• Clinical and Experimental Reproductive Medicine
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• v.23 no.1
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• pp.51-59
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• 1996

Controlled Ovarian hyperstimulation(COH) is generally used to obtain synchronous high quality oocytes in in vitro fertilization-embryo transfer(IVF-ET). Many investigators have studied the relationship between serum hormone levels and outcomes of IVF-ET because there is no accurate estimation method of oocyte quality. Early premature luteinization of follicles before oocyte retrieval is the most troublesome problem in COH for IVF-ET. Gonadotropin-releasing hormone agonists(GnRH-a) are used as adjuncts with gonadotropins for COH in patients undergoing in IVF. The possible benefits of GnRH-a pretreatment include improving oocyte quality, allowing a more synchronous cohort of follicles to be recruited, and preventing premature lueinization hormone surges. In COH of IVF cycles, we investigated whether an elevated progesterone(P4) level on the day of human chorionic gonadotropin(hCG) administration indicates premature luteinization and is associated with a lower fertilization rate. Many investigators have studied that the lower fertilization rates seen in patients with elevated P4 levels might result from an adverse effect of P4 on the oocytes. We hypothesizes that serum P4 levels around the day of hCG may be helpful prediction of out come in IVF-ET cycles. Success rates after COH of IVF-ET cycles are dependent upon many variable factors. Follicular factors including the number of follicles, follicular diameters and especially serum estradiol(E2) levels as an indirect measurement of follicular function and guality have been thought to influence the outcomes of IVF-ET. To assess whether serum P4 and E2 levels affect the fertilization and pregnancy rate, we reviewed the stimulation cycles of 113 patients (119 cycles) undergoing IVF-ET with short protocol with GnRH-a, from March 1993 to August 1994 retrospectively. The serum P4 and E2 levels were compared on the day of hCG in the pregnant group, 45 patients(47 cycles) and in the non-pregnant group, 68 patients (72 cycles) respectively. The serum E2 level in non-pregnant group was $1367{\pm}875.8$ pg/ml which was significantly lower than that of pregnant group, $1643{\pm}987.9$ pg/ml( p< 0.01 ). And the serum P4 level in non-pregnant group was $2.1{\pm}1.4$ ng/ml which was significantly higher than that of pregnant group, $1.0{\pm}0.7$ ng/ml( p< 0.001 ). The fertilization rate was $61.3{\pm}21.3%$ in pregnant group which was higher than that of non-pregnant group, $41.1{\pm}20.2%$ (p< 0.01). We suggest that the serum levels of P4 and E2 on the day of hCG administration are additional parameters that predict the outcomes of IVF-ET cycles.

• The Korean Journal of Nuclear Medicine
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• v.1 no.1
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• pp.37-54
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• 1967

The changes in histopathology of various organs and growth inhibition of the chick embryos incubated with radioactive sulfur ($^{35}S$) were experimentally studied. The various doses of $^{35}S$ were injected into the yolk sac at different intervals and the weight changes of the embryos were evaluated to determine the growth inhibition rates. The embryos sacrified on various incubation days were used for the study of histopathological changes in organs such as the bone, liver, kidney, gonad, and eye. Following were the results: 1) The weight changes of the $^{35}S$ treated groups were as follows: i. Embryos treated on the 5 th incubation day: No weight changes were noted on the 8th incubation day, however, the growth inhibition rate of 32.1% was noted in the group treated with $50{\mu}C$ and of 38.2% in the group treated with $150{\mu}C$ on the 12th incubation day. The rates were 9.1 and 12.1% on the 15th incubation day, and 6.5 and 10.6% on the 18th incubation day respectively. ii. Embryos treated on the 8th incubation day: The growth inhibition rates on the 12th, 15th and 18th incubation days in the groups treated with $50{\mu}C$ were 20.9, 25.9 and 18.8% and in those treated with $150{\mu}C$ were 20.0, 14.9 and 16.9% respectively. iii. Embryos treated on the 12th incubation day: The growth inhibition rates on the 15th and 18th in the groups treated with $50{\mu}C$ were 13.6 and 21.1% and in those treated with $150{\mu}C$ were 26.7 and 6.5% and in those treated with $250{\mu}C$ were 10.6 and 12.6% respectively. iv. Embryos treated on the 15th incubation day: The growth inhibition rates on the 18th in the groups treated with $50{\mu}C$ were 6.5% and in those treated with $150{\mu}C$ were 10.1% and in those treated with $250{\mu}C$ were 8.5% respectively. In summary, the longer the incubation days, the less the growth inhibition rates. II) The histopathological changes in the various organs were as follows: i. Bone: Hyperplasia and edematous changes of the bone cavity, irregular distribution of immature granular cells and increased number of the myeloblast, megakaryocyte and reticuloendothelial cells were noted. ii. Liver: The embryos treated with $150{\mu}C\;of\;^{35}S$ on the 8th incubation day showed necrosis and nucleolysis of the liver cell and abnormal enlargement of sinusoid on the 12th incubation day. The longer the incubation days, the more severe the changes such as the pyknotic artophy of the liver cells and heterochromatism. The embryos treated on the 5th incubation day with 50 and $150{\mu}C\;of\;^{35}S$ showed little changes, but sight enlargement and accumulation of serous fluid in the sinusoid on the 8th incubation day. iii. Kidney: No particular changes except atrophic changes of epithelium were noted in early stage, however, the infiltration of the granular cell and monocyte into the cortex and pyknotic changes of vascular glomeruli were noted in later stage. These changes were not closely related to the doses of $^{35}S$ given. iv. Gonad: The degenerative changes such as destruction of the immature germ cells, hyperplasia and vacuolization of the stroma were noted in testis and ovary. v. Eye: A slight distortion of the cornea and sclera was noted. The hypertrophy of inner layer and blood cell infiltration into the vascular layer of the choroid membrane were noted in embryo groups on the 12, 15 and 18th incubation days.

