• Clinical and Experimental Reproductive Medicine
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• 제31권4호
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• pp.253-260
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• 2004

Objectives: Klinefelter syndrome is the most common genetic cause of male infertility and presents with 47, XXY mainly or 46, XX/47, XXY mosaicism. It is characterized by hypogonadism and azoospermia due to testicular failure, however, sporadic cases of natural pregnancies have been reported. With the development of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI), sperm can be retrieved successfully and ART is applied in these patients for pregnancy. It has been suggested that the risk of chromosome aneuploidy for both sex chromosome and autosome is increased in the sperms from 47, XXY germ cells. Considering the risk for chromosomal aneuploidy in the offspring, preimplantation genetic diagnosis (PGD) could be applied as a safe and more effective treatment option in Klinefelter syndrome. The aim of this study is to assess the outcome of PGD cycles by using FISH for sex chromosome and autosome in patients with Klinefelter syndrome. Materials and Methods: From Jan. 2001 to Dec. 2003, PGD was attempted in 8 cases of Klinefelter syndrome but TESE was failed to retrieve sperm in the 3 cases, therefore PGD was performed in 8 cycles of 5 cases (four 47, XXY and one 46, XY/47, XXY mosaicism). In one case, ejaculated sperm was used and in 4 cases, TESE sperm was used for ICSI. After fertilization, blastomere biopsy was performed in $6{\sim}7$ cell stage embryo and the chromosome aneuploidy was diagnosed by using FISH with CEP probes for chromosome X, Y and 17 or 18. Results: A total of 127 oocytes were retrieved and ICSI was performed in 113 mature oocytes. The fertilization rate was $65.3{\pm}6.0%$ (mean$\pm$SEM) and 76 embryos were obtained. Blastomere biopsy was performed in 61 developing embryos and FISH analysis was successful in 95.1% of the biopsied blastomeres (58/61). The rate of balanced embryos for chromosome X, Y and 17 or 18 was $39.7{\pm}6.9%$. The rate of aneuploidy for sex chromosome (X and Y) was $45.9{\pm}5.3%$ and $43.2{\pm}5.8%$ for chromosome 17 or 18, respectively. Embryo transfer was performed in all 8 cycles and mean number of transferred embryos was $2.5{\pm}0.5$. In 2 cases, clinical pregnancies were obtained and normal 46, XX and 46, XY karyotypes were confirmed by amniocentesis, respectively. Healthy male and female babies were delivered uneventfully at term. Conclusion: The patients with Klinefelter syndrome can benefit from ART with TESE and ICSI. Considering the risk of aneuploidy for both sex chromosome and autosome in the sperms and embryos of Klinefelter syndrome, PGD could be offered as safe and more effective treatment option.

• Clinical and Experimental Reproductive Medicine
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• 제32권3호
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• pp.243-251
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• 2005

Objective: Low-dose aspirin have been proposed to improving endometrial receptivity and pregnancy rate in COH-IVF by increasing endometrial perfusion. However, the effect of low-dose aspirin in COH-IVF could be negligible because there have been large quantity of other important factors responsible for changing endometrial perfusion accompanied by COH procedure. In contrast, in frozen-thawed embryo transfer cycles which were not accompanied by COH procedure, the effects of low-dose aspirin in endometrial blood flow seems to be more certain than in COH-IVF cycles. In this study, we analyzed the effect of low-dose aspirin treatment on implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer Methods: From January 2003 to December 2003, total 264 cycles from 264 patients who attended infertility clinic at Samsung Cheil Hospital were enrolled in this study. All cases included in this study, embryos were frozen and thawed at the pronuclear stage and three days after incubation, at least 2 or more good quality embryos were transferred into uterus. In study group, low dose aspirin (100 mg/day) was administrated from the first or second date of menstrual day to 9 days after embryo transfer. On the other hand, control group did not take any medicine except estradiol valerate for endometrial priming. Several variables including implantation and pregnancy rates were compared in both groups. After then, each groups were stratified by endometrial thickness checked at embryo transfer (ET) day such as (28 mm versus <8 mm) and same variables above described were compared between study and control groups. Results: The mean age, infertility duration, endometrial thickness at embryo transfer day and mean number of transferred embryo were not significantly different in both groups. Also, implantation rates (study group: 15.8%, control group: 20.5%) and pregnancy rate (study group: 45.1%, control group: 43.5%) were not significantly different between two groups. (p>0.05) After we analyzed same variables stratified by endometrial thickness checked at embryo transfer day, we could not found any significant difference between study and control groups. Conclusions: Low-dose aspirin treatment seems to have no advantage of improving implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer.

