• Clinical and Experimental Reproductive Medicine
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• v.36 no.2
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• pp.111-119
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• 2009

Objective: The aim of this study was to compare the clinical efficacy of clomiphene citrate (CC) and letrozole combined with gonadotropins for controlled ovarian stimulation (COS) in patients with CC-induced thin endometrium Methods: Fifty-one intrauterine insemination cycles performed in patients who previously had a thin endometrium (<8 mm) to ovulation induction using CC were included in this study. A CC 100 mg/day (CC+gonadotropin group, n=26) or letrozole 2.5 or 5 mg/day (letrozole+gonadotropin group, n=25) was administered on day 3~7 of the menstrual cycle, combined with gonadotropins at dose 75~150 IU every other day starting on day 5~7. We compared total dose of gonadotropin used, endometrial thickness, endometrial pattern, number of follicles ${\geq}14\;mm$ on hCG day, pregnancy rate and multiple pregnancy rate between the two groups, which were statistically analyzed using Mann-Whitney U test or Fisher's exact test, where appropriate. Results: There were no significant differences in clinical characteristics such as age, duration of infertility, number of previous IUI cycles, basal serum hormone levels and cause of infertility between the two groups. In both groups, the endometrium was significantly thicker than that of previous ovulation induction cycles using CC. No significant differences were found in the total dose of gonadotropin used, day of hCG administration, the rate of triple endometrium and pregnancy rate. The number of follicles ${\geq}14\;mm$ was significantly lower ($3.7{\pm}1.7$ vs. $2.8{\pm}1.7$, p=0.03) and the endometrium on hCG day was significantly thicker ($7.7{\pm}1.5$ vs. $9.1{\pm}1.7$, p=0.001) in letrozole+gonadotropin group compared to CC+gonadotropin group. Conclusion: The clomiphene citrate and letrozole combined with gonadotropins appear to avoid the undesirable effects on the endometrium frequently seen with CC for ovulation induction. However, in terms of adequate endometrial development or optimal follicular growth, letrozole may be more beneficial than CC for gonadotropin-combined COS in patients with CC-induced thin endometrium. Further prospective randomized controlled studies in a larger scale will be necessary to confirm our findings.

• Clinical and Experimental Reproductive Medicine
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• v.23 no.1
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• pp.7-9
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• 1996

Here, A forty year old patient is presented, showing azoospermia following vasovasostomy. The bilateral testicular biopsies were performed to confirm whether ductal obstruction due to vasovasostomy or testicular failure existed. The finding of biopsy was spermatogenic arrest. After completion of medical testicular stimulation with clomiphene citrate and pentoxifilline for 3 months, repeat vasovasostomy was performed. Semenanaylsis revealed normal sperm parameters after operation. Necessity of testicular biopsy before deciding repeat vasovasostomy, accuracy of testicular biopsy, efficacy of testicular stimulation in the patient with spermatogenic arrest and effect of testicular biopsy on testicular fuction are discussed.

• 대한생식의학회:학술대회논문집
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• 2006.11a
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• pp.158-159
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• 2006

• Korean Journal of Veterinary Research
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• v.32 no.1
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• pp.15-24
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• 1992

The effects of CC the ovulatory response, oocyte normality, ovarian steroidogenesis and subsequent embryo developmental potential were examined in PMSG-treated rats. On Days of 25~27 of age, immature female Sprague Dawley rats were treated with three different doses(0.05, 0.1 or 1.0mg /day) of clomiphene citrate or vehicle. The females subsequently received 4IU PMSG on Day 28 and/or 10IU hCG on Day 30, and were killed on Day 31. Some females given 0.1mg CC or vehicle with 4IU PMSG were then mated and killed on Days 2, 3, 4 and 5 of pregnancy. Compared to vehicle(control) group, by increasing the doses of CC, there were a significant decrease in the ovulatory response as judged by both the proportion of rats ovulating and the mean number of oocytes per rat and a marked reduction of ovarian weight. The increasing doses of CC substantially promoted the degeneration(%) of oocytes ovulating in a dose-dependent manner. The CC-mediated inhibitions of the ovulatory response and ovarian weight were oompletely overcome by a subsequent treatment of hCG. Increasing doses of CC resulted in a siginificant elevation of serum estradiol with the decreased levels of progesterone and androgens. The additive treatment with hCG was effective to reduce the elevation of estradiol and to increase the reduction of progesterone produced by high dose(1.0mg) of CC. The preimplantation embryos recovered from 0.1mg CC-treated pregnant rats demonstrated a progressive early loss from Day 3 of pregnancy with a significant increase in the percentage of degeneration during all periods examined, compared to controls. The rate of progressive embryo cleavage in the CC-treated rats were slower than that in controls from Day 3 of pregnancy. Additionally, the percentage of the cleaved embryos recovered from the CC-treated rats remained significantly lower consistently from Day 2 of pregnancy, compared to control regimen. These results demonstrate a possible mechanism of CC-mediated inhibition of ovulatory response in the rats which may include the attenuation or blockade of the endogenous secretion of gonadotropins and also suggest that its detrimental effects observed on oocyte normality and embryonic development may be caused by abnormal follicular steroidogenesis( especially elevated estradiol) preceding fertilization.

