• Clinical and Experimental Reproductive Medicine
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• 제36권4호
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• pp.301-310
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• 2009

목 적: 폐쇄성과 비폐쇄성 무정자증 환자에서 신선고환조직 정자와 융해고환조직 정자를 이용한 배발달과 임신결과를 비교 분석하였다. 연구방법: 폐쇄성과 비폐쇄성 무정자증 환자에서 총 222 주기의 TESE-ICSI를 시행하였다. 정자는 신선 또는 융해 고환조직으로부터 회수하였다. 수정은 ICSI 후 16~18시간째 확인하였으며, 배발달률과 임신율을 분석하였다. 결 과: 폐쇄성 무정자증군과 비폐쇄성 무정자증군에서 수정률은 유의하게 차이가 났으나 (75.2% 대 56.7%, p<0.05), 배발달률에서는 차이가 나지 않았다 (96.9% 대 98.0%). 마찬가지로 임상적 임신율 (33.9% 대 36.0%)과 분만율 (28.1% 대 28.0%)에서도 차이가 나지 않았다. 신선고환조직 정자의 경우, 수정률은 폐쇄성 무정자증군과 비폐쇄성 무정자증군에서 유의하게 차이가 났으나 (76.4% 대 52.9%, p<0.05), 배발달률, 임상적 임신율, 분만율에서는 차이가 나지 않았다. 융해고환조직 정자의 경우에서도 수정률은 폐쇄성 무정자증군과 비폐쇄성 무정자증군에서 유의하게 차이가 났으나 (74.7% 대 65.6%, p<0.05), 배발달률, 임상적 임신율, 분만율에서는 차이가 나지 않았다. 결 론: 폐쇄성과 비폐쇄성 무정자증 환자에서 신선고환조직 정자와 융해고환조직 정자를 이용하였을 경우 수정률에서는 차이가 있으나, 배발달과 임상적 임신 결과에는 차이를 보이지 않았다. 그러므로, 폐쇄성 또는 비폐쇄성 여부와는 관계없이 무정자증 환자에서 신선고환조직 정자 그리고 융해고환조직 정자를 이용하여 ICSI를 시행하면 적절한 임신 성적을 거둘 수 있다.

• Clinical and Experimental Reproductive Medicine
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• 제27권1호
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• pp.91-97
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• 2000

Objective: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine levels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) in infertile women with endometriosis and normal women without endometriosis. Design: Prospective and case-control study in university hospital. Materials and Methods: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzyme-linked immunosorbent assay. Results: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were $72.7{\pm}23.7$ pg/ml and $18.5{\pm}9.7$ pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls ($445.0{\pm}89.6$, vs $45.1{\pm}48.4$, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls ($1.09{\pm}0.04$ vs $2.19{\pm}0.03$, p=0.03). The level of tumor necrosis factor-${\alpha}$ was not significantly different between the two study groups. Conclusions: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.

• Clinical and Experimental Reproductive Medicine
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• 제29권4호
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• pp.303-310
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• 2002

Objective s: To estimate the frequency of Y chromosome microdeletions in the Korean population of infertile men and to evaluate the relationship between microdeletion on the Y chromosome and clinical phenotypes of infertile men with idiopathic azoospermia and oligozoospermia. Materials and Methods: Genomic DNA was extracted from blood samples collected from 330 infertile men attending the Infertility Clinic at Samsung Cheil Hospital, Korea. Six sequence tagged sites (STSs) spanning the azoospermia factor (AZF) regions of the Y chromosome were amplified by polymerase chain reactions (PCRs). Results: Microdeletions on Y chromosome were detected in 35 (10.6%) of the 330 infertile men. Most of the microdeletions (91.4%) involved AZFb or AZFc. The high incidence of microdeletions were found in AZFc region (57.1%), but the low in AZFa (8.6%) and AZFb (5.7%). Larger microdeletions involving two or three AZF regions were detected in 28.6% of cases. All patients (6 patients) with deletion of AZFa region showed no germ cell phenotypes, Sertoli cell only syndrome or Leydig cell hyperplasia in histopathologic examinations. Conclusion: Microdeletions on the Y chromosome, especially, at AZFc/DAZ regions may be the major cause of azoospermia and severe oligozoospermia. We suggest that idiopathic infertile men have genetic counselling and microdeletion analysis on the Y chromosome before IVF-ET and ART program.

