• 대한생식의학회:학술대회논문집
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• 2002.05a
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• pp.62-63
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• 2002

• Clinical and Experimental Reproductive Medicine
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• v.35 no.1
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• pp.83-88
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• 2008

Thromboembolic disease associated with assisted reproductive techniques is considered to be extremely rare but most serious complication. The reasons for this are thought to hypercoagulable state characteristic of OHSS due to high serum levels of estrogen, hemoconcentration and reduced circulating blood volume, but is still unclear. The risk is increased those with rare hypercoagulable conditions such as antiphospholipid antibody syndrome, protein C deficiency, protein S deficiency, antithrombin III deficiency, and those with a personal or family history of thromboembolic disease. The majority of thrombosis reported were venous site but arterial thrombosis mostly intracerebral was reported 5 cases in Korea so far. We present a case of basilar a. thrombosis at 11 days after hCG injection. The patient developed the right hemiparesis, and recovered after intraarterial thrombolysis and transluminal angioplasty. Protein S activity was decreased and vWF antigen was increased. Decreased protein S activity was also found in previous reported 4 cases, so we suggest screening test for protein S in OHSS patients.

• Journal of Embryo Transfer
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• v.18 no.2
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• pp.135-142
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• 2003

본 연구는 사람의 시험관아기 프로그램에서 수정 후 1일째의 전핵 등급이 체외 수정란의 발달에 미치는 영향을 조사하였다. 정상적인 시험관 아기 시술을 시행한 실례 환자를 대상으로 과배란을 유기하여 배란 직전의 난자를 채취하여 정자를 주입한 다음 체외 수정을 유도하였다. 수정 유도 18시간 후 전핵과 핵인의 형태에 따라 전핵의 등급을 1 및 2등급으로 나누어 각각 3일 동안 체외 배양을 실시하여, 체외 수정란의 형태에 따라 1, 2 및 3등급으로 분류하였든 바, 전핵의 등급에 따라 각각 1등급 체외수정란의 발달율은 1등급 전핵란에서는 83.5%로서 2등급 전핵란의 5.5%보다 유의적으로 (P<0.05) 높았다. 1등급 및 2등급 전핵란에서 수정 후 3일째에 5-세포기 이상의 단계로 발달하는 경우는 각각 85.1% 및 24.5%를 나타내었고, 평균 할구수는 7.4$\pm$2.1 및 4.1$\pm$3.5개를 나타내어 발달 능력에서 1등급 전핵란이 2등급 전핵란보다 유의적으로 (P<0.05) 높게 나타났다.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.1
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• pp.73-81
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• 2010

Objective: To examine the efficacy of letrozole in infertile women showing a poor endometrial development at previous ovulation induction cycle by using clomiphene citrate. Methods: Eighteen infertile women were selected who showed a poor endometrial development (endometrial thickness$\leq$6.5 mm) after clomiphene treatment (50~100 mg) as ovulation induction for timed coitus. The mean age of the patients was $30.7{\pm}2.8$ years old and the mean duration of infertility was $33.1{\pm}26.6$ months. The infertility factors were identified as corrected endometriosis (n=1), polycystic ovary syndrome (n=5) and unexplained (n=12). Letrozole was given orally in a dose of 2.5 mg for 5 days starting 3~5 of menstrual cycle. Results: The number of follicles was significantly lower in the letrozole cycle when compared with previous clomiphene cycle ($1.1{\pm}0.3$ vs. $2.2{\pm}1.5$, p=0.011). The endometrial thickness (mm) at the time of triggering or LH surge was significantly greater in the letrozole cycle ($8.4{\pm}1.7$ vs. $5.8{\pm}0.5$, p<0.001). The endometrial pattern 'type C' was significantly higher in the letrozole cycle (94.4% vs. 50%, p=0.036). The pregnancy was achieved in 11.1% of the letrozole cycle. Conclusion: Use of letrozole was associated with more thick and improved endometrium than previous clomiphene cycles in which thin endometrium was identified. Use of letrozole appears to be an effective strategy for second-line treatment in women with inadequate endometrial response to clomiphene.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.1
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• pp.33-39
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• 2007

