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Transabdominal follicular aspiration in an in vitro fertilization cycle: experiences with an unusual but necessary intervention in a resource-limited setting.

Abieyuwa OSEMWENKHA ; James OSAIKHUWUOMWAN

Clinical and Experimental Reproductive Medicine.2016;43(1):54-57. doi:10.5653/cerm.2016.43.1.54

Controlled ovarian hyperstimulation is one of the major steps of in vitro fertilization. The inaccessibility or non-visualization of developing follicles on transvaginal sonography (the preferred imaging method) may be misjudged as a poor response, resulting in cycle cancellation. It is necessary to scrupulously appraise proxy indicators for ovarian response, such as estradiol levels, endometrial thickness, and other individual clinical characteristics. This can prompt meticulous transabdominal ultrasound follicular monitoring and oocyte retrieval with the goal of averting cycle cancellation and improving treatment outcomes.
Estradiol ; Fertilization in Vitro* ; Humans ; Infertility ; Oocyte Retrieval ; Ovulation Induction ; Proxy ; Ultrasonography

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Ileo-uterine fistula in a degenerated posterior wall fibroid after Caesarean section.

Ayman SHEHATA ; Naglaa HUSSEIN ; Ahmed EL HALWAGY ; Adel EL GERGAWY ; Mohamed KHAIRALLAH

Clinical and Experimental Reproductive Medicine.2016;43(1):51-53. doi:10.5653/cerm.2016.43.1.51

Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma. In our case report, we document the rare complication of a fistula occurring between a degenerated myoma in the posterior wall and the ileum 1 week postoperatively in a patient who underwent a Caesarean section but did not have a history of uterine artery embolization.
Animals ; Cesarean Section* ; Estrogens ; Female ; Fistula* ; Humans ; Ileum ; Infertility ; Leiomyoma* ; Mice ; Myoma ; Myometrium ; Pregnancy ; Uterine Artery Embolization ; Uterine Hemorrhage ; Uterus

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Clinical experience with single-port access laparoscopic cystectomy and myomectomy.

Jae Hyeok JEONG ; Yu Ri KIM ; Kil Pyo HONG ; Jae Eun HA ; Eun Jeong KIM ; Da Kyo HONG ; Kyu Sup LEE

Clinical and Experimental Reproductive Medicine.2016;43(1):44-50. doi:10.5653/cerm.2016.43.1.44

OBJECTIVE: This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. METHODS: The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. RESULTS: The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33~0.78 g/dL and 4.14%~2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34~1.13 g/dL and 4.17%~3.24% in SPA laparoscopic myomectomy, respectively. CONCLUSION: This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy.
Cystectomy* ; Hematocrit ; Humans ; Laparoscopy ; Length of Stay ; Surgical Procedures, Minimally Invasive ; Uterine Myomectomy

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Current status of assisted reproductive technology in Korea, 2011.

Gyoung Hoon LEE ; Hyun Jin SONG ; Kyu Sup LEE ; Young Min CHOI

Clinical and Experimental Reproductive Medicine.2016;43(1):38-43. doi:10.5653/cerm.2016.43.1.38

OBJECTIVE: The number of assisted reproductive technology (ART) clinics, ART cycles, clinical pregnancy rate (CPR), and number of newborns conceived using ART have steadily increased in South Korea. This aim of this study was to describe the status of ART in South Korea between January 1 and December 31, 2011. METHODS: A localized online survey was created and sent to all available ART centers via email in 2015. Fresh embryo transfer (FET) cases were categorized depending on whether standard in vitro fertilization, intracytoplasmic sperm injection (ICSI), or half-ICSI procedures were used. Thawed embryo transfer (TET) and other related procedures were surveyed. RESULTS: Data from 36,990 ART procedures were provided by 74 clinics. Of the 30,410 cycles in which oocytes were retrieved, a complete transfer was performed in 91.0% (n=27,683). In addition, 9,197 cycles were confirmed to be clinical pregnancies in the FET cycles, representing a pregnancy rate of 30.2% per oocyte pick-up and 33.2% per ET. The most common number of embryos transferred in the FET procedures was three (38.1%), followed by two (34.7%) and one (14.3%). Of the 8,826 TET cycles, 3,137 clinical pregnancies (31.1%) were confirmed by ultrasonography. CONCLUSION: While the overall clinical pregnancy rate for the TET cycles performed was lower than the rate reported in 2010 (31.1% vs. 35.4%), the overall CPR for the FET cycles was higher than in 2010 (33.2% in 2011 and 32.9% in 2010). The most common number of embryos transferred in FET cycles was three, as was the case in 2010.
Cardiopulmonary Resuscitation ; Electronic Mail ; Embryo Transfer ; Embryonic Structures ; Fertilization in Vitro ; Humans ; Infant, Newborn ; Korea* ; Oocytes ; Pregnancy ; Pregnancy Rate ; Reproductive Techniques, Assisted* ; Sperm Injections, Intracytoplasmic ; Ultrasonography

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The effects of blastocyst morphological score and blastocoele re-expansion speed after warming on pregnancy outcomes.