• Clinical and Experimental Reproductive Medicine
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• 제38권3호
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• pp.168-173
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• 2011

Objective: To examine the association between methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and hyperhomocysteinemia in women with unexplained recurrent miscarriages (RM) and to investigate the association between MTHFR genotype variants and alloimmune activation, proportion of peripheral blood natural killer (pbNK) cells. Methods: A total of 39 patients with a history of two or more unexplained miscarriages were recruited to this study. The controls were women who had a live birth without a history of RM (n=50). The proportion of pbNK cells was measured by flow cytometry. Plasma homocysteine levels and the incidence of the MTHFR variant of the RM and control groups were compared. The proportion of pbNK cells was compared to the MTHFR variants in the RM group. Results: No differences were found between the two groups' mean plasma homocysteine levels ($7.6{\pm}1.5{\mu}mol$/L vs. $7.1{\pm}2.1{\mu}mol$/L) or incidence of the MTHFR genotype variant (CC, 35% vs. 33%; CT, 40% vs. 53%; and TT, 25% vs. 14%). In the RM group, individuals with the TT variant ($7.7{\pm}1.1{\mu}mol$/L) had higher homocysteine levels than those with the CC and CT variants ($7.4{\pm}1.9{\mu}mol$/L and $7.4{\pm}1.2{\mu}mol$/L) and those with the CT variant ($19.2{\pm}8.1%$) had a higher proportion of CD3-/CD56+ pbNK cells than those with the CC and TT variants ($17.7{\pm}6.6%$ and $17.9{\pm}7.0%$), but the results of both comparisons were statistically insignificant. Conclusion: These preliminary results show no difference in plasma homocysteine levels between the RM and control groups or among MTHFR genotype variants in the RM group, which may suggest that the plasma homocysteine level is difficult to use as a predictive marker of RM in the Korean population. A study of a larger number of patients is needed.

• 생명과학회지
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• 제17권5호
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• pp.613-618
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• 2007

무정자증에 영향을 미치는 AZFa, b, c 영역은 남성불임환자에서 잦은 미세결실이 발견됨으로써 정자형성과정에서 중요한 역할을 할 것으로 주목 받아왔다. 이들 영역에 있는 유전자중 RBMY1, CDY1 그리고 VCY2유전자는 고환에서 남성의 생식선 세포의 분화와 연관되어 있는 것으로 알려졌다. 42명의 무정자증 환자의 고환조직을 RT-PCR법으로 분석해본 결과 RBMY1, CDY1 그리고 VCY2 유전자는 각각 34%, 66%, 그리고 27%의 환자에서 발현되지 않는 것으로 조사되었다. RBMY1 과 VCY2유전자가 발현되지 않는 개체는 CDY1유전자도 역시 발현이 되지 않았다. 세르토리 세포만 가진 환자에서는 CDY1 유전자가 발현되지 않았다. 따라서, CDY1 유전자는 한국인 집단에서 정자형성과정의 필수적인 요인인 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제30권3호
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• pp.207-215
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• 2003

Objective: To compare the pregnancy outcomes after in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) between obstrucvtive and non-obstrucvtive azoospermia. Methods: From January 1994 to December 2002, 524 patients with obstructive azoospermia (886 cycles) and 163 patients with non-obstructive azoospermia (277 cycles) were included in this study. Microsurgical epididymal sperm aspiration (MESA) or testicular sperm extraction (TESE) in obstructive azoospermia and TESE in non-obstructive azoospermia were perfomed to retrieve sperm, which was used for ICSI and then fertilized embryos were transferred. The results of ICSI - fertlization rate (FR), clinical pregnancy rate (CPR), clinical abortion rate (CAR) and delivery rate (DR) - were statistically analysed in obstructive versus non-obstructive azoospermia. Results: There were no differences in the number of retrieved oocytes, injected oocytes for ICSI and oocyte maturation rate. FR was significantly higher in obstructive than non-obstructive azoospermia (71.7% vs. 61.1%, p<0.001). There was no difference in CPR per embryo transfer cycle. After pregnancy was established, however, CAR was significantly higher in non-obstructive than obstructive azoospermia (25.6% vs. 12.5%, p=0.004). DR per clinical pregnancy cycle was significantly higher in obstructive than non-obstructive azoospermia (78.0% vs. 64.4%, p=0.012). In the karyotype ananlysis of abortus, abnormal karyotypes were found in 75.0% (6/8) of obstructive and 55.6% (5/9) of non-obstructive azoospermia. Conclusion: Our data show significantly higher FR in obstructive than non-obstructive azoospermia. Though there was no differrence in CPR, CAR was significantly higher in non-obstructive than obstructive azoospermia. The abortion may be related to the abnormal karyotype of embryo, but further investigations are necessary to elucidate the cause of clinical abortion in azoospermia.

