: Evaluation of embryos using early cleavage to 2-cell stage has been proposed, but a critical time-point for selecting embryos is unclear. The aim of the present study is to provide a guideline including critical time-point in the selection of early cleaving embryo for the reduction of multiple pregnancies as well as the increase of pregnancy rate in human IVF. METHODS: This prospective study was performed in 116 cycles from 85 patients who underwent conventional IVF or ICSI at the infertility clinic of Good Moonhwa Hospital from January 2002 to December 2003. Early cleavage (EC) of embryos to 2-cell stage was assessed at 25 h and 27 h postinsemination/microinjection. Embryos that had early cleaved at each time point were designated as EC-1 and EC-2, respectively, while others were designated as non-early cleavage (NEC). RESULTS: At least one early cleavage embryo was observed in 54 (46.6%) for the EC-1 and 84 (72.4%) for the EC-2 of the 116 cycles assessed. Clinical pregnancy rates (PR) were significantly higher in the EC-1 group (66.7%) compared to the EC-2 group (53.6%) or the NEC group (31.2%) (p<0.05). Significant improvement of the pregnancy rate was found when at least two or more embryos were early cleaved at 25 h postinsemination or when the proportion of early cleavage embryo at 25 h postinsemination was higher than 20% (p<0.05). CONCLUSIONS: The critical time-point for the selection of early cleavage embryos with high implantation potential is more effective in 25 h postinsemination/microinjection compared to 27 h. The proportion as well as number of early cleavage embryos is also an important factor for the prediction of pregnancy outcome and the chance of multiple pregnancies. These results demonstrated that the evaluation of early cleavage embryos to 2-cell stage is an easy, simple, and objective method for the selection of good quality embryos suitable for embryo transfer.
Embryo Transfer ; Embryonic Structures* ; Female ; Humans* ; Infertility ; Pregnancy Outcome ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Multiple ; Prospective Studies ; Sperm Injections, Intracytoplasmic

OBJECTIVE: Ovarian angiogenesis plays an important role in folliculogenesis. However, little is known about the expression of angiogenic factors during follicular development according to female age. Stromal cell derived factor-1alpha (SDF-1alpha) plays a role in granulosa cell survival and embryo quality as an angiogenic chemokine. Leptin is also involved in folliculogenesis and angiogenesis. This study examined expression of SDF-1alpha and leptin, and their effects on the expression of angiogenic factors in the ovary during follicular development according to female age. METHODS: Ovaries were collected from C57BL mice of two age groups (6-9 weeks and 24-26 weeks) at 6, 12, 24, and 48 hours after 5 IU pregnant mare's serum gonadotropin (PMSG) injection. The expression of ovarian SDF-1alpha and leptin mRNA was evaluated by RT-PCR. In the organ culture experiment, the ovaries were cultured in transwell permeable supports with Waymouth's medium treated with various doses of SDF-1alpha (50-200 ng/mL) or leptin (0.01-1 microg/mL) for 7 days. Then, mRNA expression of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and visfatin were examined in the cultured ovaries. RESULTS: Expression of SDF-1alpha and leptin in the ovary was significantly lower in the aged mouse group compared to the young mouse group (p<0.05). Expression of these two factors increased with follicular development after PMSG administration. SDF-1alpha treatment stimulated visfatin expression in a dose-dependent manner, while leptin treatment significantly increased eNOS expression. CONCLUSION: These results suggest that decrease of ovarian SDF-1alpha and leptin expression may be associated with aging-related reduction of ovarian function. SDF-1alpha and leptin may play a role in follicular development by regulating the expression of angiogenic factors in mouse ovaries.
Aged ; Aging ; Angiogenesis Inducing Agents ; Animals ; Chemokine CXCL12 ; Embryonic Structures ; Female ; Gonadotropins ; Granulosa Cells ; Humans ; Leptin ; Mice ; Mice, Inbred C57BL ; Nicotinamide Phosphoribosyltransferase ; Nitric Oxide Synthase Type III ; Organ Culture Techniques ; Ovary ; RNA, Messenger ; Stromal Cells ; Vascular Endothelial Growth Factor A

OBJECTIVE: This study aimed to examine the effect of laser-assisted zona thinning (LAZT) at one or four-points on the blastocyst formation and hatching process in mice with respect to female age. METHODS: Eight-cell or morula embryos collected from superovulated C57BL female mice with different ages (6-11 and 28-31 weeks) were treated with LAZT at one-point (LAZT1) or four-points (LAZT4). The zona pellucida was thinned to more than 70% of its initial thickness by making two holes of 15-20 microm. RESULTS: In the young mice, LAZT resulted in a significant increase in early hatching and hatching rates compared to the control group (p<0.05). However, in the old mice, LAZT significantly increased blastocyst formation as well as early hatching and hatching compared to the controls (p<0.05). These effects were more remarkable in LAZT4 than in LAZT1 and in aged mice than in young ones. CONCLUSION: These results show that multi-point LAZT leads to a significant improvement of blastocyst formation and hatching in mice compared to controls.
Animals ; Blastocyst ; Embryonic Structures* ; Female ; Herpes Zoster* ; Humans ; Mice* ; Morula ; Zona Pellucida