Objective: The objective of this study was to investigate whether serum levels of vascular endothelial growth factor (VEGF) measured at ovulation triggering day reflect ovarian response in intrauterine insemination (IUI) cycles. Methods: Forty-nine fertile women who undergoing superovulation and IUI were included. Superovulation was performed using clomiphene citrate (100 mg/d on day 3$\sim$7) in combination with human menopausal gonadotropin (150 IU every other day starting on day 5). Serum samples were obtained on the day of hCG administration and the levels of VEGF-A and estradiol were measured. The numbers of mature follicle $\geq$17 mm in diameter were also counted. Results: Serum VEGF-A levels did not correlate with the numbers of mature follicle count nor serum estradiol levels. Serum estradiol level was positively associated with mature follicle count. Serum VEGF-A levels tended to be lower in women with mature follicle count less than three or women with more than five. Conclusion: Our results indicate that serum VEGF-A levels do not have an association with superovulation outcome in IUI cycles. However, a tendency of lower VEGF-A level in poor and high responder suggests that those with extreme response to superovulation may be related with abnormal angiogenesis. Further studies should be warranted in larger populations.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.2
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• pp.135-142
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• 2010

Objective: To evaluate the effectiveness of soft stimulation protocol using GnRH antagonist/clomiphene citrate (CC)/recombinant FSH (rFSH) in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI), compared with GnRH antagonist multiple dose protocol (MDP) using GnRH antagonist/rFSH. Methods: Eighty infertile women were randomized to soft stimulation protocol group (n=40) or GnRH antagonist MDP group (n=40). In both groups, IUI was performed 36~40 hours after hCG injection. Statistical analysis was performed using Student's t-test, $\chi^2$ test or Fisher's exact test as appropriate. Results: Total dose and days of rFSH required for COS were significantly fewer in soft stimulation protocol group (p<0.001, p<0.001). A premature LH surge did not occur in any patients of both groups. Clinical pregnancy rate per cycle was similar between the two groups. Conclusion: Soft stimulation protocol provides comparable pregnancy rates to GnRH antagonist MDP despite fewer total dose and days of rFSH, and so can become one of the patient-friendly, cost-effective alternatives for infertile patients undergoing COS with IUI.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.30 no.2
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• pp.203-210
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• 1997

The aim of this study was to determine the effect of steroids and human chorionic gonadotropin (HCG) on in vitro maturation and ovulation of oocyte in Pseudobagrus fulvidraco. Oocytes were incubated in the media Leibovitz L15 supplemented with the various concentration of $17\alpha,\;20\beta-dihydroxy-4-pregnen-3-one(17\alpha20{\beta}OHP),\;17\alpha-hydroxyprogesterone(17{\alpha}OHP),\;progesterone(P_4),\;estradiol-17\beta(E_2)and\;HCG$. After 60 hours incubation, the maturation ability of oocyte was assessed by the appearance of germinal vesicle breakdown (GVBD). GVBD was significantly enhanced by the addition of $17\alpha20{\beta}OHP,\;17{\alpha}OHP,\;P_4\;and\;HCD(P<0.05)$. The highest CVBD was observed when $17\alpha20{\beta}OHP$ and HCG were supplemented to media. When oocytes were cultured for 16 hours in media containing $10\~1,000\;ng/ml\;17\alpha20{\beta}OHP,\;17{\alpha}OHP\;and\;P_4$, the rate of GVBD in oocytes cultured in the medium supplemented with 100 ng/ml $17\alpha20{\beta}OHP(65\%)$ was significantly higher than that with $17{\alpha}OHP\;(40\%)\;and\;P_4(35\%)$. The efforts of $17\alpha20{\beta}OHP$ and HCG on GVBD were assessed by various concentration of these hormones. When oocytes were cultured for 60 hours in various media containing $1\~1,000\;ng/ml\;17{\alpha}20{\beta}OHP\;or\;5\~1,000\;IU/ml$ HCG, the GVBD of oocytes was significantly increased in the medium with $10\~100\;ng/ml\;17\alpha20{\beta}OHP$ and 500 IU/ml HCT. When oocytes were cultured in the various media supplemented with $1\~1,000\;ng/ml\;17\alpha20{\beta}OHP\;or\;5\~1,000\;IU/ml$ HCG for 60 hours, the media with $1\~100\;ng/ml\;17\alpha20{\beta}OHP\;or\;50\~1,000IU/ml$ HCG significantly increased in the rate of ovulation. However supplementation with $1,000\;ng/ml\;17\alpha20{\beta}OHP$or 5 IU/ml HCG did not improve the rate of ovulation compared to controls. This results indicate that supplementation of steroid and HCG except $E_2$ can improve the in vitro maturation and ovulation of oocyte in P. fulvidrac; HCG and $17\alpha20{\beta}OHP$ may be more effective than other steroids on oocyte maturation and ovulation in P. fulvidraco.

