• Title/Summary/Keyword: 불임여성

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The Role of the Endometrium and Embryo in Human Implantation (인간 착상 과정에 자궁내막과 배아의 역할)

  • Jee, Byung-Chul
    • Development and Reproduction
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    • v.13 no.1
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    • pp.1-11
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    • 2009
  • Implantation itself is governed by an array of endocrine, paracrine and autocrine modulators, of embryonic and maternal origin. Window of implantation is the unique temporal and spatial expression of factors allows the embryo to implant via signaling, appositioning, attachment, and invasion in a specific time frame of $2{\sim}4$ days. When the embryo has arrived in the uterine cavity, a preprogrammed sequence of events occurs, which involves the production and secretion of a multitude of biochemical factors such as cytokines, growth factors, and adhesion molecules by the endometrium and the embryo, thus leading to the formation of a receptive endometrium. Cytokines such as LIF, CSF-1, and IL-1 have all been shown to play important roles in the cascade of events that leads to implantation. Integrin, L-selectin ligands, glycodelin, mucin-1, HB-EGF and pinopodes are involved in appositioning and attachment. The embryo also produces cytokines and growth factors (ILs, VEGF) and receptors for endometrial signals such as LIF, CSF-1, IGF and HB-EGF. The immune system and angiogenesis play an important role. The usefulness of these factors to assess endometrial receptivity and to estimate the prognosis for pregnancy in natural and artificial cycles remains to be proven. Integrins, pinopodes, glycodelin and LIF (from biopsies) are promising candidates; from uterine flushings, glycodelin and LIF are also candidates. The ideal serum marker is not available, but VEGF, glycodelin and CSF have some clinical implications. Further evaluation that includes larger groups of infertile women and fertile controls are needed to elucidate whether their presence in plasma, flushing fluid, or endometrial samples can be used as some kind of a screening tool to assess endometrial function and prognosis for pregnancy before and after artificial reproductive therapy. A better understanding of their function in human implantation may lead to therapeutic intervention, thereby improving the success rate in reproduction treatment. New molecular techniques are becoming available for measuring both embryonic and endometrial changes prior to and during implantation. The use of predictive sets of markers may prove to be more reliable than a single marker. Ultimately, the aim is to use these tools to increase implantation in artificial cycles and consequently improve live-birth rates.

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Increased Peripheral NK Cell Fraction and Their Cytolytic activity in Patients with History of Recurrent Spontaneous Abortion (말초혈액 자연살해세포 분획 및 세포용해 활성도 분석을 통한 습관성 유산 위험군의 진단적 유용성에 관한 연구)

  • Choi, Ji-Young;Hwang, Su-Jin;Han, Ae-Ra;Yoo, Ji-Hee;Park, Dong-Wook;Park, Chan-Woo;Kim, Hye-Ok;Cha, Sun-Hwa;Kim, Jin-Young;Song, In-Ok;Koong, Mi-Kyoung;Kang, In-Soo;Yang, Kwang-Moon
    • Clinical and Experimental Reproductive Medicine
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    • v.37 no.2
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    • pp.115-124
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    • 2010
  • Objective: To testify whether the increased peripheral blood natural killer (pbNK) cells fraction and their cytolytic activity could coincide with patient's history of recurrent spontaneous abortion (RSA) and to evaluate these factors are can be valuable diagnostic markers in RSA. Methods: Women with a history of RSA comprised the patient group (n=35). Normal fertile women, who were experienced at least one healthy term birth without history of infertility or recurrent miscarriage, were included as the healthy control group (n=15). The pbNK cells of $CD3^-/CD56^+/CD16^+$ and their cytolytic activities against K562 cells were measured by flow cytometry and the values were compared between study and control groups. Results: Proportions of pbNK cells among peripheral blood monocytes (PBMC) ($14.2{\pm}5.2$ vs. $9.4{\pm}3.7%$, p=0.002, 95% confidence interval [CI], 1.8 to 7.8) was significantly higher in the patient group. The odds ratio of having RSA history was increased as 8.4 folds (59% of sensitivity, 80% of specificity, and 95% CI: 2.0 to 35.8) in patients who showed pbNK cells fraction above 12.1% which was determined as cut-off value by using ROC curve analysis. The cytolytic activities of pbNK cells which measured by three different ratio of effecter pbNK cells to target K562 cells and calculated by the percent of cytolytic K562 cells, were significantly higher in study group than that of control group (in 50:1 ratio, $48.3{\pm}19.0$ vs. $31.3{\pm}11.9%$, p=0.002; in 25:1 ratio, $37.0{\pm}18.1$ vs. $20.2{\pm}9.2%$, p<0.001; in 12.5:1 ratio, $23.5{\pm}12.7$ vs. $12.4{\pm}7.3%$, p=0.001). With the cut-off values of cytolytic activity of pbNK cells as 43.1% (50:1), 26.9% (25:1), and 17.4% (12.5:1) each, the risk of having RSA history was increased by 10.0, 11.4, and 15.0 folds in patients who had increased in each effector of pbNK to target of K562 cells ratio. Conclusion: The analysis of pbNK cells fraction and their cytolytic activity can be valuable diagnostic markers for RSA. We are going to planning the large scaled studies which include the data of obstetric outcomes in subsequent pregnancies to clarify our results of this study.

