• Clinical and Experimental Reproductive Medicine
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• 제36권4호
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• pp.275-281
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• 2009

목 적: 본 연구는 반복적으로 체외수정시술/난자세포질내 정자주입술을 실패했던 환자에서 배아 이식시 옥시토신 길항제의 투여가 임신율 및 착상율에 미치는 영향을 알아보고자 하였다. 연구방법: 2회 이상의 체외수정시술/난자세포질내 정자주입술을 실패했던 40명의 환자들을 대상으로 전향적 무작위 연구를 진행하였다. 과배란유도 방법으로 생식샘자극호르몬분비호르몬 길항제 다회투여법이 사용되었다. 실험군에서는 옥시토신 길항제로 atosiban (vasopressin $V_{1A}$/oxytocin antagonist)을 배아 이식 한 시간 전에 atosiban 6.25 mg을 일회 정주한 뒤, 18 mg/hour의 속도로 지속적 정맥 주입하였다. 배아 이식이 끝난 뒤 atosiban을 6 mg/hour로 감속하여 2시간 동안 추가로 정맥 주입하였다. 실험군과 대조군간의 체외수정시술 결과를 비교 분석하였다. 결 과: 실험군과 대조군간의 평균 나이, 불임 기간 및 체질량 지수와 기저 혈중 난포자극호르몬 및 에스트라디올 농도, 기저 난포강 난포의 수에 통계적으로 유의한 차이는 없었다. 또한 투여된 재조합 인간 난포자극호르몬 (rhFSH)의 총 용량과 투여 기간, 발달된 난포의 개수 및 자궁내막의 두께 역시 통계학적 유의한 차이를 보이지 않았다. 수집된 난자 및 성숙 난자의 수와 수정된 난자와 1등급 혹은 2등급의 배아 및 이식된 배아의 수에도 두 군간의 통계학적으로 유의한 차이를 보이지 않았다. 착상율을 비교하였을 때 실험군은 16.9% (11/65), 대조군은 6.0% (4/67)로 나타났고, p=0.047로 두군 간에 통계학적으로 유의한 차이를 보였다. 임상적 임신율의 경우 실험군은 40.0%로 대조군의 20.0%에 비해 높게 나타나으나 통계학적 유의성엔 도달하지 못하였다. 또한 자궁외 임신 및 유산율에 있어서는 두 군 간에 유의한 차이를 보이지 않았다. 결 론: 체외수정시술/난자세포질내 정자주입술을 시행 받는 환자들에서 배아 이식 동안 옥시토신 길항제를 투여하는 것은 자궁의 수축을 감소시켜 착상율을 증가시킬 수 있을 것으로 생각된다.

• Clinical and Experimental Reproductive Medicine
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• 제24권3호
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• pp.281-292
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• 1997

The objective of this study was to compare retrospectively the survival and pregnancy rates(PR) of cryopresered-thawed embryos obtained from intracytoplasmic sperm injection (ICSI) or conventional in vitro fertilization (IVF). Ninety-six cycles of cryopresered-thawed embryo transfer (ET) were performed in 79 patients from June, 1996 to September, 1997 and grouped as followings: 20 cycles (16 patients) inseminated by ICSI (ICSI Group) and 76 cycles (63 patients) by conventional IVF (IVF Group). Slow-freezing and rapid-thawing protocol was used with 1.5M propanediol (PROH) and 0.1M sucrose as cryoprotectant. All embryos were frozen-thawed at the two pronuclear (2 PN) stage excluding four cycles in which the early cleavage stage embryos were frozen, and allowed to cleave in vitro for one day before ET. The duration from freezing to thawing was comparable in both groups ($mean{\pm}SD$, $112.1{\pm}80.0$ vs. $124.8{\pm}140.1$ days). The age of female ($31.2{\pm}3.4$ vs. $32.6{\pm}3.3$ years) and the endometrial thickness prior to progesterone injection ($9.4{\pm}2.0$ vs. $9.3{\pm}1.8$ mm) were also comparable in both groups. There was no significant difference in the outcomes of cryopreserved-thawed ET between two groups: survival rate ($85.2{\pm}16.1%$ vs. $82.2{\pm}19.7%$), cleavage rate ($96.9{\pm}6.7%$ vs. $94.7{\pm}13.0%$), cumulative embryo score (CES, $54.5{\pm}31.1$ vs. $49.0{\pm}20.0$), preclinical loss rate (5.0% vs. 5.3%), clinical miscarriage rate (0% vs 29.4%), clinical PR per transfer (35.0% vs. 22.4%), implantation rate (9.9% vs. 5.6%), and multifetal PR (42.9% vs. 17.6%). In conclusion, human embryos resulting from ICSI can be cryopreserved-thawed and transferred successfully, and the survival rate and PR are comparable to conventional IVF.