• Journal of Embryo Transfer
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• v.17 no.1
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• pp.1-5
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• 2002

The purpose of this study was carried out to determine the possibility of continued embryo collection by repeatable superovulation from a Hanwoo elite cow, who was already estimated to an elite cow by DNA analysis. The donor cow was superovulated with Folltropin-V and PG $F_2$$\alpha$ combination method for 5 times, 2 months interval during 10 months. The estrus cows were inseminated with frozen semen 3 times 12 hrs interval. Embryo collection from superovulated cows was flushed non-surgical method at 7 to 8 days after artificial insemination. The superovulated cow was collected from 1 to 5$^{th}$ times as total (14, 4, 10, 6, 9 embryos; total 30 embryos) and transferable embryos (7, 4, 10, 3, 6; Mean$\pm$S.E : 6.0$\pm$2.7 embryos). Seventeen recipients were transferred 24 embryos and then detected to pregnant 10 recipients after embryo transfer (58.8%; 10/17 recipients) The results indicated that the possibility of repeatable superovulation from elite donor cow for embryo transfer could be confirmed in this study, although the replicated number was not enough.

• 대한생식의학회:학술대회논문집
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• 2006.11a
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• pp.67-80
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• 2006

비만 특히 복부비만은 여성의 임신 및 출산에 많은 악영향을 미친다. 비만이 가임력에 영향을 미치는 기전은 명확히 밝혀지지는 않았지만, functional hyperandrogenism과 insulin resistance에 수반된 hyperinsulinemia가 중요한 역할을 하리라 여겨진다. 또한 지방조직은 활발하게 대사 작용이 일어나는 장소로서 steroid hormone을 modification 시키고, 여러 가지 adipokine들을 분비시키는데 이런 지방조직의 분비물들은 생식계에 영향을 미친다. 비만이 생식계에 미치는 영향은 간략히 다음 표와 같이 정리할 수 있다 (Table 3). 특히 PCOS 환자에서 비만은 hyperinsulinemia에 의한 난소의 steroidogenesis 증가와 SHBG의 감소에 연관되어 hyperandrogenism 과 무배란의 원인으로 작용한다. 비만은 약물에 의한 배란유도 및 체외수정의 성공률 또한 떨어뜨리며， 임신이 되더라도 자연 유산, 조산, 임신성 당뇨, 임신성 고혈압 등의 위험은 높인다. 이와 같이 최근 급격히 증가하는 비만은 여성의 건강 특히 생식계에 많은 문제를 야기시킨다. 특히 청소년기의 비만은 성인이 된 뒤 PCOS로 발전하여 불임, 심혈관 질환 등과 같은 많은 합병증을 일으킬 수 있으므로 세심한 주의를 기울여야 하겠다.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.684-691
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• 1997

1be ovarian hyperstimulation syndrome is a rare but serious complication of ovulation induction therapy with gonadotropin. The clinical manifestations are generalized edema, ascites with pleural effusion and may become life-threatening in severe cases. The pathophysiology is still unknown, therefore, the treatment should be symptomatic and conservative. We report a case of severe OHSS with massive right pleural effusion in excess of ten liters after human menopausal gonadotropin therapy because of secondary infertility. Fluid and electrolyte imbalances were corrected and albumin was administered. A right chest tube was placed for a total of sixteen days, draining eleven liters of pleural effusion totally, resulting a dramatic decrease of pleural effusion and improvement of symptoms.