• The Journal of Korean Obstetrics and Gynecology
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• v.30 no.4
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• pp.59-76
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• 2017

Objectives: The purpose of this study is to investigate the effect on both herbal medicine periodic therapy and western medicine for polycystic ovary syndrome subfertility. Methods: We searched 8 electronic databases and search keywords were 'PCOS' and 'periodic therapy' or 'cyclic treatment'. We included randomized controlled clinical trials (RCTs) using the periodic therapy combined western medicine for PCOS patients. Results: We selected 8 studies. In studies, there were three studies in which the menstrual cycle was divided into 2 periods, one study divided into 3 periods, and four study divided into 4 periods. The meta-analysis of the 7 trials indicated that pregnancy rates integrated clomiphene and periodic therapy were higher than clomiphene alone. Conclusions: The periodic therapy combined western medicine for PCOS subfertility patients seems to improve pregnancy rates from this research. However, this result should be taken cautiously by unclear risk of bias. It would be necessary to fulfill further clinical study with herbal medicine periodic therapy on PCOS in Korean medicine to establish standard evidence of them.

• Clinical and Experimental Reproductive Medicine
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• v.22 no.2
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• pp.123-130
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• 1995

Many types of medication regimens have been used for controlled ovarian hyperstimulation for assisted reproductive technique(ART). Questions are now being raised regarding how to lower the escalating costs of assisted reproduction and decrease the extent of patient discomfort and disruption of life style without sacrificing success rates. In this investigation, from January 1994 through August 1994 patients presenting to the Chung-Ang university hospital, infertility clinic were offered the option of the clomiphene citrate (CC)/single Human Menopausal Gonadotropin(HMG) combination and conventional GnRH-agonist combination method. 60 patients (78 cycles) were given CC/single HMG combination as a study group, and 78 patients (102 cycles) were given conventional GnRH-a combined ultrashort protocol as a control group for IVF-ET program and the resulting number of oocyte retrieved, embryo produced, and pregnancy initiated were compared. There were no differences between the two groups in mean age, serum $E_2$, LH and FSH level on menstrual cycle day 2. HMG requirement was 2 ampules in study group and $24.2{\pm}6.8$ ampules in control group. On the day of HCG injection, serum LH and FSH levels were not significantly different, but serum $E_2$, was significantly higher in control group(p<0.001). There was relatively well endometrial quality in control group but not significant compare to study group. In control group, numbers of retrieved oocyte and transferred embryo were significantly more than study group(p<0.001). Fertilization rate was not significantly different in the two groups and pregnancy rates were 20.2% in study group 28.4% in control group(p<0.001). CC/single HMG protocol for IVF-ET is less expensive than GnRH-a combined ultrashort protocol and minimizes patients discomfort. In addition, CC/single HMG protocol produces acceptable pregnancy rate and represents an attractive alternative to select patients undergoing IVF-ET.

• The Journal of Korean Obstetrics and Gynecology
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• v.36 no.2
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• pp.36-54
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• 2023

Objectives: This study was aimed to develop a Korean Medicine (KM) clinical practice guideline (CPG) of Nausea and Vomiting of Pregnancy (NVP). Methods: We conducted a questionnaire survey targeting KM doctors belonging to the Association of Korean Medicine by e-mail. We received 1,023 responds, and analyzed the answers. Results: 1. 83.0% of respondents knew the concepts and contents of CPG, and 98.1% had practical use plan. 2. 82.1% of respondents used pattern identification diagnosis for NVP patients, and the most commonly diagnosed pattern was spleen-stomach weakness (脾胃虛弱) with 41.3%. 3. The most frequently used treatment for NVP patients was KM combined treatment (46.7%). Herbal medicine+acupuncture (46.8%) was most used among KM combined treatments, and herbal medicine (37.1%) was most used among KM single treatments. 4. Among the contents of CPG for NVP, the fields of interest were selected in the order of KM treatment, KM-Western medicine cooperative treatment, KM diagnosis, prevention and regimen management. In the 'diagnosis part', the use of the symptom evaluation scale questionnaire was 41.8%, higher than the KM pattern diagnosis (34.4%). In the 'treatment part', herbal medicine accounted for 33.8%, higher than that of acupuncture (including electro-acupuncture) at 23.7%. 5. As for the expected development effects, opinions on evidence-based, safety, clinical use, and standardization were the most common. Conclusions: We figured out KM doctors' recognition of KM clinical practice guideline, clinical diagnosis, treatment on NVP to make the contents of the CPG reflecting the clinical situation.

