• Clinical and Experimental Reproductive Medicine
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• v.37 no.1
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• pp.1-12
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• 2010

진단적 복강경을 하지 않으면 자궁내막증의 진단이 불가능하다는 점은 의사들이 해결해야 할 과제 중 하나이다. 아직까지는 자궁내막증을 진단할 수 있는 획기적인 표지자가 없기 때문에 CA-125 같은 종양 표지자의 혈중 농도를 측정하였으나 진단 도구로 이용하기에는 한계가 있다. 이러한 이유로 초기 자궁내막증을 진단할 수 있는 방법을 연구하기 위한 여러 시도들이 있었는데 특히 자궁내막증 1, 2기 환자에서 병의 초기 상태에 복강경적 치료를 하였을 경우 자연 임신 성공률이 2배 가까이 높은 것으로 보고되었기 때문에 불임 여성에 있어 자궁내막증의 진단 시기는 임상적으로도 그 중요성이 매우 크다고 할 수 있겠다. CA-125는 자궁내막증 환자의 추적관찰에 있어 특이도가 높은 편이며 효용성이 있는데 특히 수술적 치료 후 장기적으로 병의 활성 혹은 재발을 평가하는데 있어 유용하다. 무작위적인 임상 연구 결과 자궁내막증과 관련된 불임이나 통증은 수술적 치료시 분명한 이득이 있는 것으로 보고된 바84 자궁내막증은 적절한 진단과 치료가 중요한 질환이라는 점을 다시 한번 상기해야 한다. 또한 병의 진행에 따른 여러 면역학적인 변화들이 확인되면서 자궁내막증의 진단에 있어 면역학적 표지자의 중요성이 부각되고 있다. 그 중에서도 복막액이나 혈청 내 사이토카인은 진단 도구로서 그 가능성에 주목을 받고 있으며 이에 대한 대규모 연구가 추후 필요할 것으로 사료된다. 최근의 면역학적 발견과 DNA 기술 발전은 자궁내막증의 진단에 있어 핵심적인 screening 도구의 발견에 일조할 것이며 이러한 기술적 발전을 근간으로 하여 머지 않아 획기적인 표지자가 개발될 것으로 기대한다.

• Clinical and Experimental Reproductive Medicine
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• v.33 no.3
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• pp.199-205
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• 2006

Objective: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. Methods: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. Results: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). Conclusion: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis.

• Development and Reproduction
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• v.4 no.1
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• pp.101-108
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• 2000

Objectives: The pleiotrophin (PTN) and midkine (MK) are secreted heparin-binding neurokines that share 50％ sequence homology. PTN and MK are expressed in the range of primary human tumors. The association of PTN and MK with carcinogenesis, enhancement of plasminogen activator activity and angiogenic factor are reported. Patients with endometriosis are characterized by the ability of the endometrium to implant; angiogenic and growth factors may play a significant role in the pathogenesis of endometriosis. To test the hypothesis that higher expression of PTN and MK in endometrium from women with endometriosis might be increase angiogenesis and growth ectopic endometriosis implants, we investigated PTN and MK expression by quantitative and competitive polymerase chain reaction (QC-PCR) in endometrium from women with and without endometriosis throughout the menstrual cycle. Design: MK and PTN mRNA expression in endomeoium from women with endometriosis and control patients without endometriosis were determined by QC-PCR throughout the menstrual cycle. Methods: Endometrial tissue was obtained from 25 patients with severe endometriosis and 30 patients without endometriosis undergoing hysterectomy or endometrial biopsy. Stage of endometrial cycle and a diagnosis of endometriosis were confirmed histologically. Total RNA was extracted and reverse transcribed into c-DNA. QC-PCR was performed to evaluate PTN and MK mRNA expression. Results were analysed by Post Hoc test. Results: MK and PTN were expressed throughout the menstrual cycle in both groups. MK expression was higher in follicular phase than luteal phase in endometrium from normal women. endometrium from endometriosis patients showed increased expression of PTN and MK compared to endometrium from normal women in the luteal phase (p<0.05). Conclusion: Our results suggest that uterine endometrium from women with endometriosis expresses higher levels of MK and PTN than endometrium from normal women during luteal phase. Increased MK and PTN expression may be related to the initiation of ectopic endometrial implants and their subsequent peritoneal invasion.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.275-283
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• 2007

