• Clinical and Experimental Reproductive Medicine
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• v.16 no.2
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• pp.211-220
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• 1989

The aim of this study was to compare the response and their outcome of superovulation induction protocol in IVF-ET program. One hundued seventy seven infertile women were stimulated by FSH/hMG(group I, N=128), clomiphene citrate/hMG(group II, N=51), and hMG(group III, N=18) for the purpose of ovulation induction. The results were as follows; 1. The mean ages of patients were $31.9{\pm}3.8$ in group I, $30.6{\pm}3.3$ in group II, and $29.3{\pm}2.5$ in group III. 2. The day of hCG administration was $11.1{\pm}1.8$ in group I, $12.1{\pm}2.0$ in group II, and $13.7{\pm}6.8$ in group III. The hCG administration day of group III was significantly delayed compared with that of group I (p<0.001). 3. The terminal E2 pattern in group II was different from those of group I and III, but there was no significant difference. 4. The mean numbers of mature eggs aspirated were $5.5{\pm}3.8$ in group I, $5.0{\pm}3.3$ in group II, and $5.6{\pm}5.4$ in group III. There was no significant differences in the mean numbers of mature eggs retrieved among the three groups. 5. The fertilization rate of eggs was significantly higher in group II (67.9%) than that of group I (52.2%)(p<0.001). 6. The cleavage rate of group I (67.0%) was significantly lower than those of group II (93.2%) and group III (95.8%) (p<0.0001). 7. The mean numbers of embryos transfered were $3.3{\pm}1.4$ in group I, $3.1{\pm}1.3$ in group II, and $3.2{\pm}1.6$ in group III and the ET rate was 69.0% in group I, 77.3% in group II, and 100% in group III. There was significant difference in ET rate between group I and group III (p<0.005). 8. The pregnancy rates per OPU cycle or ET cycle were not significantly different among the three groups, but delivered and ongoing pregnancy rates were significantly different between group I (36.8%) and group II (p<88.8%) (p<0.05).

• Clinical and Experimental Reproductive Medicine
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• v.16 no.1
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• pp.69-79
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• 1989

Steroid hormone profiles during luteal phase of clomiphene citrate(CC)/human menopausal gonadotropin(hMG)/human chorionic gonadotropin(hCG)-stimulated in vitro fertilization (IVF) cycles and of follicle-stimulating hormone(FSH)/hMG/hCG-stimulated IVF cycles were compared. In seventy three cycles stimulated with CC/hMG/hCG regimen, follicles were aspirated during exploratory laparotomy and yielded 7 pregnancies, and in 83 cycles stimulated with FSH/hMG/hCG regimen, follicles were aspirated by laparoscope and made 13 pregnancies. Serum estradiol($E_2$) and progesterone($P_4$) levels were determined on days 2, 5, 7, and 9 after follicle aspiration. The FSH/hMG/hCG regimen was more effective than the CC/hMG/hCG regimen in folliculogenesis, ie, ovarian stimulation, follicular phase $E_2$ peak levels, oocyte maturation, and the number of retrieved oocytes. There was no significant difference between luteal serum $P_4/E_2$ ratio of the two regimens, suggesting that secretory endometrial build-up ability for implantation may not differ each other. Several significant correlations were observed between follicular phase seum $E_2$ peak levels and luteal phase serum $E_2$ and $P_4$ levels in the FSH/hMG/hCG-stimulated cycles but any correlation was not significant in the CC/hMG/hCG-stimulated cycles, suggesting that somewhat more follicles may eventually fall in atresia even after attaining dominant stage in the CC/hMG/hCG-stimulated cycles than the FSH/hMG/hCG-stimulated cycles.

• Clinical and Experimental Reproductive Medicine
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• v.37 no.2
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• pp.153-158
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• 2010

Objective: To compare the clinical outcomes between oral micronized progesterone and dydrogesterone as a luteal phase support in stimulated intrauterine insemination (IUI) cycles. Methods: A retrospective analysis was performed in 183 IUI cycles during January 2007 to August 2009. Superovulation was achieved by using gonadotropins combined with or without clomiphene citrate. The luteal phase was supported by oral micronized progesterone 300 mg/day (n=136 cycles) or dydrogesterone 20 mg/day (n=47 cycles) from day of insemination. Results: There were no significant differences in clinical characteristics such as age of female, infertility factors, number of mature follicles ($\geq$16 mm), total motile sperm counts, and endometrial thickness on triggering day between the two groups. The clinical pregnancy rates per cycle were similar between the two groups (21.3% in the micronized progesterone group vs. 19.1% in the dydrogesterone group, p=0.92). The clinical miscarriage rate tended to be 3-fold higher in the micronized progesterone group (34.5% vs. 11.1%, p=0.36). Conclusion: Supplementation of oral dydrogesterone as a luteal support has similar clinical outcomes compared with oral micronized progesterone. Large-scaled randomized study would be required to confirm our findings.