• 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.15 no.1
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• pp.61-65
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• 1988

Retrograde ejaculation, an infrequent cause of male infertility, may be the sequala of prostate or bladder neck surgery or the result of interruption in the sympathetic innervation, the diagnosis is established by history and examination of urine. Infertile couple artificial insemination homologous(AIH) using retrograde ejaculate recovered from bladder has been successfully acomplished. In this case, ovulation was induced by clomiphene citrate, osmorality and pH of urine was controlled by buffer solution and immediately specimen collection, to improve sperm mobility. We had experienced a successful pregnancy and delivery case by above method. So here reported with brief review of literature.

• Clinical and Experimental Reproductive Medicine
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• v.18 no.2
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• pp.215-222
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• 1991

Treatment with low-dose follicle-stimulating hormone and laparoscopic laser vaporization is associated with a high rate of ovulation in anovulatory women with polycystic ovarian syndrome (PCOS), but it is not clear which is better. We undertook a randomized controlled study to compare the effects of urinary FSH and hMG using a low dose regimen and laparoscopic laser vaporization of ovaries in sixty women with PCOS. Ovulation occured in 65% subjects and in 71.1% of cycles induced with FSH and in 70% of women and 76% of cycles of those treated with hMG and in 80% of women in laparoscopic laser vaporization of ovaries. A single dominant follicle developed in 62.2% (FSH) and 60% (hMG) of cycles, respectively. Eight singleton pregnancies occured in FSH, hMG group and 12 singleton pregnancies occured in laparoscopic laser vaporization. This study shows that selected patients with PCOS and by induced to ovulate and subsequently conceive by laparoscopically partially vaporizing their ovaries with laser energy.

• Clinical and Experimental Reproductive Medicine
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• v.28 no.1
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• pp.47-53
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• 2001

Objective: This study is to investigate the clinical efficacy of low-dose FSH regimen, comparing with clomiphene citrate and human menopausal gonadotropin (CC/hMG) regimen. Methods: Retrospective study of the ovulatory factor infertility 39 patients who had been treated by intrauterine insemination (IUI). The 31 cycles of 21 patients were stimulated by CC/hMG regimen, the 22 cycles of 18 patients were stimulated by low-dose FSH regimen. We compared the rate of clinical pregnancy, multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) of both group. Results: The rate of clinical pregnancy of the CC/hMG group was 25.7% per cycle, and that of the low-dose FSH group was 54.5% per cycle. The low-dose FSH group showed a higher rate of clinical pregnancy per cycle than CC/hMG group (p=0.028). However, no differences was found statistically in the rate of multiple pregnancy and OHSS between CC/hMG group (22.2%, 5.7%) and low-dose FSH group (33.3%, 13.6%). Conclusion: This study showed that the low-dose FSH regimen is superior to CC/hMG regimen in getting clinical pregnancy, but dose not reduce the ovulation induction complications.

• Clinical and Experimental Reproductive Medicine
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• v.11 no.2
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• pp.17-25
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• 1984

Hypothalamic-pituitary function in patients of 6 selected groups of amenorrhea was evaluated by performing premarin test. Selected amenorrheic patients were divided into 6 groups of Turner's syndrome(5), adrenogenital syndrome(3), Sheehan's syndrome(4), moderate hyperprolactinemia(3), severe hyperprolactinemia(9) and functional oligoamenorrhea(9) the diagnoses of which were performed according to modified our own protocol for management of amenorrheic patients. As control 20 normally cycling women in mid follicular phase determined by their symptothermal charts during last 6 months designed by WHO were compared. The premarin test which is one of the tests evaluating the hypothalamic-pituitary function by the principle of negative and positive feed back effect's of estrogen was performed by injecting 20 mg of premarin in volus intravenously. The levels of serum LH before, 24, 48, 72, 96 and 120 hours after injection of premarin were measured by double antibody technique radioimmunoassay the reagents of which were supplied by WHO. The results were as follows: 1. Both negative and positive feed back effects by exogenous estrogen were well preserved even in the patients of gonadal dysgenesis although the baseline levels were much higher than normal. 2. In the patients of Sheehan's syndrome one could observe the minimal response of feed back effect in the case with minimal pituitary function. 3, Androgens in adrenogenital syndrome and prolactin in hyperprolactinemia may suppress mainly the positive feed back effect rather than the negative one. The suppressive effect can be abolished by proper treatments which can eliminate those suppressive hormones. 4. This premarin test may be beneficial for predicting the result of clomiphene in ovulation induction.

• Clinical and Experimental Reproductive Medicine
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• v.20 no.2
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• pp.125-130
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• 1993

Polycystic ovarian syndrome (PCOS) patients have a characteristic of high leuteinizing hormone (LH) to follicle -stimulating hormone (FSH) ratio. Usually, human menopausal gonadotropin (hMG) is used to induce ovulation in clomiphene citrate-resistant PCOS patients. However, HMG contains two components, namely, LH and FSH, with 50%, respectively. Therefore, FSH is theoretically recommended to stimulate follicular maturation. From the pituitary, LH is secreted by pulsatile pattern. So, we have been using intermittent subcutaneous injection of pure FSH for ovulation induction in 10 PCOS patients from March, 1990 to August, 1992. We obtained good results by intermittent subcutaneous injection of pure FSH. Ovulation is 100% per patient, and 88.2% per cycle. Pregnancy rate is 80% per patient, and 23.5% per cycle. Ovarian hyperstimulation syndrome (OHSS) is 50% per patient, 41.2% per all cycles, and 46.7% per all ovulated cycles. In comparison with HMG, pregnancy rate per cycle is relatively low. But, ovulation rate and pregnacy rate per person is higher than HMG. Because of the strict check of ovaries by the vaginal ultrasonography, OHSS rate is relatively high.