Objective: This study was performed to investigate the expressions of endometriosis related genes in shed endometrial tissues from menstrual blood of patients with or without endometriosis. Methods: The shed endometrial tissues were collected on 2$^{nd}$ or 3$^{rd}$ day of menstrual cycle with Wallace catheter in patients with endometriosis (n=16) and without endometriosis (n=26). The mRNA expressions of twelve kinds of endometriosis related genes were compared between two groups using semi-quantitative RT-PCR. Results: The collected shed endometrium was confirmed by histological observation. Expressions of telomerase, c-kit and aromatase mRNA were not detected by RT-PCR in shed endometrial tissues. The mRNA expressions of apoptosis related genes (fas, fas ligand, bcl-2, bax), stem cell factor, estrogen receptor-$\alpha$/$\alpha$, endometriosis protein-I and secretory leukocyte protease inhibitor gene were similar between shed endometrial tissues with endometriosis and without endometriosis. Conclusion: We could not find the difference of mRNA expressions of tested endometriosis related genes between shed endometrial tissues with or without endometriosis by semi-quantitative RT-PCR analysis. It may be related to the dynamical changes of gene expressions in the endometrium with menstrual cycle.

• Clinical and Experimental Reproductive Medicine
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• v.33 no.4
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• pp.219-227
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• 2006

Objective: To evaluate the impact of endometriosis on IVF-ET cycles and to compare IVF outcomes between stage I/II and stage III/IV endometriosis. Methods: We analyzed 697 patients (1,199 cycles) with endometriosis (stage I-II:638 cycles, stage III-IV: 561 cycles) and 325 pts (459 cycles) with tubal factor as controls between January 1994 and April 2004. Pts with endometriosis were diagnosed by laparoscopy and medical and surgical treatment were done in 353 cycles (55.3%) and 466 cycles (83.1%) of stage I-ll/stage III-IV endometriosis. Cycles with age>35 years or FSH>20 miU/mL or severe male factor infertility were excluded. Results: The number of retrieved oocytes ($9.97{\pm}7.2$ vs. $13.4{\pm}7.9$ (p<0.0001 )), total number of embryos ($6.5{\pm}4.8$ vs. $9.1{\pm}5.6$ (p<0.0001)), and good quality embryos ($2.43{\pm}1.6$ vs. $2.74{\pm}1.7$ (p=0.013)) significantly decreased in stage III-IV endometriosis than in control. But pregnancy rate of stage III-IV endometriosis was comparable with control (35.7% vs. 36.8%). Fertilization rate and number of total embryos were lower in stage I-II endometriosis than in control ($64.8{\pm}22.9$ vs. $70.8{\pm}20.8$ (p<0.0001), $7.6{\pm}5.0$ vs. $9.1{\pm}5.6$ (p<0.0001)). In patients with medical and surgical treatment of endometriosis, pregnancy rate and live birth rate was significantly lower in stage I-II than in stage III-IV endometriosis (29.2 vs. 36.2 (%), p=0.045, 23.9 vs. 31.5 (%), p=0.043). There was no difference in the mean age, but the duration of infertility was significantly longer ($56.5{\pm}26.3$ vs. $46.9{\pm}25.8$ (mon), p<0.0001) and fertilization rate was lower ($64.7{\pm}23.3$ vs. $70.5{\pm}22.7$ (%), p=0.001) in stage I-II than stage III-IV endometriosis. Conclusion: We suggest that IVF should be considered earlier in patients with minimal to mild endometriosis because of significantly decreased fertilization rates.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.2
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• pp.159-168
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• 2010