• Clinical and Experimental Reproductive Medicine
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• v.24 no.3
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• pp.311-318
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• 1997

Bypassing acrosome reaction and fusion process in intracytoplasmic sperm injection(ICSI), most of injected spermatozoa still contain intact acrosome contents and plasma membrane. It Is not known yet what acrosome contents and plasma membrane of spermatozoa have effect on the development of embryo. For further understanding of fertilization process after ICSI, we studied the time of pronucleus formation, disappearance and first cleavage in human zygote, and pregnancy rate in relation to acrosome reaction rate of spermatozoa after ICSI. Seventy cycles undergoing ICSI program were randomly selected. Sperm suspension from 38 cycles were treated 50% human follicular fluid(hFF) for 3 hours in order to induce acrosome reaction, others were not treated as control. Acrosome reaction in hFF treated and non-treated group was assessed by fluorescein isothiocyanate(FITC)-conjugated Arachis hypogea(PNA) and Pisum sativum agglutinin(PSA). Oocytes were classified into 'good' and 'poor' according to their morphology. After ICSI, fertilization of oocytes were assessed by detection of two pronuclei at 16 hours. The pronuclei disappearance and first cleavage of zygotes were observed at 24 hours, and then embryos were transferred to uterus after culture for 72 hours. The rate of acrosome reaction of spermatozoa in hFF treated group was significantly higher than that in control(p<0.01). Fertilization rates of good oocytes were not different both control and hFF treated group(81.3%(174/206) vs. 72.1%(102/130)). But, in poor oocytes, the fertilization rates in hFF treated group(72.1%(149/183)) were increased compared than those of control group (63.6%(98/140), p<0.01). In either good or poor oocytes, the rates of pronuclei disappearance in hFF treated-spermatozoa injected oocytes were higher than control (59.1%(103/174), 56.4%(84/149) vs. 32.4%(33/102), 37.8%(37/98), p<0.01). Also, the rates of thirst cleavage were increased in hFF treated group (31%(54/174), 24.1%(36/149)) compared than those of control group (10.8%(11/102), 13.2%(13/98), p<0.01). The pregnancy rates of hFF treated group (42.1%(16/38)) were slightly higher than control group (28.1%(9/32), p>0.05). But, the pregnancy rate of group which possessed more than one cleavaged zygote at 24 hours was higher than group which did not (45.2%(19/42) vs. 21.4%(6/28), p<0.05). From these results, the development of zygotes were faster in higher acrosome reacted sperm group than lower acrosome reacted sperm group after ICSI. Our results may be explained that acrosomal membrane and plasma membrane are easily detached from spermatozoa in acrosome reacted spermatozoa compared with acrosome intact sperm in the cytoplasm of oocyte during pronuclear formation. We conclude that the injection of acrosome reacted spermatozoa will increase the pregnancy rate as they can induce fast embryonic development in ICSI.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.2
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• pp.125-131
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• 2007

Objective: The aim of this study was to compare GnRH antagonist and agonist flare-up treatment in the management of poor responder patients. Methods: One hundred forty-four patients from Jan. 1, 2002 to Aug. 31, 2005 undergoing IVF/ICSI treatment who responded poorly to the previous cycle (No. of oocyte retrieved$\leq$5) and had high early follicular phase follicle stimulating hormone (FSH>12 mIU/ml were selected. Seventy-five patients received agonist flare-up protocol and 71 patients received antagonist protocol. We analyzed the number of oocytes retrieved, number of good embryos (GI, GI-1), total dose of hMG administered, implantation rate, cycle cancellation rate, pregnancy rate, live birth rate. Results: The cancellation rate was high in antagonist protocol (53.5% vs. 30.1%). The number of oocyte retrieved, the number of good embyos were high in agonist flare-up group. There was no statistical difference between GnRH agonist flare up protocol and GnRH antagonist protocol in implantation rate (14.5%, 10.1%), clinical pregnancy rate per transfer (29.4%, 21.2%) and live birth rate per transfer (21.6%, 18.2%). Although the result was not statistically significant, GnRH agonist flare up group showed a nearly doubled pregnancy rate and live birth rate per initial cycle than GnRH antagonist group. Conclusions: The agonist flare-up protocol appears to be slightly more effective than the GnRH antagonist protocol in implantation rate, pregnancy rate, live birth rate but shows statistically no significance. Agonist flare-up protocol improved the ovarian response in poor responders. However, based of the result of the study, we can expect improved ovarian response in poor responders by GnRH agonist flare up protocol.