• Clinical and Experimental Reproductive Medicine
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• v.15 no.1
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• pp.17-24
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• 1988

Follicular fluid(FF) prostaglandin $E_2$(PG$E_2$) and $PGF_{2{\alpha}}$ levels were compared in 3 groups of spontaneously ovulatory women undergoing ovulation induction with clomiphene citrate (CC) alone or with human menopausal gonadotropin(hMG) (14 patients), hMG(9 patients), or pure FSH/hMG(11 patients) for the purpose of in vitro fertilization. FF volume aspirated did not differ significantly according to the maturity of the oocyte. According to hyperstimulation regimens, the volume of FF from which preovulatory occytes were obtained was significantly less in the hMG-treated group than in the other groups. In follicles of preovulatory oocytes, FF PG$E_2$ values were significantly lower in the FSH treated group than in the Cc.treated or hMG-treated group, and FF $PGF_{2{\alpha}}$ values were significantly higher in the hMG-treated group than in the CC-treated or FSH-treated group. In follicles of immature or atretic oocytes, there was no significant difference in FF PG$E_2$ and PG$F_{2{\alpha}}$ concentrations of the similar morphology of the oocyte according to hyperstimulation regimens. In all cycles, FF PG$E_2$ and PG$F_{2{\alpha}}$ values of preovulatory oocytes were not significantly different from those of immature oocytes, but those of atretic oocytes were relatively lower than those of fertilizable oocytes and it was statistically signifincant in PG$E_2$ values of CC-treated group. In all treatment groups, FF PG$E_2$ and PG$F_{2{\alpha}}$ levels did not show and close relationship with the success of fertilization in vitro and of pregnancy after embryo transfer. Above results suggested that FF PG$E_2$ and PG$F_{2{\alpha}}$ be involved in oocyte maturation and ovulation, but their relationship with the success of in vitro fertilization was not found.

• Clinical and Experimental Reproductive Medicine
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• v.26 no.2
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• pp.239-249
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• 1999

The role of amino acids in culture media for IVF-ET was examined in a total of 76 cycles. Patients received clomiphene citrate (CC) followed by hMG or GnRH-a combined with gonadotropins (FSH/hMG) for controlled ovarian hyperstimulation. Severe male (<$4{\times}10^6$ motile sperm) or age factor (>39 y) patients were excluded in this study. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. No significant differences were found in age, duration of infertility, follicle size, the level of $E_2$ on the day of hCG injection, the mean number of oocytes retrieved, total motile sperm count, fertilization rate and the mean number of embryos transferred between bHTF (without amino acids) and mHTF (with amino acids) groups. However, total ampules of gonadotropins were higher (p<0.01) in mHTF group than bHTF group. Significantly (p<0.05) more clinical pregnancies were recorded in mHTF group (13/30) compared with bHTF group (9/46). The multiple pregnancy rates were 11.1% in bHTF group and 7.7% in mHTF group. There were one ectopic pregnancy in mHTF group and one heterotopic pregnancy in bHTF group. Abortion rates were 22.2% in bHTF group and 7.7% in mHTF, respectively. The ongoing pregnancy or livebirth rate was significantly (p<0.05) higher in mHTF group (12/30) than bHTF group (7/46). These results suggest that the addition of amino acids in culture media is essential for culture of zygotes in vitro and adjustment of energy substrates in phosphate-free culture media appears to be beneficial for human IVF-ET procedure.

• Clinical and Experimental Reproductive Medicine
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• v.26 no.3
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• pp.389-398
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• 1999

Objective: This study was designed to evaluate the effects of endogenous LH surge, GnRH agonist (GnRH-a) or human chorionic gonadotropin (hCG) as ovulation trigger on pregnancy rate by intrauterine insemination (IUI). Method: Patients received daily 100 mg of clomiphene citrate (CC) for 5 days starting on the third day of the menstrual cycle followed by human menopausal gonadotropin (hMG) for ovulation induction. Follicles larger than >16 mm in diameter were present in the ovary, frequent LH tests in urine were introduced to detect an endogenous LH surge. Final follicular maturation and ovulation were induced by GnRH-a 0.1 mg (s.c.) or hCG $5,000{\sim}10,000$ IU (i.m.) administration except natural ovulation. Pregnancy was classified as clinical if a gestational sac or fetal cardiac activity was seen on ultrasound. Results: There were no differences in age, duration of infertility and follicle size, but more ampules of hMG were used in GnRH-a group compared to hCG 10,000 IU treated group (p<0.05). Lower level of estradiol ($E_2$) on the day of hCG or GnRH-a injection was observed in hCG 10,000 IU group than other treatment groups (p<0.01). The overall clinical pregnancy rate was 19.8% per cycle (32/162) and 22.2% per patient (32/144). Pregnancy rate was higher in natural-endogenous LH surge group (37.5%, 9/24) than GnRH-a (18.8%) or hCG treated group (20.9% & 13.9%), but this difference was not statistically significant. No patient developed ovarian hyperstimulation. Abortion rate was 22.2% (2/9) in hCG 5,000 IU group. Delivery or ongoing pregnancy rate was 37.5% (9/24), 18.8% (3/16), 16.3% (7/43) and 13.9% (11/79) in endogenous LH surge, GnRH-a, hCG 5,000 IU and hCG 10,000 IU treatment groups, respectively. Conclusion: These results support the concept that use of natural-endogenous LH surge in stimulated cycles may be more effective to obtain pregnancies by IUI than GnRH-a or hCG administration.