• 대한한방부인과학회지
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• 제20권4호
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• pp.202-209
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• 2007

Purpose: The purpose of this study was to report the clinical effectiveness of Traditional Korean Treatment on infertility patients with endometriosis. Methods: The patient in this case was 32 years-old female. The chief complains were lower abdominal pain, dysmenorrhea, infertility with endometriosis. She was treated by Traditional Korean Medicine, acupuncture and retention enema therapy. So the symptom of she complained was improved. Results: After the retetion enema therapy and Traditional Korean Medicine, the lower abdominal pain and dysmenorrhea of endometriosis was improved. And she was pregnant and delivered. Conclusion: This case study shows that the retetion enema and Traditional korean therapy were effective in treating endometriosis and fertility. So we make more studis about this disease, it will bring the high satisfaction of patient and the improvement of treatment rate.

• Clinical and Experimental Reproductive Medicine
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• 제40권2호
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• pp.55-59
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• 2013

Endometriosis is defined as the presence of functional endometrial tissue outside the uterus, causing diverse progressive symptoms such as infertility, pelvic pain, and dysmenorrhea. Although endometriosis has been described since the 1800s, the mechanisms responsible for its pathogenesis and progression remain poorly understood. It is well established that endometriosis grows and regresses in an estrogen-dependent fashion and the disease can be effectively cured by definitive surgery. However, prolonged medical therapy may be needed in most of the cases since conservative surgery is usually performed especially in young women. This treatment modality is often associated with only partial relief and/or recurrence of the disease. In the present review, up-to-date findings on the treatment of endometriosis will be briefly summarized. The outcomes of surgery in patients with endometriosis will be reviewed in terms of pelvic pain relief as well as infertility treatment largely based on recent Cochrane reviews and clinical reports. The efficacy of newer drugs including aromatase inhibitor, anti-tumor necrosis factor-alpha, and dienogest will be also reviewed based on recent clinical studies.

• Clinical and Experimental Reproductive Medicine
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• 제46권3호
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• pp.119-124
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• 2019

Objective: It is widely accepted that aging decreases women's fertility capacity. The aim of this study was to assess correlations between maternal age and the morphokinetic parameters and cleavage pattern of embryos. Methods: The morphokinetics of embryos derived from women < 30, 30-35, 36-40, and > 40 years of age were compared retrospectively in terms of time of second polar body extrusion, time of pronuclei appearance, time of pronuclei fading, and time of two to eight discrete cells (t2-t8). Furthermore, abnormal cleavage patterns such as uneven blastomeres at the two-cell stage, cell fusion (Fu), and trichotomous mitoses (TM) were assessed. Results: Only t5 occurred later in women aged 36-40 and > 40 years when compared with those aged < 30 and 30-35 years (p< 0.001). Other morphokinetic timing parameters, as well the presence of uneven blastomeres, were comparable between the groups (p> 0.05). However, Fu and TM were more common in women aged > 40 years than in younger women (p< 0.001). Conclusion: Maternal age was correlated with the cleavage pattern of embryos. Therefore, evaluating embryo morphokinetics may contribute to optimal embryo selection, thereby increasing fertility in patients with advanced maternal age.

• Clinical and Experimental Reproductive Medicine
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• 제42권4호
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• pp.149-155
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• 2015

Objective: The goal of this study was to investigate the relationship between serum progesterone (P4) levels on the day of human chorionic gonadotropin (hCG) administration and the pregnancy rate among women undergoing controlled ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) using a flexible antagonist protocol. Methods: This prospective study included 200 IVF and ICSI-ET cycles in which a flexible antagonist protocol was used. The patients were divided into five distinct groups according to their serum P4 levels at the time of hCG administration (0.80, 0.85, 0.90, 0.95, and 1.00 ng/mL). The clinical pregnancy rate (CPR) was calculated for each P4 interval. Statistically significant differences were observed at a serum P4 level of 0.9 ng/mL. These data suggest that a serum P4 concentration of 0.9 ng/mL may represent the optimal threshold level for defining premature luteinization (PL) based on the presence of a significant negative impact on the CPR. Results: The CPR for each round of ET was significantly lower in the PL group defined using this threshold (25.8% vs. 41.8%; p=0.019), and the number of oocytes retrieved was significantly higher than in the non-PL group ($17.3{\pm}7.2$ vs. $11.0{\pm}7.2$; p=0.001). Elevated serum P4 levels on the day of hCG administration were associated with a reduced CPR, despite the retrieval of many oocytes. Conclusion: Measuring serum P4 values at the time of hCG administration is necessary in order to determine the optimal strategy for embryo transfer.