• Clinical and Experimental Reproductive Medicine
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• 제35권3호
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• pp.193-202
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• 2008

목 적: 보조부화술이 적용되는 좋지 않은 예후를 보여주는 선별된 환자군을 대상으로 산성 용액을 이용한 AHA 방법과 레이저를 이용한 AHL 방법의 효용성을 비교하여, 보다 효과적으로 임신율과 착상률을 높일 수 있는 보조부화술 방법을 찾고자 하였다. 연구방법: 2006년 2월부터 9월까지 체외수정 시술을 시행한 환자 중 보조부화술이 필요한 328주기를 대상으로 산성용액을 이용한 AHA 방법 (180주기)과 ZILOS-tk 레이저를 이용한 AHL 방법 (148주기)으로 나누어 시행하였다. 보조부화술을 시행한 환자군은 환자의 나이가 38세 이상이거나 투명대의 두께가 $18{\mu}m$ 이상, 기저 FSH 농도가 15 mIU/ml이상, 체외수정 시술을 3번 이상 실패한 환자, 이식하는 배아의 상태가 양호하지 않은 환자들로 이상에 적용요인이 있으면 시행하여 무작위로 보조부화술 방법간에 환자들의 임상적 특징과 임신율과 착상률을 분석하였다. 결 과: 전체 보조부화술을 시행한 환자군에 AHL 방법과 AHA 방법간에 임신율 (42.6%, 63/148 vs. 33.3%, 60/180)과 착상률 (17.4%, 82/470 vs. 16.0%, 89/556)에 유의적 차이는 나타나지 않았다. 그러나 나이가 많은 환자군인 Group 1은 임신율 (37.0%, 20/54 vs. 18.7%, 14/75)과 착상률 (14.4%, 23/160 vs. 7.1%, 15/210)이 AHL 방법이 AHA 방법보다 유의적 (p<0.05)으로 높게 나타났다. 전체 환자군이나 선별된 각 군내에 보조부화술 방법간에 환자의 임상적 특징은 유의적 차이가 나타나지 않았다. 3번 이상 체외시술에 실패한 환자군 [Group 2: 43.8% (21/48)과 31.6% (25/79)], 투명대의 두께가 $18{\mu}m$ 이상인 환자군 [Group 3: 43.8% (32/73)과 34.1% (28/82)], 이식한 배아의 질이 양호하지 않은 환자군[Group 4: 25.0% (7/28)과 14.6% (6/41)]에서는 AHL 방법이 임상결과는 좋았으나 유의적 차이는 없었다. 결 론: 레이저를 이용한 AHL 방법이 나이가 많은 환자군과 3번 이상 체외수정 시술에 실패한 환자군에서 AHA방법에 비해 높은 임신율과 착상률을 나타내었다. 결론적으로, AHL을 이용한 보조부화술이 임상적으로 보다 효과적이고 안전한 방법이라고 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제17권1호
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• pp.45-56
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• 1990

Maternal serum ${\beta}$-specific human chorionic gonadotropin(${\beta}$-hCG) and pregnancy-specific ${\beta}_1$-glycoprotein($SP_1$) levels were determined more than one per week during 11-41 days post embryo transfer(ET) in 21 consecutive pregnancies after in vitro fertilization(IVF), which included 8 normal singleton pregnancies, 3 twin pregnancies, 4 clinical abortions, 1 ectopic pregnancy, and 5 preclinical abortions. The sensitivity of serum ${\beta}$-hCG and $SP_1$ radioimmunoassays was 3mIU/ml and 0.7ng/ml relatively. At the 7th to 8th week of gestation, ultrasonographic confirmation of fetal pole and fetal heartbeat was performed. Both serm ${\beta}$-hCG and $SP_1$ levels showed logarithmic increase, but log[$SP_1$] had more steep rising curve and had wider variation than log[${\beta}$-hCG] in normal singleton pregnancies. In 3 twin pregnancies and one ectopic pregnancy, both serum ${\beta}$-hCG and $SP_1$ levels located within the 95% confidence interval of the mean levels of 8 normal singleton pregnancies(normal range). In 2 clinical abortions which had a fetal pole without heartbeat, serum ${\beta}$-hCG level showed lower limit of the normal range or just below, but all $SP_1$ levels showed within the normal range. In other 2 clinical abortions which were diagnosed as blighted ovum, both serum ${\beta}$-hCG levels from 11 days post-ET and serum $SP_1$ levels from later days compared with ${\beta}$-hCG were below the normal range. In 5 preclinical abortions, serum $SP_1$ levels were within the normal range but serum ${\beta}$-hCG levels were far below the normal range. In conclusion, both serum ${\beta}$-hCG and $SP_1$ levels increased exponentially with similar pattern in normally conceived pregancy after IVF-ET. Both serum ${\beta}$-hCG and $SP_1$ levels could predict outcome of early pregnancy to a certain degree, but log[${\beta}$-hCG] levels had more significant correlation with outcome of pregnancy compared with log[$SP_1$] levels. In addition, ultrasonographic examination of fetal poles and fetal heartbeats gives very important clinical information and prognosis.