OBJECTIVE: The content of meconium in amniotic fluid(AF) is important for assessing the risk of several perinatal problems. This estimate is usually performed subjectively by visual inspection. The purpose of this study is to evaluate the clinical usefulness of meconium-crit method as an objective method for quantitative measurement of meconium content in AF. METHODS: Seventy of AF samples were obtained with amniocentesis from the pregnants of 30 weeks and over. Twenty-four of meconium-stained AF(MSAF)samples among them were separated through the subjective and gross assessment of clinicians. MSAF samples, except for the two samples contaminated by blood, were again divided into two categories: AF with fresh-meconium (11 samples) and AF with old-meconium(11 samples). Absorption spectra and meconium-crit of the samples were measured. RESULTS: Correlation coefficients between meconium-crit and absorption spectra at 425nm were 0.741 for 11 AF with fresh meconium, 0.255 for AF with old meconium and 0.354 for all MSAF samples. Those at 550nm were 0.934 for 11 AF with fresh meconium, 0.669 for 11 AF with old meconium and 0.639 for all MSAF samples. Those at 700nm were 0.916 for 11 AF with fresh meconium, 0.680 for 11 AF with old meconium and 0.706 for all MSAF samples. Analyses of correlation coefficients show very good or excellent relationship between absorption spectra and meconium-crit for AF with fresh meconium while little or moderate relationship for AF with old meconium. CONCLUSIONS: Therefore meconium-crit can be used as the objective and quantitative method that can measure meconium content in AF although variable results are shown in AF with old meconium.
Absorption ; Amniocentesis ; Amniotic Fluid* ; Female ; Meconium*

PURPOSE: We retrospectively reviewed the results of radiotherapy for localized ocular adnexal MALT lymphoma (OAML) to investigate the risk factors of cataract. METHODS: Sixty-seven patients with stage IE OAML treated with radiotherapy at Seoul St. Mary's Hospital from 2001 to 2016 were included. Median treatment dose was 30 Gy. Lens protection was done in 52 (76%) patients. Radiation therapy (RT) extent was as follows: superficial (82.1%), tumor mass (4.5%), and entire orbital socket (13.4%). The risk factors for symptomatic cataract were analyzed using the Cox proportional hazard model. RESULTS: Median follow-up time was 50.9 months (range, 1.9 to 149.4 months). All patients were alive at the time of analysis. There were 7 recurrences and there was no local recurrence. Median time to recurrence was 40.4 months. There were 14 cases of symptomatic cataract. Dose >30 Gy had hazard ratio of 3.47 for cataract (p = 0.026). Omitting lens protection showed hazard ratio of 4.10 (p = 0.008). CONCLUSIONS: RT achieves excellent local control of ocular MALT lymphoma. Consideration of RT-related factors such as lens protection and radiation dose at the stage of RT planning may reduce the risk of RT-induced cataract after radiotherapy.
Cataract* ; Follow-Up Studies ; Humans ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Orbit ; Proportional Hazards Models ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Factors ; Seoul ; Treatment Outcome*

PURPOSE: We retrospectively reviewed the results of radiotherapy for localized ocular adnexal MALT lymphoma (OAML) to investigate the risk factors of cataract. METHODS: Sixty-seven patients with stage IE OAML treated with radiotherapy at Seoul St. Mary's Hospital from 2001 to 2016 were included. Median treatment dose was 30 Gy. Lens protection was done in 52 (76%) patients. Radiation therapy (RT) extent was as follows: superficial (82.1%), tumor mass (4.5%), and entire orbital socket (13.4%). The risk factors for symptomatic cataract were analyzed using the Cox proportional hazard model. RESULTS: Median follow-up time was 50.9 months (range, 1.9 to 149.4 months). All patients were alive at the time of analysis. There were 7 recurrences and there was no local recurrence. Median time to recurrence was 40.4 months. There were 14 cases of symptomatic cataract. Dose >30 Gy had hazard ratio of 3.47 for cataract (p = 0.026). Omitting lens protection showed hazard ratio of 4.10 (p = 0.008). CONCLUSIONS: RT achieves excellent local control of ocular MALT lymphoma. Consideration of RT-related factors such as lens protection and radiation dose at the stage of RT planning may reduce the risk of RT-induced cataract after radiotherapy.
Cataract* ; Follow-Up Studies ; Humans ; Lymphoid Tissue* ; Lymphoma* ; Lymphoma, B-Cell, Marginal Zone ; Orbit ; Proportional Hazards Models ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Factors ; Seoul ; Treatment Outcome*