• The Journal of Korean Obstetrics and Gynecology
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• v.36 no.1
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• pp.54-72
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• 2023

Objectives: The purpose of this study is to review the recent clinical study trends on Korean Medicine treatment for vaginitis during pregnancy. Methods: We searched articles published from electric databases including Oasis, KISS, Pubmed, and CNKI. The period was set from 2012 to 2021. Searched keywords were "임신 중 질염", "한약", "Vaginitis during pregnancy", "Herbal medicine", "妊娠合并阴道炎", "中药". Results: 34 articles were finally selected. Except 1 case series study, there were 33 RCTs, 1 article of which used both herbal decoction and herbal fumigation for treatment group (TG) ; 18 employed herbal fumigation only, and 14 took both herbal fumigation and western medicine. The total effective rate or cure rate in TGs, regardless of treatment methods, was higher than that of control group in all RCT studies. Conclusions: Our review found that Korean medicine alone or combined with western medicine is more effective for alleviating symptoms of vaginitis during pregnancy than the control group.

• Clinical and Experimental Reproductive Medicine
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• v.20 no.2
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• pp.149-156
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• 1993

Human chorionic gonadotropin(hCG) and intravenous immunoglobulin(IVIG) treatment were attempted as a novel therapeutic approach for unexplained recurrent spontaneous abortion(RSA). Forty-four and 3 women with a history of RSA were treated with hCG and IVIG, respectively, during pregnancy. Of these patients, serum blocking factor assay was performed before and after each treatment, in 15 patients; 12 cases with hCG and 3 cases with IVIG. The results were as follows: 1. Of 44 women who receive hCG during pregnancy, 24 delivered healthy infants at term, 10 patients suffered repeat abortion, and 10 women are still pregnant under 28 weeks. Over all success rate of hCG treatment was 70.6% (24/34). Although there is no statistical significance, absolute serm blocking level was decreased after treatment(N=12). 2. Of 3 women who receive IVIG during pregnancy, all 3 women are still pregnant under 28 weeks. Serum blocking level was increased after treatment, however, this increment was not statistically significant. Although no conclusion could be extracted from the patients who received IVIG, the therapeutic effect of hCG is comparable to that of the other therapeutic regimens, such as allogeneic leukocytes. It was postulated that actual etiology of unknown RSA would be classified as hormonal origin although combined etiologies are common in Korean women.

• Women's Health Nursing
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• v.6 no.4
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• pp.549-565
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• 2000

Comprehensive review of the literature was conducted to determine 1) selected risk factors and its impact that affect pregnancy outcome such as smoking, alcohol consumption, and substance abuse 2) these factors can facilitate future strategies for health promotion and prevention for both pregnant women and fetus. Review of literature were extracted from searching MEDLINE(1966 - Oct. 2000). CINAHL (1982 - Oct. 2000) and the domestic literature. The following factors were identified: 1. The effects of risk behaviors on pregnancy. ${\cdot}$Maternal smoking was associated with the occurrence of premature or LBW delivery, fetal growth retardation, extremities defects, heart defects and sudden infant death syndrome. ${\cdot}$Maternal alcohol consumption was associated with spontaneous abortion, premature or LBW delivery, morphologic/neurologic problems, especially fetal alcohol syndrome. ${\cdot}$Heroin was associated with withdrawal after birth in which were born to heroine addicts for gestational age and lung maturation in animal studies. ${\cdot}$Cocaine was associated with spontaneous abortion, abruptio placenta and a poor response to environmental stimuli. ${\cdot}$So far, the effects of caffeine on pregnancy was controversial, but severe caffeine consumption was associated with premature or LBW delivery, spontaneous abortion, still birth and dystocia. 2. Intervention methods and its effects identified were as follows ${\cdot}$Conducted intervention for smoking, alcohol and drug consumption were single or combined. ${\cdot}$Intervention methods were counseling, phone contact, mailing, use of educational videotape, booklet, support person and alternatives such as nicotine patch. ${\cdot}$The interventions increased the rates of smoking cessation during pregnancy and awareness of the risk of drug consumption, and decreased amount of alcohol consumption. ${\cdot}$The intervention outcome found positive effect on birth weight and length. 3. Our recommendations were as follows ${\cdot}$The personal and social cognition should be enhanced through education and the mass media. ${\cdot}$It's necessary to educate and give information of preconceptional care, planned pregnancy and early prenatal care for optimal pregnancy outcome. ${\cdot}$It's necessary to develop comprehensive assessment tool which is reliable and valid on smoking, alcohol consumption and substance abuse to identify supportive or interventional program.