Huiqun YIN ; Hong JIANG ; Ruibing HE ; Cunli WANG ; Jie ZHU ; Yang LI

Clinical and Experimental Reproductive Medicine.2016;43(1):31-37. doi:10.5653/cerm.2016.43.1.31

OBJECTIVE: The aim of this study was to investigate associations between the morphology score of blastocysts and blastocoele re-expansion speed after warming with clinical outcomes, which could assist in making correct and cost-effective decisions regarding the appropriate time to vitrify blastocysts and to transfer vitrified-warmed blastocysts. METHODS: A total of 327 vitrified-warmed two-blastocyst transfer cycles in women 38 years old and younger were included in this retrospective study. RESULTS: The clinical pregnancy rate (CPR) and implantation rate (IR) of transfers of two good-morphology grade 4 blastocysts vitrified on day 5 (64.1% and 46.8%, respectively) were significantly higher than the CPR and IR associated with the transfers of two good-morphology grade 3 blastocysts vitrified on day 5 (46.7% and 32.2%, respectively). No significant differences were found in the CPR and IR among the transfers of two good-morphology grade 4 blastocysts regardless of the day of cryopreservation. Logistic regression analysis showed that blastocoele re-expansion speed after warming was associated with the CPR. CONCLUSION: The selection of a good-morphology grade 4 blastocyst to be vitrified could be superior to the choice of a grade 3 blastocyst. Extending the culture of grade 3 blastocysts and freezing grade 4 or higher blastocysts on day 6 could lead to a greater likelihood of pregnancy. Since re-expansion was shown to be a morphological marker of superior blastocyst viability, blastocysts that quickly re-expand after warming should be prioritized for transfer.
Blastocyst* ; Cardiopulmonary Resuscitation ; Cryopreservation ; Embryo Transfer ; Embryonic Development ; Female ; Freezing ; Humans ; Logistic Models ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Rate ; Pregnancy* ; Retrospective Studies

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Successful birth with preimplantation genetic diagnosis using single-cell allele-specific PCR and sequencing in a woman with hypochondroplasia due to FGFR3 mutation (c.1620C>A, p.N540K).

Kyung Eui PARK ; Sung Ah KIM ; Moon Joo KANG ; Hee Sun KIM ; Sung Im CHO ; Kyoung Won YOO ; So Yeon KIM ; Hye Jun LEE ; Sun Kyung OH ; Moon Woo SEONG ; Seung Yup KU ; Jong Kwan JUN ; Sung Sup PARK ; Young Min CHOI ; Shin Yong MOON

Clinical and Experimental Reproductive Medicine.2013;40(1):42-46. doi:10.5653/cerm.2013.40.1.42

Hypochondroplasia (HCH) is an autosomal dominant inherited skeletal dysplasia, usually caused by a heterozygous mutation in the fibroblast growth factor receptor 3 gene (FGFR3). A 27-year-old HCH woman with a history of two consecutive abortions of HCH-affected fetuses visited our clinic for preimplantation genetic diagnosis (PGD). We confirmed the mutation in the proband (FGFR3:c.1620C>A, p.N540K), and established a nested allele-specific PCR and sequence analysis for PGD using single lymphocyte cells. We performed this molecular genetic analysis to detect the presence of mutation among 20 blastomeres from 18 different embryos, and selected 9 embryos with the wild-type sequence (FGFR3:c.1620C). A successful pregnancy was achieved through a frozen-thawed cycle and resulted in the full-term birth of a normal neonate. To the best of our knowledge, this is the first report of a successful pregnancy and birth using single-cell allele-specific PCR and sequencing for PGD in an HCH patient.
Blastomeres ; Bone and Bones ; Dwarfism ; Embryonic Structures ; Female ; Fetus ; Humans ; Infant, Newborn ; Limb Deformities, Congenital ; Lordosis ; Lymphocytes ; Molecular Biology ; Parturition ; Polymerase Chain Reaction ; Pregnancy ; Preimplantation Diagnosis ; Prostaglandins D ; Receptor, Fibroblast Growth Factor, Type 3 ; Sequence Analysis

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Ovarian stimulation and liver dysfunction: Is a clinical relationship possible? A case of hepatic failure after repeated cycles of ovarian stimulation.

Emilio GIUGLIANO ; Elisa CAGNAZZO ; Giancarlo PANSINI ; Fortunato VESCE ; Roberto MARCI

Clinical and Experimental Reproductive Medicine.2013;40(1):38-41. doi:10.5653/cerm.2013.40.1.38

Liver damage induced by ovarian stimulation has been demonstrated in some cases reported in the literature. However, there has never been a fruitful debate on this topic. The present manuscript tried to fill this gap. We reported a case of a 35-year-old nulliparous woman admitted to our obstetric emergency room for severe pre-eclampsia. She had been subjected to four cycles of controlled ovarian stimulation for intrauterine insemination. At 32 weeks of gestation, she developed severe pre-eclampsia, which led to HELLP syndrome complicated by fatal liver failure. The etiological link between ovarian stimulation and HELLP syndrome is intriguing. Further investigations are needed to understand whether repeated ovarian stimulation may represent a risk factor in pre-eclamptic patients.
Aluminum Hydroxide ; Carbonates ; Emergencies ; Female ; Fruit ; HELLP Syndrome ; Humans ; Insemination ; Liver ; Liver Failure ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Pre-Eclampsia ; Pregnancy ; Risk Factors