Comparison of Estradiol Results according to Manufacturer (제조회사에 따른 Estradiol 결과값의 비교)

  • Kim, Dae-Woon;Shin, Hee-Jung;You, Tae-Min;Noh, Gyeong-Woon;Kim, Hyun-Joo
    • The Korean Journal of Nuclear Medicine Technology
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    • v.15 no.1
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    • pp.101-105
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    • 2011
  • Purpose: Estradiol in the menstrual cycle and ovulation induction as an important test of currently national nuclear medicine laboratory in the normal patients and patients with infertility tests are being performed. For the diagnosis of menopause is an important test with follicle stimulating hormone (FSH) and Luteinizing hormone (LH). Currently participating in external quality control of the nation's hospitals that is 54 percent of 37 hospitals, 20 hospitals have been using A's reagent. The kit's test results are highly different from other kit comes with the test results of specimens have been found. And for the phenomenon is to study the problem. Materials and Methods: Estraiol test were referred to our hospital which results of samples as more than 100pg/ml 75 specimens measured by radioimmunoassay(RIA) test with company A company B company C company D Kit, Chemiluminescent assay (CMIA) to examine and compare to the results from april to August in 2010. Results: Kit for each manufacturing company as measured by the results obtained using the average value of the correlation coefficient (R2) and A company 0.8906 B 0.9527 C 0.9547 and D company correlation coefficient of 0.873 showed a good correlation that measuring the results of A company high concentrations when Company B Company C Company D with CMIA test concentrations measured low results that the two cases were discovered specimens. Conclusion: Most of the test results of 75 samples came up with a similar trend, but two cases were reported in the patients very differently. A company result reported higher than 700 pg/ml, while the rest of other test results report was approximately 10 pg/ml. The common point of two samples more than 50 years patients are estimated to be diagnosed with cancer in postmenopausal patients receiving treatment and levels of FSH were found to be greater than 50 mIU/ml. Did not identify the exact cause. I suggest if you are using A company kit that need to again check when Estradiol result and follicle stimulating hormone results is higher.

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The Comparison of Pregnancy Outcomes between Elective Two and Three Cleavage-state Embryos Transfer in Fresh IVF-ET (체외수정술시 난할단계 배아 2개와 3개를 이식했을 때의 임신예후의 비교)