Objective: The purpose of this study was to evaluate the correlation between the expression pattern of vascular endothelial growth factor (VEGF) in endometrium and the pathogenesis of endometriosis by investigating VEGF expression patterns and their difference between eutopic endometrium of patients with endometriosis and that of normal controls without endometriosis. Methods: Endometrial sections were obtained from 64 hysterectomy specimens from women under age of 40, who had undergone hysterectomies and had histological evidence of endometriosis, with stage 3 and 4 according to the revised American Society for Reproductive Medicine classification. As for controls, 37 sections were gained from women diagnosed as having cervical intraepithelial neoplasia (CIN) of the uterine cervix and without evidence of pelvic endometriosis or adenomyosis during their operation. The VEGF content was evaluated immunohistochemically in the eutopic endometrium from 64 patients with endometriosis and 37 normal controls. Histological semiquantitative score (H-score) was calculated and compared between study group and control group throughout the menstrual cycle. Results: There was no significant difference in the H-score of VEGF in the eutopic endometrium between patients with endometriosis and controls without endometriosis when compared according to the same phase of the cycle, although the H-score of the study group was significantly higher in the secretory phase than the proliferative phase. Conclusion: The VEGF expression in the eutopic endometrium of women with endometriosis was not different from that of women without endometriosis. This study suggests VEGF expression in eutopic endometrium is unlikely associated with the pathogenesis of endometriosis.

• Clinical and Experimental Reproductive Medicine
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• v.29 no.3
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• pp.223-227
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• 2002

연구목적: 전반적인 자궁내막증이 체외수정시술에 미치는 영향을 알아보고, 특히 stage III-IV 자궁내막증을 갖는 불임환자 체외수정시술 결과에 대하여 알아보고자 본 연구를 시행하였다. 연구재료 및 방법: 1998년 9월부터 2001년 9월까지 진단복강경을 통해 자궁내막증으로 진단된 환자 중 체외수정시술을 시행 받은 91명 131주기를 대상으로 하였으며 이중 stage III-IV의 자궁내막증을 갖는 환자는 27명 34주기였다. 비교군은 이시기에 진단된 순수 난관원인으로 체외수정시술을 시행한 40명 56주기를 대상으로 하였다. 통계학적 검사는 Student's t-test와 Chi-square test를 시행하였고, p<0.05를 유의성이 있는 것으로 판정하였다. 결 과: 전체 자궁내막증 환자와 난관인자의 체외수정시술에서 두 군간의 나이는 $31.6{\pm}3.3$, $32.6{\pm}3.6$세로 비슷하였다. 채취된 난자의 수 ($10.3{\pm}6.6$ vs $11.7{\pm}5.1$), 성숙난자 수 ($7.4{\pm}4.7$ vs $7.7{\pm}4.9$), 수정율 ($70.2{\pm}32.4%$ vs $73.7{\pm}20.0%$), Good embryo quality rate (8세포 (G1+G2)를 2PN의 개수로 나눈 값) (32.6% vs 32.4%) 및 배아이식 수 ($4.6{\pm}1.4$ vs $4.8{\pm}1.1$)로 두 군간에 차이는 없었다. 또한 임상적 임신율의 경우도 각각 30.7%, 42.8%로 비슷하였다. 중등도 및 중증의 자궁내막증과 난관인자의 비교에서 성숙난자 및 채취된 난자의 개수는 각각 $8.8{\pm}4.9$, $7.7{\pm}3.9$, $11.3{\pm}7.0$, $11.7{\pm}5.1$개로 두 군간에 차이는 없었다. 수정율은 stage III와 IV 군에서 감소되는 경향을 보였으나 통계학적인 유의성은 없었다 ($66.2{\pm}30.0%$ vs $73.7{\pm}20.0%$). Good qulity embryo rate (GQER)는 stage III-IV 자궁내막증 환자군에서 22.0%로 순수 난관인자의 32.4%에 비하여 감소하는 경향을 보였으나 통계학적인 유의성은 없었다 (p=0.15, Chi-square test). 배아이식 수의 경우는 각각 $4.7{\pm}1.5$, $4.8{\pm}1.1$개로 차이가 없었다. 배아이식 주기당 임상적 임신율의 경우는 stage III-IV군에서 25.0% (8/32), 난관인자 군의 42.8% (24/56)로 통계학적인 유의성은 없었으나 (p=0.06, Chi-square test), 중등도 및 중증의 자궁내막증을 갖는 환자에서 임신율이 감소하는 경향을 보였다. 결 론: 체외수정시술시 자궁내막증이 임신율에 나쁜 영향을 미치지 않지만, 중등도 및 중증의 자궁 내막증을 갖는 불임환자의 체외수정시술에서는 임신율에 나쁜 영향을 끼칠 가능성이 있을 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• v.33 no.4
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• pp.229-236
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• 2006