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Barbara CHIFENTI ; Maria Teresa LOCCI ; Gloria LAZZERI ; Mariangela GUAGNOZZI ; Dino DINUCCI ; Federica CHIELLINI ; Maria Elena FILICE ; Maria Giovanna SALERNO ; Lorella BATTINI

Clinical and Experimental Reproductive Medicine.2013;40(1):33-37. doi:10.5653/cerm.2013.40.1.33

Autophagy is a degradation process that acts in response to environmental stressors. Recently, autophagy has been detected in normal term, preeclamptic and intrauterine growth-restricted placentas. The object of this work was to investigate the presence of autophagy in first trimester voluntary interruption of pregnancy placental villi by the expression of autophagy-related proteins, light chain 3 (LC3), and Beclin-1. In first trimester placental villi laser scanning confocal microscopy (LSCM) analysis revealed LC3 and Beclin-1 immunoreactivity prevalently located in villous cytotrophoblasts. Using LSCM, LC3, and Beclin-1 were localized to the cytoplasm of the trophoblast layer in human full-term placentas. Beclin-1 expression and LC3 activation were confirmed by western blotting. These data emphasize that autophagy activation is different among cytotrophoblasts and syncytiotrophoblasts depending on the gestational age and thus we speculate that autophagy might play a prosurvival role throughout human pregnancy.
Autophagy ; Blotting, Western ; Chorionic Villi ; Cytoplasm ; Female ; Gestational Age ; Humans ; Light ; Microscopy, Confocal ; Placenta ; Pregnancy ; Pregnancy Trimester, First ; Proteins ; Trophoblasts

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Natural conception rate following laparoscopic surgery in infertile women with endometriosis.

Hye Jun LEE ; Jae Eun LEE ; Seung Yup KU ; Seok Hyun KIM ; Jung Gu KIM ; Shin Yong MOON ; Young Min CHOI

Clinical and Experimental Reproductive Medicine.2013;40(1):29-32. doi:10.5653/cerm.2013.40.1.29

OBJECTIVE: To investigate the influence of laparoscopic surgery on the natural conception rate in infertile women with endometriosis during the first year after the operation. METHODS: We retrospectively studied 43 infertile women with surgically proven endometriosis. The natural conception rate was investigated for the 12 months after the laparoscopy. RESULTS: The overall pregnancy rate was 41.9% (18/43). 66.7% (12/18) and 94.4% (17/18) of the patients conceived within postoperative 3 months and 6 months, respectively. The spontaneous pregnancy rate was not associated with the severity of endometriosis or laparoscopic findings or the type of surgery. The pregnancy rate for stage IV was relatively low (20.0%) compared to stage I, II, and III (35.7%, 44.4%, and 53.3%, respectively), although it did not reach statistical significance. CONCLUSION: Conservative surgical treatment with laparoscopy and a prompt attempt at natural conception may be effective for infertile patients with endometriosis.
Endometriosis ; Female ; Fertilization ; Humans ; Infertility ; Laparoscopy ; Pregnancy Rate ; Retrospective Studies

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The utility of sperm DNA damage assay using toluidine blue and aniline blue staining in routine semen analysis.

Hee Sun KIM ; Moon Joo KANG ; Sung Ah KIM ; Sun Kyung OH ; Hoon KIM ; Seung Yup KU ; Seok Hyun KIM ; Shin Yong MOON ; Young Min CHOI

Clinical and Experimental Reproductive Medicine.2013;40(1):23-28. doi:10.5653/cerm.2013.40.1.23

OBJECTIVE: The aim of the present study was to examine the relationship among male age, strict morphology, and sperm chromatin structure and condensation. METHODS: Sperm samples from a total of 100 men underwent semen analysis, and sperm chromatin structure and condensation were assessed with toluidine blue (TB) and aniline blue (AB) tests. RESULTS: Prevalence of strict morphology of less than 4%, and abnormal sperm chromatin structure and condensation did not show any statistically significant differences according to male age (p=0.605, p=0.235, and p=0.080). No significant correlation was demonstrated among age of male partners, strict morphology, and abnormal sperm chromatin structure using TB and AB tests. However, abnormal sperm chromatin condensation was positively associated with sperm chromatin structure (r=0.594, p=0.000) and showed negative correlation with strict morphology (r=-0.219, p=0.029). CONCLUSION: The tests for sperm chromatin condensation showed a significant association with strict morphology. Further study is needed to elucidate the relationship between clinical outcome and sperm chromatin tests.
Aniline Compounds ; Chromatin ; DNA ; DNA Damage ; Humans ; Male ; Prevalence ; Semen ; Semen Analysis ; Spermatozoa ; Tolonium Chloride

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