  • Lyu, Sang-Woo;Won, Hyung-Jae;Lee, Woo-Sik;Han, Ji-Eun;Kim, A-Ri;Kim, You-Shin;Seok, Hyun-Ha;Yoon, Tae-Ki
    • Clinical and Experimental Reproductive Medicine
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    • v.37 no.1
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    • pp.65-72
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    • 2010
  • Objective: To compare the respective pregnancy outcomes of cycles undergoing elective two cleavage-stage embryos transfer (2ET) and three cleavage-stage embryos transfer (3ET) in fresh in vitro fertilization and embryo transfer (IVF-ET) program. Methods: We conducted a retrospective matched case control study that included 100 women with 2ET and 100 women with 3ET from January 2007 to June 2009. Subjects were matched for reproductive profiles and cycle characteristics. All of transferred embryos in both groups had good qualities. Pregnancy rates (PR), implantation rate, and multiple PR were compared. Results: Demographics, stimulation parameters and embryological data were comparable in both groups. Main pregnancy outcomes with 2ET and 3ET groups were not statistically different; implantation rate (41.0% vs. 35.3%), positive pregnancy rate (58.0% vs. 60.0%), clinical PR (55.0% vs. 59.0%), ongoing PR (51.0% vs. 55.0%), respectively. However, the 3ET group showed significantly higher multiple pregnancy and triplet pregnancy rates (30.9% vs. 50.8%, p=0.031; 1.8% vs. 11.9%, p=0.036, respectively). Conclusion: In women with favorable conditions and good quality embryos undergoing IVF, 2ET can get pregnancy outcomes comparable to those of 3ET and reduce multiple pregnancy (especially, triplet pregnancy).

Comparison of ICSI Outcomes between Fresh and Cryopreserved-Thawed Testicular Spermatozoa (신선 고환조직 정자와 냉동보존-융해 고환조직 정자를 이용한 난자세포질내 정자주입술 결과의 비교 연구)

  • Choi, Young-Sik;Choi, Young-Min;Kim, Soo-Woong;Paick, Jae-Seung;Jee, Byung-Chul;Ku, Seung-Yup;Suh, Chang-Suk;Kim, Seok-Hyun;Kim, Jung-Gu;Moon, Shin-Yong
    • Clinical and Experimental Reproductive Medicine
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    • v.35 no.2
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    • pp.131-141
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    • 2008
  • Objective: To compare the outcomes of intracytoplasmic sperm injection (ICSI) with fresh and cryopreserved-thawed testicular spermatozoa in patients with azoospermia. Methods: One hundred and nine cycles (66 couples) where ICSI was planned with fresh or cryopreserved-thawed testicular spermatozoa were included in this study; Ninety two cycles (61 couples) with fresh testicular spermatozoa (fresh group) and seventeen cycles (13 couples) with cryopreserved-thawed testicular spermatozoa (cryopreserved-thawed group). We compared ICSI outcomes such as fertilization rate, implantation rate, pregnancy rate and miscarriage rate, which were statistically analyzed using Mann-Whitney U test or Fisher's exact test, where appropriate. Results: In 9 out of the 92 cycles where ICSI was planned with fresh testicular spermatozoa, testicular spermatozoa could not be retrieved. Fertilization rate tended to be higher in the fresh group than in the cryopreserved-thawed group ($58.0{\pm}27.8%$ vs. $45.9{\pm}25.0%$, p=0.076). The number of high quality embryos was significantly higher in the fresh group ($0.9{\pm}1.2$ vs. $0.2{\pm}0.5$, p=0.002). However, there were no significant differences in clinical pregnancy rate, implantation rate and miscarriage rate between the two groups. Conclusion: The results of this study suggest that although the use of cryopreserved-thawed testicular sperm for ICSI in patients with azoospermia may reduce fertilization capacity and embryo quality, it may not affect pregnancy rate, implantation rate and miscarriage rate. If testicular sperm can be obtained before ICSI procedure, the use of cryopreserved-thawed testicular sperm may also avoid unnecessary controlled ovarian hyperstimulation and cancellation of oocyte retrieval when spermatozoa cannot be retrieved as well as damage on testicular function by repeated TESE.