• 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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• 제19권1호
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• pp.71-79
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• 1992

In vitro fertilization and embryo transfer (IVF & ET) is widely used for the males with subnormal or abnormal semen quality, as this was recommended in view of the relatively small numbers of spermatozoa required for fertilization and subsequent pregnancies could be obtained. The aim of this study is to know how the various functional parameters of spermatozoa in semen analysis affect the outcome IVF. This study was carried out between 1988-1989, with male factor patients selected on the basis of the semen quality. The selection criteria was based upon the mean values of concentration,% motility and % normal morphology from at least two semen analysis. There is a significant decrease in the fertilization and embryo transfer rates in the study group compared with control group (35.9% vs. 68% and 48.6% vs. 85.5% respectively), however, there was no significant difference in the pregnancy or delivery rates (19.6% vs. 21.4% and 60.0% vs. 62.5% respectively) per embryo transfer cycles. Fertilization rate is variously affected by the type and degree of sperm defect. No pregnancy was occurred in triple defect group and asthenoteratospermia group. There is no significant increase in the abortion rate in the male factor group. Improvement have to be made with the fertilization rate, as the pregnancy rate per OPU cycle in male factor group is still lower than that of normal group (9.5% vs. 18.3%). In conclusion, IVF can be used as a treatment for male factor infertility and the preparation of the semen sample can be modified to improve sperm recovery and obtain fertilization from abnormal semen samples.

• Clinical and Experimental Reproductive Medicine
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• 제45권2호
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• pp.88-93
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• 2018

Objective: The aim of this study was to measure reactive oxygen species (ROS) production and total antioxidant capacity (TAC) in the seminal fluid of the male partners in couples undergoing intrauterine insemination and to evaluate correlations between these values and their semen parameters. Methods: The study was conducted at Vamsam Fertility Center, Coimbatore, India and enrolled 110 male patients from whom semen samples were collected. ROS production was measured by a thiobarbituric acid reactive species assay, and TAC was measured by a 2,2-diphenyl-2-picrylhydrazyl free radical assay. The differences in the TAC and malondialdehyde (MDA) levels between the subfertile and fertile groups were analysed. Correlations between sperm parameters and TAC and MDA levels were statistically analysed, and cutoff values with respect to the controls were determined. All hypothesis tests used were two-tailed, with statistical significance assessed at the level of p< 0.05. Results: A total of 87 subfertile and 23 fertile men were included in the study. The mean MDA level was significantly higher in the subfertile subjects than in the fertile subjects, and the mean antioxidant level was significantly lower in the subfertile subjects than in the fertile subjects. Seminal MDA levels were negatively associated with sperm concentration, motility, and morphology, whereas the opposite was seen with TAC levels. Conclusion: Measurements of seminal TAC and ROS are valuable for predicting semen quality, and hence predicting the outcomes of fertility treatment.

• Asian Pacific Journal of Cancer Prevention
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• 제17권sup3호
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• pp.23-26
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• 2016

Breast cancer (BC) is the most common cancer and the second cause of mortality in women all around the world. It is caused by several factors including genetic determinants, so that both genetic susceptibility factors and environmental factors are involved in the etiology. Significance of genes functioning in steroid hormone synthesis and metabolism are well established in breast cancer susceptibility. In this study, 134 women with BC and 135 normal controls were analyzed for their genotypes for the polymorphisms, rs743572, rs10046 and rs4646903, resided in CYP17, CYP19 and CYP1A1 genes, respectively. Significant differences in distributions of allele and genotype frequencies were found for the rs10046 polymorphism in CYP19 (p-value=0.01, OR (CI 95%) =1.59 (1.1-2.3), p-value=0.04, OR (CI 95%) =1.7 (1.1-2.5) respectively). For rs743,572 and rs 4646903 polymorphisms, no significant associations were observed. A significant association was observed between the rs10046 polymorphism of the CYP19gene and breast cancer in Iranian patients. Due to inconsistent previous results, more studies in different populations with larger sample sizes are indicated.

• Clinical and Experimental Reproductive Medicine
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• 제37권4호
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• pp.293-305
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• 2010

난소과자극증후군은 발생 시 생명을 위협하는 심각한 의인성 합병증으로, 불임 치료를 목적으로 성선자극호르몬을 사용하여 과배란을 유도할 때 발생한다. 따라서, 과배란 유도를 하기에 앞서 위험요인을 가진 환자를 파악하여 저용량의 성선자극호르몬을 사용하거나, GnRH antagonist protocol을 이용함으로써 발생을 예방하는 것이 중요하고, 과배란 유도 중 ovarian hyperstimulation syndrome (OHSS)의 발생이 예측될 때는 성선자극호르몬 투여 시 coasting을 하고 난포 성숙을 유도할 때 저용량의 hCG 혹은 GnRH agonist를 이용하고, 중증의 OHSS가 예측될 때에는 주기취소로 OHSS의 유병기간을 줄이거나 배아동결 등을 통해 후발성 난소과자극증후군을 예방할 수 있다. 그리고, metformin과 dopamine agonist를 난소과자극증후군을 예방을 위해 고려해 볼 수 있겠다.

