• Clinical and Experimental Reproductive Medicine
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• 제28권1호
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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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• 제14권2호
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• pp.101-108
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• 1987

In order to evaluate the consistency of the serum estradiol pattern and response and to determine the influence of number of ovary on them in repeat cycles in the same patient, 57 cycles in 24 patients who underwent in Vitro Fertilization-Embryo Transfer or Gamete Intrafallopian Transfer in Seoul National University Hospital. The patients were stimulated by follicular stimulating hormone and human menopausal gonadotropin and classified as high(${\geqq}$400 pg/ml) and low(<400 pg/ml) response group according to preovulatory estradiol concentration and classified as three estradiol patterns (A,G.B) according to Jones criteria. Seventeen(89.5%) of 19 patients in when a high response to ovulation induction in their first cycle showed a high response. 40%(2/5) of the second ovulation induction cycle were low response in the patient whose first cycle resulted resulted in a low response. Serum estradiol pattern in the first ovulation induction cycle tended to be repeated in the second cycle. Women with high response tended to be more likely to have A and G patterns and less likely to have a cancellation than those with low response. One-ovary patients were at higher risk for inadequate ovulation induction response.

• Clinical and Experimental Reproductive Medicine
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• 제38권4호
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• pp.234-237
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• 2011

Objective: During stimulated IVF cycles, up to 15% of oocytes are recovered as immature. The purpose of this study was to investigate the trend of oocyte maturity in repeated ovarian stimulation for IVF. Methods: One hundred forty-eight patients were selected who underwent two consecutive IVF cycles using same stimulation protocol during 2008 to 2010. Ovarian stimulation was performed with FSH and human menopausal gonadotropin and flexible GnRH antagonist protocol in both cycles. Oocyte maturity was assessed according to presence of germinal vesicle (GV) and the first polar body. Immature oocyte was defined as GV stage or metaphase I oocyte (GV breakdown with no visible polar body) and cultured up to 48 hours. If matured, they were fertilized with ICSI. Results: Percentages of immature oocytes were 30.8% and 32.9% ($p$=0.466) and IVM rates of immature oocytes were 36.2% and 25.7% ($p$=0.077), respectively. A significant correlation was noted between percentage of immature oocytes in the two cycles (R=0.178, $p$=0.03). Women with >40% immaturity in both cycles (n=21) showed lower fertilization rate of $in$ $vivo$ matured oocytes (56.4% vs. 72.0%, $p$=0.005) and lower pregnancy rate (19.0% vs. 27.1%, $p$=0.454) after the second cycle when compared with women with <40% immaturity (n=70). In both groups, female age, number of total retrieved oocyte and embryos transferred were similar. Conclusion: In repeated ovarian stimulation cycles for IVF, the immature oocyte tended to be retrieved repetitively in consecutive IVF cycles.

• Clinical and Experimental Reproductive Medicine
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• 제16권1호
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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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• 제26권3호
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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.

• The Korean Journal of Physiology and Pharmacology
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• 제22권6호
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• pp.637-647
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• 2018

Extra-hypothalamic growth hormone-releasing hormone (GHRH) plays an important role in reproduction. To study the treatment effect of Grin (a novel hGHRH homodimer), the infertility models of 85 male Chinese hamsters were established by intraperitoneally injecting 20 mg/kg of cyclophosphamide once in a week for 5 weeks and the treatment with Grin or human menopausal gonadotropin (hMG) as positive control was evaluated by performing a 3-week mating experiment. 2-8 mg/kg of Grin and 200 U/kg of hMG showed similar effect and different pathological characteristics. Compared to the single cyclophosphamide group (0%), the pregnancy rates (H-, M-, L-Grin 26.7, 30.8, 31.3%, and hMG 31.3%) showed significant difference, but there was no difference between the hMG and Grin groups. The single cyclophosphamide group presented loose tubules with pathologic vacuoles and significant TUNEL positive cells. Grin induced less weight of body or testis, compactly aligned tubules with little intra-lumens, whereas hMG caused more weight of body or testis, enlarging tubules with annular clearance. Grin presented a dose-dependent manner or cell differentiation-dependentincrease in testicular GHRH receptor, and did not impact the levels of blood and testicular GH, testosterone. Grin promotes fertility by proliferating and differentiating primitive cells through up-regulating testicular GHRH receptor without triggering GH secretion, which might solve the etiology of oligoasthenozoospermia.