• Clinical and Experimental Reproductive Medicine
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• 제34권1호
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• pp.49-56
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• 2007

목 적: 성선자극호르몬과 GnRH agonist (GnRH)를 동시에 중단하는 1$\sim$2 일간의 단기 coasting이 임신율을 포함한 난소과자극증후군 예방에 미치는 효과를 조사하고자 한다. 연구방법: 체외수정시술을 위한 과배란유도 시 15 mm 이상의 난포가 20 개 이상이고 혈중 E$_2$ 농도가 4,000 pg/ml 이상일 때 coasting을 시도한 37 명의 여성들을 대상으로 하였다. Coasting은 성선자극호르몬과 GnRH agonist를 동시에 중단하였으며, 초음파상 난포의 상태와 혈중 E$_2$ 농도 에 따라 1일 또는 2일 동안 시행하였다. 혈중 E$_2$ 농도, 채취된 난자 수, 수정율, 임신율 등을 후향적으로 비교 분석하였다. 결 과: 평균 혈중 E$_2$ 농도는 coasting 시작 당일 6,993 pg/ml 에서 hCG 투여일에 3,396 pg/ml로 감소하였다. 평균 채취 난자 수와 수정율은 15.7개와 70%였다. 15명 (40.6%)이 임신을 하였고 착상율은 15.2%였다. 26명 (70.3%)이 1일, 11명 (29.7%)이 2일 동안 coasting 하였다. 평균 혈중 농도의 감소율은 1일 coasting한 군에서 43%, 2일 costing한 군은 15% (첫날)와 81% (둘째날)이었다. 임신율은 두 군간 유사하였고, 중증도 이상의 OHSS는 발생하지 않았으며 3명 (8.1%)에서 경미한 OHSS가 나타났다. 결 론: 성선자극호르몬과 GnRH agonist의 통시 중단에 의한 1$\sim$2 일의 단기 coasting은 체외수정의 결과에 영향을 주지않고 OHSS 를 예방하는데 성공적으로 적용될 수 있을 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제32권1호
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• pp.47-54
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• 2005

Objective: Evaluation of embryos using early cleavage to 2-cell stage has been proposed, but a critical time-point for selecting embryos is unclear. The aim of the present study is to provide a guideline including critical time-point in the selection of early cleaving embryo for the reduction of multiple pregnancies as well as the increase of pregnancy rate in human IVF. Methods: This prospective study was performed in 116 cycles from 85 patients who underwent conventional IVF or ICSI at the infertility clinic of Good Moonhwa Hospital from January 2002 to December 2003. Early cleavage (EC) of embryos to 2-cell stage was assessed at 25 h and 27 h postinsemination/microinjection. Embryos that had early cleaved at each time point were designated as EC-1 and EC-2, respectively, while others were designated as non-early cleavage (NEC). Results: At least one early cleavage embryo was observed in 54 (46.6%) for the EC-1 and 84 (72.4%) for the EC-2 of the 116 cycles assessed. Clinical pregnancy rates (PR) were significantly higher in the EC-1 group (66.7%) compared to the EC-2 group (53.6%) or the NEC group (31.2%) (p<0.05). Significant improvement of the pregnancy rate was found when at least two or more embryos were early cleaved at 25 h postinsemination or when the proportion of early cleavage embryo at 25 h postinsemination was higher than 20% (p<0.05). Conclusion: The critical time-point for the selection of early cleavage embryos with high implantation potential is more effective in 25 h postinsemination/microinjection compared to 27 h. The proportion as well as number of early cleavage embryos is also an important factor for the prediction of pregnancy outcome and the chance of multiple pregnancies. These results demonstrated that the evaluation of early cleavage embryos to 2-cell stage is an easy, simple, and objective method for the selection of good quality embryos suitable for embryo transfer.