• 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.21 no.1
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• pp.13-20
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• 1994

Status of endometrium is a very important factor which influences the implantation of fertilized embryos. In this study, we evaluated the possibility that the endometrial depth and pattern assessed by vaginal sonography on the day of human chorionic gonadotropin (HCG) injection in in vitro fertilization (IVF) cycles could be used to predict the IVF outcome. A total of 112 cycles using gonadotropin releasing hormone agonist (GnRHa) for ovulation induction were evaluated. We classified all patients into group A(<9mm) or group B(${\geq}$ 9mm) according to endometrial depth, and into group l(hyperechogenic), group 2(isoechogenic) or group 3(hypoechogenic and triple line) according to endometrial pattern. The other classification was made considering both endometrial depth and pattern. There was no significant correlation between serum estradiol level and endometrial sonographic findings(depth and pattern)(p>0.05). The pregnancy rate of group A(31.3%) did not differ significantly from that of group B(43.7%), but no pregnancies were found in any patients with endometrial depth less than 6mm. The pregnancy rate was 40%, 35.7%, and 44.6 % for group 1, gorup 2, and group 3, respectively, but there was no statistically significant difference between these groups(p>0.05). In combined classification, there was a trend of higher pregnancy rate in case of endometrial depth greater than 9mm and hypoechogenic triple line pattern, but there was no statistically significant differences between these groups(p>0.05). The conclusion from the present data is that endometrial ultrasonography on the day of hCG administration had no predictive value for conception in IVF cycles.

• Clinical and Experimental Reproductive Medicine
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• v.42 no.3
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• pp.106-110
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• 2015

Objective: This study aimed to investigate the effect of a new clomiphene citrate (CC) regimen on preventing thin endometrial lining in polycystic ovary syndrome (PCOS) patients receiving CC plus gonadotropin treatment with a timed intercourse cycle. Methods: A total of 114 women with PCOS were included in this trial. Patients were divided into two groups and treated in accordance with the controlled ovarian stimulation (COS) protocol. In group A, 104 COS cycles in 67 patients were included, and in each cycle 150 mg CC was given for three days, starting from day 3. In group B, 69 COS cycles in 47 patients were included, in which 100 mg CC was given for five days, starting from day 3. The thickness of the endometrium was measured on the day of human chorionic gonadotropin (hCG) injection. Timed intercourse was recommended at 24 and 48 hours after the hCG injection. Results: Additional doses of human menopausal gonadotropin and the number of days of hCG administration were not significantly different between the two groups. Endometrial thickness on the day of hCG administration was significantly larger in group A than group B (4$9.4{\pm}2.1mm$ vs. $8.5{\pm}1.7mm$, p=0.004). The pregnancy rate was significantly higher in group A than in group B (38.4% vs. 21.7%, p=0.030). Conclusion: Three-day CC treatment resulted in a significantly higher pregnancy rate than the standard five-day CC treatment in a timed intercourse cycle in PCOS patients. Facilitating adequate endometrial growth via the early discontinuation of CC might be a crucial factor in achieving a higher pregnancy rate.

• Clinical and Experimental Reproductive Medicine
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• v.43 no.4
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• pp.228-232
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• 2016

Objective: The aim of this study was to investigate the impact of pretreatment with transdermal estradiol ($E_2$) compared to oral contraceptive pills (OCPs) on controlled ovarian stimulation (COS) response in normal responders undergoing fresh in vitro fertilization (IVF)-embryo transfer (ET) cycles. Methods: A retrospective cohort study was performed of normal responders undergoing fresh IVF-ET cycles who received pretreatment with transdermal $E_2$ versus OCPs prior to fresh IVF-ET. The total days of ovarian stimulation, total dosage of gonadotropins, total number of oocytes, and mature oocytes retrieved were noted. Pregnancy outcomes after ET were also recorded. Results: A total of 2,092 patients met the inclusion criteria: 1,057 and 1,035 patients in the transdermal $E_2$ and OCP groups, respectively. Patients in the OCP group had a longer duration of COS ($10.7{\pm}1.63days$, p< 0.01) than the $E_2$ group ($9.92{\pm}1.94days$). Patients in the OCP group also required higher cumulative doses of gonadotropins ($2,657.3{\pm}1,187.9IU$) than those in the $E_2$ group ($2,550.1{\pm}1,270.2IU$, p= 0.002). No statistically significant differences were found in the total and mature oocytes retrieved or in the rates of biochemical pregnancy, clinical pregnancy, spontaneous miscarriage, and live birth between the groups. Conclusion: Our findings suggest that compared to OCPs, pretreatment with transdermal $E_2$ is associated with a shorter duration of ovarian stimulation and lower gonadotropin utilization, without compromising the oocyte yield or pregnancy outcomes in normal-responder patients undergoing fresh IVF.