• Clinical and Experimental Reproductive Medicine
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• 제20권2호
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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.

• Clinical and Experimental Reproductive Medicine
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• 제17권2호
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• pp.115-121
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• 1990

Ultrasonically guided oocyte collection gradually replaces laparoscope in many IVF center. In present study, we compare the efficacy of both methods in our IVF program. Totally 377 cycles which were undertaken in vitro fertilization treatment were divided into 2 groups. Ultrasonically guided transvaginal follicular aspiration was performed in 188 cycles and laparoscopic follicular aspiration was performed in 189 cycles under local anesthesisa. The mean age for both groups was similar. Follicular recruitment was achieved with human menopausal gonadotropin (hMG) or a com bination of clomiphene citrate and hMG or a combination of FSH and hMG. In the ultrasonically guided aspiration group, 1821 follicles were aspirated with 61.8% of recovery rate (1125 oocytes), 81.5% of embryo transfer rate (145 cycles) and (17%), 26 cases intrauterine pregnancies were estabilished. In the laparoscopic group, 604 follicles were aspirated with 68.7% recovery rate (445 oocytes) and a 79.9% ET rate (127 cycles), 11 cases (8.7%) intrauterine pregnancies were estabilished. A valid comparison of these data is not possible because the 2 groups are dissimilar for factors known to influence oocyte development and recovery. No statistically significant differences could be demonstrated between 2 groups in all but the recovery rate and clinical pregnancy rate, In ultrasound group, the clinical pregnancy rate was significantly higher than that of laparoscope group. The potentially detrimental effect of CO2 pnemoperitonium present during laparoscope but not in ultrasound guided recovery on ova quality may underlie the observed difference in the clinical pregnancy rate between the 2 groups. Ultrasound guided aspiration seems to be as effective as laparoscopy in terms of oocyte retrieval and conception rate. Furthermore, the procedure is simple and inexpensive, it may replace laparoscopy as a method for oocyte collection in most patients who undergo IVF.

• Clinical and Experimental Reproductive Medicine
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• 제13권2호
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• pp.101-112
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• 1986

It is now common practice to attempt ovarian hyperstimulation in vitro fertilization and embryo transfer (IVF-ET) to promote the development of multiple preovulatory follicles and to maximize the number of mature egg available. There are several drugs for hyperstimulation such as clomiphene citrate only, clomiphene citrate and human menopausal gonadotropin (HMG) and HMG only. Accumlated experience has shown that the hyperstimulation of the ovary in IVF-ET results in high pregnancy rate. But the hyperstimulation of the ovary in IVF-ET may cause the hyperandrogenism, so we must consider the adverse effect on pregnancy rate of the hyperandrogenism. Little is known about the functional significance of androgen for the follicular growth, however, the hyperandrogenism might interfere with oocyte maturation. The aim of the present investigation was to determine the serum profiles of estradiol, androstenedione and testosterone during the hyperstimulated menstrual cycles in IVF. The results were summarized as follows: 1. There was a gradual increase in the mean levels of serum estradiol, androstenedione, and testosterone approaching follicular maturation. 2. The mean serum estradiol levels in the hyperstimulated groups were significantly higher than that in the control group in late follicular phase and ovum retrieval (ovulation) day (p<0.01). 3. The mean serum androstenedione levels in the clomiphene citrate groups were significantly higher than that in the control group in late follicular phase (p<0.01). There was no statistically significant different in the mean serum androstenedione levels between the control group and the HMG group (p>0.05). 4. There was no statistically significant difference in the mean levels of testosterone among each group (p>0.05). 5. There was no statistically significant different in the mean levels of estradiol, androstenedione and testosterone between the fertilized patients and non-fertilized patients in clomiphene citrate and HMG group (p>0.05).

• Clinical and Experimental Reproductive Medicine
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• 제15권1호
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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.