• Clinical and Experimental Reproductive Medicine
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• 제16권2호
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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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• 제40권3호
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• pp.122-125
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• 2013

Objective: The majority of embryo transfers (ETs) to date have been performed on day 3 to reduce the potential risk of developmental arrest of in vitro cultured embryos before ET. Development of sequential media has significantly improved culture conditions and allowed blastocyst transfer on day 5. While day 5 ET provides higher clinical pregnancy outcomes with reduced risks of multiple pregnancies, it still has potential risks of developmental arrest of IVF embryos. The aim of this study was to evaluate the clinical outcomes of day 4 ETs and compare the efficacy of day 4 ET with day 5 ET. Methods: From 2006 to 2009, a total of 747 fresh IVF-ET cycles were retrospectively analyzed (day 4, n=440 or and day 5, n=307). The cycles with any genetic factors were excluded. The rates of matured oocytes, fertilization, good embryos, and clinical pregnancy of the two groups were compared. The chi-square test and t-test were used for statistical analysis. Results: There were no significant differences between the two groups with respect to the mean age of the females and rates of matured oocytes. The pregnancy outcomes of day 4 ET (40.7%) were similar to those of day 5 ET (44.6%). The implantation rate of day 5 ET (24.2%) was significantly higher than that of day 4 ET (18.4%) (p=0.003). Conclusion: Day 4 ET can be chosen to avoid ET cancellation in day 5 ET resulting from suboptimal circumstances in the IVF laboratory, but the decremented quality of embryos for transfer and the decreased pregnancy rate must be taken into consideration.

• Clinical and Experimental Reproductive Medicine
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• 제27권1호
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• pp.59-65
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• 2000

Objective: The purpose of this study was to determine the important factors affecting survival and pregnancy rate in frozen-thawed embryo transfer cycles. Methods: we performed retrospective analysis in 738 cycles of frozen-thawed embryo transfers, in relation to the insemination methods, the freezing stage of embryo, patient's age, infertility factors and the origin of injected sperm in ICSI cycles. After conventional IVF or ICSI, the supernumerary PN stage zygotes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propanediol (PROH) as a cryoprotectant. Results: The survival rates of thawed embryos were 69.3% (1585/2287) in conventional IVF group and 71.7% (1645/2295) in ICSI group. After frozen-thawed embryo transfers, 27.0% (92/341) and 32.0% (109/341) of pregnancy rates were achieved in conventional IVF and ICSI group, respectively. There were no significant difference in the survival and pregnancy rates according to the insemination methods, the freezing stage and patient's age. However, the pregnancy rate (36.2%) of male factor infertility was significantly higher than the tubal (27.2%) and other female factor infertility (22.9%). In ICSI group, the origin of injected sperm did not affect the outcome of frozen-thawed embryo transfer cycles. Conclusion: The present study demonstrates that acceptable clinical outcomes can be achieved after the transfer of frozen-thawed embryos regardless of the stage of embryos for freezing, the patient's age and the origin of injected sperm.

• Clinical and Experimental Reproductive Medicine
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• 제38권3호
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• pp.153-158
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• 2011

Objective: The aim of this study was to investigate whether anti-M$\ddot{u}$llerian hormone (AMH) levels could be predict ovarian poor/hyper response and IVF cycle outcome. Methods: Between May 2010 and January 2011, serum AMH levels were evaluated with retrospective analysis. Three hundred seventy infertile women undergoing 461 IVF cycles between the ages of 20 and 42 were studied. We defined the poor response as the number of oocytes retrieved was equal or less than 3, and the hyper response as more than 25 oocytes retrieved. Serum AMH was measured by commercial enzymelinked immunoassay. Results: The number of oocytes retrieved was more correlated with the serum AMH level (r=0.781, $p$ <0.01) than serum FSH (r=-0.412, $p$ <0.01). The cut-off value of serum AMH levels for poor response was 1.05 ng/mL (receiver operating characteristic [ROC] curves/area under the curve [AUC], $ROC_{AUC}$=0.85, sensitivity 74%, specificity 87%). Hyper response cut-off value was 3.55 ng/mL $ROC_{AUC}$=0.91, sensitivity 94%, specificity 81%). When the study group was divided according to the serum AMH levels (low: <1.05 ng/mL, middle: 1.05 ng/mL - 3.55 ng/mL, high: >3.55 ng/mL), the groups showed no statistical differences in mature oocyte rates (71.6% vs. 76.5% vs. 74.8%) or fertilization rates (76.9% vs. 76.6% vs. 73.8%), but showed significant differences in clinical pregnancy rates (21.7% vs. 24.1% vs. 40.8%, $p$=0.017). Conclusion: The serum AMH level can be used to predict the number of oocytes retrieved in patients, distinguishing poor and high responders.