Objective: We investigated the expression of uPA and uPAR in eutopic endometrium of advanced stage endometriosis and control patients. Methods: The 33 endometriosis patients and 32 controls were enrolled. Endometrial samples were obtained from 65 premenopausal women aged 29-44 years, undergoing laparoscopic surgery or hysterectomy for non-malignant lesions. Sufficient samples were collected from 33 patients with endometriosis stage Ill and IV and 32 controls without endometriosis confirmed by laparoscopic surgery. The mRNA expression of uPA and uPAR from eutopic endometrium were analyzed by RT-QC PCR. Results: The mRNAs of uPA and uPAR were expressed in eutopic endometrium from endometriosis and normal controls throughout the menstrual cycle. Uterine endometrium from women with endometriosis expresses significantly (p<0.05) higher levels of u-PA mRNA than endometrium from normal women without endometriosis in the proliferative phase. There were no significant differences in expression of uPAR in eutopic endometrium between controls and endometriosis patients. Conclusion: These results suggest that eutopic endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation because of greater u-PA mRNA expression than endometrium from women without endometriosis. Thus, increased proteolytic activity may be one etiology for the invasive properties of the endometrium resulting in the development of endometriosis.

• Journal of Digital Convergence
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• v.16 no.8
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• pp.243-252
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• 2018

The purpose of this study was to examine relationships among disease-related characteristics, symptom stress, quality of life in women with endometriosis, and then to identify predictors of quality of life in them. The self-reported questionnaires were administered to 99 women in one general hospital. As results of multiple regression analysis, the factors affecting quality of life in women with endometriosis were sick leave (${\beta}=-.27$, p=.000) and symptom stress (${\beta}=.59$, p=.000), explained women's quality of life with 57.0% (F=11.39, p<.001). Based on the findings, there is a need to develop a self-care program for chronic pain and a nursing intervention for enhancing a quality of life in women with endometriosis.

• Development and Reproduction
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• v.3 no.1
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• pp.29-38
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• 1999

The pathogenesis of endometriosis is unknown, but retrograde menstruation is widely accepted as an etiology. Refluxed endometrium from endometriosis patients is more prone to implant and invade peritoneum possibly through the action of extracellular proteolysis. This proteolytic action may involve plasminogen activators and the collagenase system. Plasminogen activators (PAs) and matrix metalloproteinases (MMPs) play a critical role in the breakdown of extracellular matrix components and basement membrane in the processes of implantation and tumor invasion. PAs are inhibited by plasminogen activator inhibitor (PAI) and MMPs activity is inhibited by tissue inhibitor of metalloproteinase (TIMP). To test the hypothesis that lower expression of PAI-1 and TIMP-3 in endometrium from women with endometriosis, we investigated their PAI-1 and TIMP-3 expression by quantitative competitive RT PCR in endometrium from women with and without endometriosis. Endometrial tissues were obtained from 14 patients with severe endometriosis and 14 patients without endometriosis. Total RNA was extracted and reverse transcribed into cDNA, and quantitative competitive PCR (QC PCR) was performed to evaluate PAI-1 and TIMP-3 mRNA expression. Endometrium from patients with endometriosis showed decreased expression of PAI-1 and TIMP-3 mRNA compared to endometrium from control in luteal phase (p<0.05). Our results suggest that endometrium from women with endometriosis expresses lower levels of PAI-1 and TIMP-3 than endometrium from normal women. Endometrium from endometriosis patients may be more invasive and prone to peritoneal implantation than control because of higher PA and MMP enzymatic activity. Thus, increased proteolytic activity may be one of the reasons for the invasive properties of the endometrium resulting in the development of endometriosis.