OBJECTIVE: To evaluate the effect of short coasting, by withdrawing both gonadotropins and GnRH agonist (GnRHa), on the prevention in severe ovarian hyperstimulation syndrome (OHSS) without compromising pregnancy outcome. METHOD: Thirty-seven women who had been coasted during COH for IVF were coasted when > or =20 follicles > 15 mm with serum E2 level of 4,000 pg/ml were detected. Coasting was initiated for one or two days depending on the status of follicle on ultrasound and serum E2 level. Both gonadotropin and GnRHa were withheld for coasting. Retrospective study was carried and changes of serum E2 levels, number of oocytes retrieved, fertilization rate, pregnancy rate were compared and analyzed. RESULTS: The mean serum E2 level fell from 6,993 pg/ml on the onset of coasting to 3,396 pg/ml on the day of hCG administration. The mean number of oocytes retrieved and fertilization rate were 15.7 and 70.0%, respectively. Fifteen patients were pregnant (40.6%) and implantation rate was 15.2%. Twenty-six (70.3%) patients were coasted for one day and 11 (29.7%) were coasted for two days. The mean decrease rate of serum E2 level was 43% in one day coasting group and 15% (1st day) and 81% (2nd day) in two day coasting group. The pregnancy outcome was similar between the two groups. After coasting, no severe or moderate OHSS occurred in any patients and mild OHSS occurred in 3 (8.1%) patients. CONCLUSIONS: Coasting for one or two days can be used successfully in the prevention of OHSS without compromising IVF cycle outcome.
Female ; Fertilization ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; Oocytes ; Ovarian Hyperstimulation Syndrome* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Ultrasonography

No abstract available.
Embryonic Development* ; Embryonic Structures* ; Female ; Nitric Oxide* ; Pregnancy

OBJECTIVE: To evaluate the effects of serum E2 levels on the day of hCG administration on the pregnancy outcome of IVF-ET after controlled ovarian hyperstimulation (COH). METHODS: Data of 455 cycles of fresh IVF-ET with COH were retrospectively investigated. Serum E2 levels on the day of hCG administration were categorized into 5 groups; A (<1,000 pg/mL), group B (1,000~2,000 pg/mL), group C (2,000~3,000 pg/mL), group D (3,000~4,000 pg/mL), and group E (> or =4,000 pg/mL). RESULTS: Mean E2 levels on the day of hCG administration were 3,745.3 pg/mL and mean number of retrieved oocytes were 10.1. Of 455 cycles, 148 (32.5%) cycles were clinically pregnant. Implantation rate was 12.2% and delivery rate was 18.7%. The number of obtained oocytes increased with increasing levels of serum E2. Pregnancy rate gradually increased as E2 levels increased up to the group D, but began to fall in the group E. In younger women (<38 yrs), the IVF-ET outcomes were similar to those of total patients but in older women (> or =38 yrs), pregnancy rate and delivery rate were significantly higher in the group C than other groups. CONCLUSIONS: This result shows that serum E2 levels have a concentration-dependent effect on the pregnancy outcome and there is an optimal range of E2 levels to achieve for a successful pregnancy. Excessive E2 levels seem more deleterious to the pregnancy outcome in older women aged > or =38 years.
Aged ; Female ; Humans ; Oocytes ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies

This study aims to examine the effect of methylphenidate, which is the most extensively prescribed medicine treating children with Attention Deficit Hyperactivity Disorder (ADHD), on the children's neuropsychiatric functions by comparing the symptomatic differences before and after its medication. MEHTODS: The subjects of this study were 48 children who corresponded to the diagnostic criteria for ADHD of DSM-IV, did not have any problem in vision or hearing, did not have neurologic disorder such as epilepsy and brain damage, and did not have other long term medication. To evaluate the effects of behavioral response and medication, after stopping medication over a week we handed out questionnaires to the parents and conducted CPT to the subjects. A dose of 0.3-0.7 mg/kg (bid or tid) was medicated at 8AM and 1PM everyday. After 4 weeks of medication, the same tests were conducted. RESULTS: Average age of the subjects was 8.88+/-1.55. There were 44 boys (91.7%) and 4 girls (8.3%). Mean intelligence was 96.60+/-18.12 and mental processing was 102.90+/-16.51. On ADDES-HV, after medication attention, impulsivity and hyperactivity were significantly improved (p<0.05). On AcTeRS, after medication attention, impulsivity and social skill were significantly improved (p<0.05). On CAPs, after medication inattention and hyperactivity were significantly improved (p<0.05). On SNAP, after medication inattention impulsivity and hyperactivity were significantly improved (p<0.05). On the academic performance rating scale, after medication total score, learning ability, impulse control and social withdrawal were significantly improved (p<0.05). On performing CPT, after medication commissions error, hit reaction time standard error, variability of standard error and attentiveness were significantly improved (p<0.05). CONCLUSIONS: With these results, we recognized methy-lphenidate is more effective in children's impulsivity and hyperactivity than attention, contrary to the clinical observation.
Attention Deficit Disorder with Hyperactivity* ; Brain ; Child* ; Diagnostic and Statistical Manual of Mental Disorders ; Epilepsy ; Female ; Hand ; Hearing ; Humans ; Impulsive Behavior ; Intelligence ; Learning ; Methylphenidate* ; Nervous System Diseases ; Parents ; Surveys and Questionnaires ; Reaction Time