• 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.

• Clinical and Experimental Reproductive Medicine
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• v.15 no.2
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• pp.103-117
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• 1988

Ovulation induction was done with 3 different regimens as clomid combined with HMG, HMG only, and FSH combined with HMG in 28 menstrual cycles for IVF-ET and GIFT program. The appearance of endogenous LH surge, estradiol plateau, atypical LH surge, and time from initiation to peak of LH surge in serum and urine were observed and compared in 3 groups. 1. The estradiol concentration of serum LH surge day was similar in three groups but 1st group (Clomiphene Citrate+Sequential HMG) was slightly higher at $1924.0{\pm}865.1\;pg/ml$. In regards to the existence of serum estradiol plateau, 3rd group (FSH+Sequential HMG) was highest at 60%, and 1st group and 2nd group (HMG only) were similar at 33% and 44% respectively. 2. The number of ovarian of ovarian follicle which was more than 18mm in diameter was $4.1{\pm}2.0$, $4.2{\pm}2.1$ respectibely for 2nd group and 3rd group. Although the numbers were slightly higher thean 1st group for each ovarian follicle, serum estradiol value per follicle was higher for 1st group at $583.0{\pm}261.2pg/ml$. 3. When measuring the urine LH surge according to Hi-Gonavi and according to the standard set by three different types of surge, simultameous satisfaction for 1st group, 2nd group, 3rd group was two cases, five cases, four cases respectively at 40%, and the remained cases were composed of numorous type combination which satisfied the two definition, simultaneously in this study, the LH surge starting time was determined only in the cases tow combination were satisfied simultaneously at first, but there are something to study more. In one case of the 3rd group. 4. The concentration of LH surge start in urine and serum of 2nd group was highest at306. $0{\pm}287.2IU/l$ and $34.0{\pm}9.9mIU/ml$ and 1st group was low at $116.6{\pm}66.1IU/l$ and 7.4mIU/ml. The urine and serum value of LH was highest at $1644.4{\pm}988.8IU/l$, $65.9{\pm}15.0mIU/ml$ for 2nd group, 1st group was low at urine, and 3rd group was low of serum. With pregnancy established, the LH concentration of urine was relatively high but on the contrary the LH concentration of serum was low compared to urine concentration. 5. Time from LH surge start to the maximun of urine and serum value was highest at 15. $7{\pm}9.1$ hrs and $10.8{\pm}4.9$ hrs for 1st group and 3rd group. With pregnancy established, time was shortened for urine but on the contrary serum showed an increase in time. 6. The concentration of LH which increases with time on urine was highest at 2nd group ($194.6{\pm}76.8\;IU/hour$). The lowest increase for serum was at 3rd group (2.1mIU/hour). With pregnancy established, urine showed more increase than control group ($266.5{\pm}47.4\;IU/hour$) and for serum there was similar increase ($3.4{\pm}0.8\;mIU/hour$). 7. There were two examples of non-typical surge from 1st group and 3rd group each. Among these three cases showed a reestablishment of LH surge after 10-24 hours. 8. Endogenous spontaneous Lh surge occurs once for each 2nd group and 3rd group.

• Clinical and Experimental Reproductive Medicine
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• v.35 no.2
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• pp.155-162
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• 2008

Objectives: The aim of this study was to assess the change of ovarian reserve after removal of ovarian tumor using basal FSH, $E_2$, clomiphene citrate challenge test and ovarian volume. Methods: Twenty two patients with unilateral ovarian tumor, ${\leq}35$ years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, $E_2$ and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis. Results: The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ${\geq}10\;cm$ group ($4.79{\pm}2.57\;cm^3$ and $5.21{\pm}1.33\;cm^3$, respectively), but not in the non-endometrioma <10 cm group ($6.18{\pm}2.85\;cm^3$). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were $4.25{\pm}0.20\;mIU/ml$ and $3.79{\pm}0.80\;mIU/ml$, $4.24{\pm}0.85\;mIU/ml$ and $4.28{\pm}0.92\;mIU/ml$, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups. Conclusions: Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique.