OBJECTIVE: To assess the efficacy of GnRH antagonist in controlled ovarian hyperstimulation (COH) for IVF-ET compared with GnRH agonist in infertile patients who are expected to have normal ovarian response. METHODS: This study reviewed 105 cycles of 105 women who underwent IVF-ET for the first time in SNUH from January, 2001 to October, 2003. In the study group (n=51), a daily dose of 0.25 mg of GnRH antagonist (cetrorelix or ganirelix) was administered beginning when leading follicles reached mean diameter of 13-14 mm and continued until the day of hCG injection. In the control group (n=54), patients were first desensitized with GnRH agonist (triptorelin) long protocol, which was continued during the gonadotropins treatment until the day of hCG injection. The outcome parameters of COH and IVF-ET were compared retrospectively between the two groups. Statistical analysis was performed using Student's t-test for the comparison of means, and the chi-square test where appropriate. Statistical significance was defined as p<0.05. RESULTS: General characteristics of the patients in respect to age, parity, body mass index of the two groups were comparable. In the study group, there were significant reduction in the dosages of gonadotropins used (1818.1 +/- 812.3 IU vs. 2420.2 +/- 839.2 IU)and the duration of COH (8.9 +/- 2.1 days vs. 10.9 +/- 1.6 days). The mean serum level of estradiol and endometrial thickness on hCG day were significantly lower in the study group. Number of embryos transferred and CES (cumulative embryo score) were significantly lower in the study group compared to the control group. However there were no significant differences in the number of oocytes retrieved, the fertilization, implantation, and clinical pregnancy rates, and the incidence of OHSS between the two groups. CONCLUSION: For patients who are expected to have normal ovarian response, a GnRH antagonist multiple dose protocol in flexible fashion can be used as a protocol of choice in COH for IVF-ET. This protocol showed comparable pregnancy rate as GnRH agonist long protocol. However, the mean number of gonadotropin ampules administered and the mean number of stimulation days were significantly less in the GnRH antagonist group optimizing the convenience for the patients.
Body Mass Index ; Embryonic Structures ; Estradiol ; Female ; Fertilization ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Incidence ; Oocytes ; Parity ; Pregnancy Rate ; Retrospective Studies

To determine the ventricular looping pattern in relation to cardiac laterality, we studied rat embryos treated with retinoic acid (RA). A total of 243 Wistar rat embryos from an in vivo treated group (a single dose of 20-40 mg/kg all-trans RA administered to pregnant rats on day 6.5 to 9.5) and 29 control embryos were examined on day 13 of gestation. Twenty-nine embryos from the in-vitro treated group (treated by all-trans RA at 2 x 10(-7) M for 6 hr on day 9.0 or 9.5 during the entire embryo culture for 72 hr) and seven control embryos were examined on day 12 of gestation. Abnormalities in cardiac laterality and ventricular looping were found in the in-vivo groups treated on day 8.5 and 8.75 and in the in-vitro group on day 9.0. Among 25 animals with abnormal laterality, right isomerism was the most common feature (22 cases), while the type of ventricular looping varied. Cases with normal laterality had a low incidence of abnormal looping (1.4%). In rat embryos treated with all-trans RA, normal cardiac looping was expected when cardiac laterality was normal. But in cases with abnormal laterality, the type of abnormal ventricular looping was unexpected.
Animal ; Cell Division ; Female ; Heart/drug effects* ; Heart Defects, Congenital/pathology ; Heart Defects, Congenital/chemically induced* ; Heart Ventricle/pathology ; Heart Ventricle/abnormalities* ; Incidence ; Male ; Pregnancy ; Rats ; Rats, Wistar ; Tretinoin/pharmacology*

This study was conducted to develop a computerized food frequency questionnaire (FFQ) for assessing nutritional status of women of child-bearing age. Computerized food frequency questionnaire (FFQ) that reflect intakes of energy, carbohydrate, fat and protein was developed for women of child-bearing age. This FFQ is composed of 61 foods or food groups containing 192 dish items. To estimate of energy intake easily, we have developed a computer program that can be viewed on a computer screen in an actual size of dish items. Nutrient intakes of the last three months by the FFQ was validated with comparing the result of a 3-day diet record through 92 college students aged from 20 to 30. The level of energy, carbohydrate and sodium of estimating by the FFQ method was significantly higher than the level of a 3-day diet records method (p < 0.01). Pearson's correlation coefficients between the two methods were 0.50 for carbohydrate (p < 0.01), 0.55 for energy (p < 0.01) and 0.56 for protein (p < 0.01). Spearman's correlation coefficients were 0.53 for carbohydrate (p < 0.01), 0.55 for energy (p < 0.01) and 0.52 for protein (p < 0.01). The percent of subject in the lowest quartile in a 3-day diet record belonged to the first and second lowest quartile in food frequency questionnaire is 78.2% in energy, 91.3% in carbohydrate, 78.2% in protein, 69.5% in fat. Also, the percent of subject in the highest quartile in a 3-day diet record belong to the first and second highest quartile in food frequency questionnaire is 78.3% in energy, 73.9% in carbohydrate, 82.6% in protein, and 73.9% in fat. On the whole, the result of this study seemed to be in good agreement with other studies. Therefore, the FFQ developed by this study is considered to be a reliable tool to assess nutrients and food intakes for women of child-bearing age.
Aged ; Diet Records ; Energy Intake ; Female ; Humans ; Nutritional Status ; Sodium ; Software

OBJECTIVE: The aim of our study is to determine clinical factors and sonographic findings associated with endometrial hyperplasia or cancer (EH+) in premenopausal and perimenopausal women. METHODS: A total of 14,340 transvaginal ultrasonography examinations of 9,888 healthy premenopausal and perimenopausal women were included in this retrospective study. One hundred sixty-two subjects underwent endometrial biopsy based on abnormal uterine bleeding (AUB), sonographic endometrial abnormalities (thickened endometrium, endometrial mass, or endometrial stripe abnormality), or both. The clinical factors and sonographic endometrial abnormalities were evaluated with regard to EH+. RESULTS: Histologically verified EH+ was found in fourteen subjects (8.6%); ten cases of endometrial hyperplasia (EH) without atypia, three cases of EH with atypia (AEH), and one case of endometrial cancer. Neither clinical factors nor AUB were associated with EH+ (P=0.32) or AEH+ (P=0.72). Of sonographic findings, endometrial stripe abnormality was significantly associated with EH+ (P=0.003) and marginally associated with AEH+ (P=0.05), but a thickened endometrium was not associated with EH+ (P=0.43). CONCLUSION: Endometrial stripe abnormality is a significant factor to predict EH+ in healthy premenopausal and perimenopausal women with and without AUB. However, simple measurement of endometrial thickness has a limited role in this capacity.
Biopsy ; Diagnosis ; Endometrial Hyperplasia* ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Mass Screening* ; Retrospective Studies ; Ultrasonography* ; Uterine Hemorrhage

We report two cases of adenoid cystic carcinoma of Bartholin's gland. One of these patients had positive margin on operation and is scheduled for adjuvant radiotherapy. The other was first diagnosed 13 years ago and presented with her second recurrence without distant metastasis. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed, the treatment should be individualized to the patient. When the surgical margin is found to be positive, adjuvant radiotherapy seems to be beneficial.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Humans ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Vulva

We report two cases of adenoid cystic carcinoma of Bartholin's gland. One of these patients had positive margin on operation and is scheduled for adjuvant radiotherapy. The other was first diagnosed 13 years ago and presented with her second recurrence without distant metastasis. Adenoid cystic carcinoma of the Bartholin's gland is a rare tumor of the vulva. When diagnosed, the treatment should be individualized to the patient. When the surgical margin is found to be positive, adjuvant radiotherapy seems to be beneficial.
Adenoids* ; Carcinoma, Adenoid Cystic* ; Humans ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Vulva

Morus alba L. is well-known for its medicinal and economic value, particularly in Asian countries. Among the isolated compounds from this plant, steppogenin is exhibited as a flavonoid with promising pharmacological properties. This study focused on isolating bioactive compounds, notably steppogenin, from the ethyl acetate extract of M. alba. Additionally, a high-performance liquid chromatography-diode array detector (HPLC-DAD) method for the simultaneous quantification of steppogenin and isolated compounds was developed and validated. The calibration curve showed excellent linearity, with a correlation coefficient (R 2 ) value greater than 0.9957. The limit of detection (LOD) ranged from 0.006 to 0.018 μg/mL, whereas the limit of quantification (LOQ) ranged from 0.020 to 0.061 μg/mL. In precision tests conducted intra-day and inter-day, the accuracy was between 97.32% and 106.39%, with relative standard deviations (RSD) less than 2.27% and 1.65%, respectively. The presence of steppogenin and other flavonoids was confirmed by the study, contributing to the understanding of the chemical composition of M. alba. This validated analytical method offers a reliable means of quantifying steppogenin and aiding future research into its therapeutic potential.

Herein, we report a case of successful mature oocyte retrieval during laparotomy after random-start controlled ovarian stimulation (COS) in a 21-year-old nulliparous woman with suspected recurrent ovarian immature teratoma. The patient had been diagnosed with stage IIIC immature teratoma two years earlier following a staging operation, including right oophorectomy and left ovarian cystectomy. And she had subsequently undergone four rounds of postoperative adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. Approximately two years after the initial surgery, she was strongly suspected of having recurrent ovarian immature teratoma on radiologic follow-up. We performed random-start COS and in vivo oocyte retrieval during laparotomic debulking surgery including left oophorectomy. Eight mature oocytes were successfully retrieved and vitrified for fertility preservation. The final pathologic diagnosis was mature cystic teratoma of the ovary and peritoneal implants consistent with gliomatosis peritonei. This is the first case report in which random-start COS and in vivo oocyte retrieval were performed.
Bleomycin ; Chemotherapy, Adjuvant ; Cisplatin ; Cystectomy ; Diagnosis ; Etoposide ; Female ; Fertility Preservation* ; Fertility* ; Follow-Up Studies ; Humans ; Laparotomy ; Oocyte Retrieval* ; Oocytes* ; Ovarian Neoplasms* ; Ovariectomy ; Ovary ; Ovulation Induction* ; Teratoma ; Young Adult

OBJECTIVE: To determine the impact of the changes in the amount of abdominal fat, directly measured by computed tomography, body composition, and the metabolic syndrome (MetS) risk factors on the bone mineral density (BMD) of Korean women. METHODS: A retrospective cohort study involving 534 Korean women aged 29 to 78 years, who had undergone both dual-energy X-ray absorptiometry and abdominal adipose tissue analysis by computed tomography scan more than twice between January 2004 and December 2010. The changes in the BMD values were examined in association with the changes in fat amount, body composition parameters, and risk factors of MetS. RESULTS: On cross sectional analysis, there was a significant positive correlation between femoral BMD and total abdominal fat amount at the initial visit. However, the correlation disappeared when the impact of change of the fat amount on the change in BMD was analyzed over the study period. When the MetS and body composition parameters were analyzed, a significantly positive correlation was found between skeletal muscle mass and BMD. There was no significant relationship between the MetS risk factors or other body composition parameters and BMD throughout the study period after adjusting for age (time interval). CONCLUSION: Among body composition parameters, only increased skeletal muscle mass had a positive correlation with increased BMD over the study period of 2.7 years.
Abdominal Fat ; Absorptiometry, Photon ; Body Composition ; Bone Density* ; Cohort Studies* ; Cross-Sectional Studies ; Female ; Humans ; Muscle, Skeletal* ; Retrospective Studies* ; Risk Factors

OBJECTIVE: Uterine contraction induced by the embryo transfer (ET) process has an adverse effect on embryo implantation. The aim of this study was to determine the effect of oxytocin antagonist supplementation on the day of ET on in vitro fertilization outcomes via a meta-analysis. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs). Four online databases (Embase, Medline, PubMed, and Cochrane Library) were searched through May 2015 for RCTs that investigated oxytocin antagonist supplementation on the day of ET. Studies were selected according to predefined inclusion criteria and meta-analyzed using RevMan 5.3. Only RCTs were included in this study. The main outcome measures were the clinical pregnancy rate, the implantation rate, and the miscarriage rate. RESULTS: A total of 123 studies were reviewed and assessed for eligibility. Three RCTs, which included 1,020 patients, met the selection criteria. The implantation rate was significantly better in patients who underwent oxytocin antagonist infusion (19.8%) than in the control group (11.3%) (n=681; odds ratio [OR], 1.92; 95% confidence interval [CI], 1.25–2.96). No significant difference was found between the two groups in the clinical pregnancy rate (n=1,020; OR, 1.57; 95% CI, 0.92–2.67) or the miscarriage rate (n=456; OR, 0.76; 95% CI, 0.44–1.33). CONCLUSION: The results of this meta-analysis of the currently available literature suggest that the administration of an oxytocin antagonist on the day of ET improves the implantation rate but not the clinical pregnancy rate or miscarriage rate. Additional, large-scale, prospective, randomized studies are necessary to confirm these findings.
Abortion, Spontaneous ; Embryo Implantation ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Humans ; In Vitro Techniques* ; Odds Ratio ; Outcome Assessment (Health Care) ; Oxytocin* ; Patient Selection ; Pregnancy ; Pregnancy Rate ; Prospective Studies ; Uterine Contraction