• Clinical and Experimental Reproductive Medicine
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• 제30권4호
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• pp.281-291
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• 2003

Objectives: In determining to perform non-spousal artificial insemination by donor (AID) to an infertile married couple, infertile couple requires not only the thorough understanding of the medical procedure but also scrutinizing the effect, which it will have on the relationship of the family including the baby to be born itself. Materials and methods: 148 cases with non-curable male infertility were enrolled in this inquiry survey. The donor insemination questionnaire consists of 18-items which are assessing subjects' clinical properties, the background for AID practice, psychological traits, and long term influence. Results: Of the survey, 49 cases were returned (33.1%) and 10 cases (20.4%) of these gave birth after AID practice. The mean age of husbands and wives of the 49 cases were $34.6{\pm}4.2$ and $32.1{\pm}3.0$ yers old, respectively and the duration of marriage was 5 years and 4 months. In about half of the cases, AID was first suggested by husband and the decision was made by only the couple. The major reason for the operation was to form a complete family. In the item of the psychological effects, two-third of the couples felt anxiety related to the procedure which are mostly about the possible congenital or acquired deformity of baby. The AID was positively suggested in overall by all of recipients. After giving birth to a child, most couples felt positive about their decision. As a child grows up, about half of the couples felt the child as their own and expected not to tell of the AID. In overall, about 50% of couples presented satisfaction with the procedure. Conclusions: As the above results, various psychological impacts including anxiety about a child-to-be-born were accompanied to those who were recommended of AID. To overcome these problems, sufficient medical information and consultation about the course of selecting the donor and the whole procedures of AID should be provided beforehand.

• Clinical and Experimental Reproductive Medicine
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• 제47권4호
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• pp.277-283
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• 2020

Objective: The sperm DNA fragmentation index (DFI) guides the clinician's choice of an appropriate assisted reproductive technology (ART) procedure. The DFI can be determined using commercially available methodologies, including sperm chromatin dispersion (SCD) kits and sperm chromatin structure assay (SCSA). Currently, when DFI is evaluated using SCD kits, the result is analyzed in reference to the SCSA-derived threshold for the choice of an ART procedure. In this study, we compared DFI values obtained using SCSA with those obtained using SCD and determined whether the difference affects the choice of ART procedure. Methods: We compared SCSA to two SCD kits, CANfrag (n=36) and Halosperm (n=31), to assess the DFI values obtained, the correlations between tests, the technical repeatability, and the impact of DFI on the choice of ART. Results: We obtained higher median DFI values using SCD kits than when using SCSA, and this difference was significant for the CANfrag kit (p<0.001). The SCD kits had significantly higher coefficients of variation than SCSA (p<0.001). In vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) would be chosen for a significantly higher proportion of patients if a decision were made based on DFI derived from SCD rather than DFI determined using SCSA (p=0.003). Conclusion: Our results indicate that SCD kit-specific thresholds should be established in order to avoid the unnecessary use of IVF/ICSI based on sperm DNA damage for the management of infertility. Appropriate measures should be taken to mitigate the increased variability inherent to the methods used in these tests.

• Anatomy and Cell Biology
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• 제56권4호
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• pp.508-517
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• 2023

In cancer patients, chemo/radio therapy may cause infertility by damaging the spermatogenesis affecting the self-renewal and differentiation of spermatogonial stem cells (SSCs). In vitro differentiation of stem cells especially mesenchymal stem cells (MSCs) into germ cells has recently been proposed as a new strategy for infertility treatment. The aim of this study was to evaluate the proliferation and differentiation of SSCs using their co-culture with Sertoli cells and conditioned medium (CM) from adipose tissue-derived MSCs (AD-MSCs). Testicular tissues were separated from 2-7 days old neonate Wistar Rats and after mechanical and enzymatic digestion, the SSCs and Sertoli cells were isolated and cultured in Dulbecco's modified eagle medium with 10% fetal bovine serum, 1X antibiotic, basic fibroblast growth factor, and glial cell line-derived neurotrophic factor. The cells were treated with the CM from AD-MSCs for 12 days and then the expression level of differentiation-related genes were measured. Also, the expression level of two major spermatogenic markers of DAZL and DDX4 was calculated. Scp3, Dazl, and Prm1 were significantly increased after treatment compared to the control group, whereas no significant difference was observed in Stra8 expression. The immunocytochemistry images showed that DAZL and DDX4 were positive in experimental group comparing with control. Also, western blotting revealed that both DAZL and DDX4 had higher expression in the treated group than the control group, however, no significant difference was observed. In this study, we concluded that the CM obtained from AD-MSCs can be considered as a suitable biological material to induce the differentiation in SSCs.