Discovery of UBE2I as a Novel Binding Protein of a Premature Ovarian Failure-Related Protein, FOXL2 (조기 난소 부전증 유발 관련 단백질인 FOXL2의 새로운 결합 단백질 UBE2I의 발견)

  • Park, Mira;Jung, Hyun Sook;Kim, Hyun-Lee;Pisarska, Margareta D.;Ha, Hye-Jeong;Lee, Kangseok;Bae, Jeehyeon;Ko, Jeong-Jae
    • Development and Reproduction
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    • v.12 no.3
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    • pp.289-296
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    • 2008
  • BPES (Blepharophimosis/Ptosis/Epicanthus inversus Syndrome) is an autosomal dominant disorder caused by mutations in FOXL2. Affected individuals have premature ovarian failure (POF) in addition to small palpebral fissures, drooping eyelids, and broad nasal bridge. FOXL2 is a member of the forkhead family transcription factors. In FOXL2-deficient ovaries, granulosa cell differentiation dose not progress, leading to arrest of folliculogenesis and oocytes atresia. Using yeast two-hybrid screening of rat ovarian cDNA library with FOXL2 as bait, we found that small ubiquitin-related modifier (SUMO)-conjugating E2 enzyme UBE2I protein interacted with FOXL2 protein. UBE2I also known as UBC9 is an essential protein for processing SUMO modification. Sumoylation is a form of post-translational modification involved in diverse signaling pathways including the regulation of transcriptional activities of many transcriptional factors. In the present study, we confirmed the protein-protein interaction between FOXL2 and UBE2I in human cells, 293T, by in vivo immunoprecipitation. In addition, we generated truncated FOXL2 mutants and identified the region of FOXL2 required for its association with UBE2I using yeast-two hybrid system. Therefore, the identification of UBE2I as an interacting protein of FOXL2 further suggests a presence of novel regulatory mechanism of FOXL2 by sumoylation.

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Developmental Capacity of Mouse Oocytes within Preantral Follicles Cultured in Medium Supplemented with Gonadotroplhins (성선자극호르몬이 첨가된 배양액에서 체외배양된 생쥐 Preantral Follicles 내 난자의 발생능력)

  • Kim, D.H;Kang, H.G.;Kim, M.K.;Han, S.W.;Chi, H.J.;Lee, H.J.;Lee, H.T.;Chung, K.S.
    • Korean Journal of Animal Reproduction
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    • v.24 no.4
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    • pp.395-406
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    • 2000
  • The present study was conducted to examine the developmental capacity of mouse oocytes within prenatal follicles cultured various concentrations of FSH and LH and the expression of cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc) and cytochrome P450 17 $\alpha$ -hydroxylase (P450)$_{17{\alpha}}$ mRNA, as luteinization and atretic marker, in these culture conditions. In addition, we investigated the concentrations of progesterone and testosterone in culture medium. The developmental potential up to blastocyst of the oocytes grown in vitro was higher in the FSH alone (30.2%) and 10 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH treated (28.0%) groups than in the 100 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH treated group (22.0%). And the mean numbers of cell per blastocyst was higher in the FSH alone (50.9$\pm$26.1) and 10 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH treated (51.0$\pm$21.1) groups when compared to the 100 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH treated group (45.2$\pm$15.1). The expressions of P450scc and P450$_{17{\alpha}}$ mRNA in the oocyte -cumulus complexes were increased with increasing of LH concentration, and also the secretions of progesterone and testosterone were increased. Especially, in the 100 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH treated group, the expression of P450scc and P450$_{17{\alpha}}$ were significantly increased, and the secretion of progesterone and testosterone were significantly increased. Therefore, these data show that gonadotrophins are essential for the in vitro culture of preantral follicles, but that increasing of LH concentration is reduced the developmental capacity of oocytes. The cause of these findings may be due to increasing of progesterone and testosterone secretion by the enhance of P450scc and P450$_{17{\alpha}}$ mRNA expressions, as markers of luteinization and atresia. Conclusively, this study suggest that supplementation of 100 $m\ell$U/$m\ell$ FSH or 10 $m\ell$U/$m\ell$ LH and 100 $m\ell$U/$m\ell$ FSH may be optimal condition for the culture of mouse pre antral follicles.

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