• Clinical and Experimental Reproductive Medicine
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• 제35권3호
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• pp.223-229
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• 2008

목 적: 본 예비 연구는 비만하지 않은 다낭성난소증후군 환자들에게서 인슐린 저항성, 혈중 호르몬 농도 및 혈중 지질 농도에 관한 metformin의 효과를 알아보기 위해 수행하였다. 연구방법: 본 연구는 2006년 6월부터 2007년 9월까지 본원에서 다낭성난소증후군으로 진단받은 16명의 비만하지 않은 환자를 대상으로 하였다. 혈액 검사는 metformin 치료 전과 치료 후 6개월이 경과한 후에 실시하였으며 공복 혈당과 공복 인슐린 치, 75 g의 액상 포도당 섭취 후 2시간째의 혈당과 혈중 인슐린 농도를 측정 하였다. 혈중 호르몬 및 혈중 지질 농도는 FSH, LH, estradiol, testosterone, free testosterone, serum lipid profile을 포함하였다. 인슐린 저항성을 평가하기 위해 공복 시 혈당/인슐린 비율 (fasting glucose/insulin ratio; FGIR)과 액상 포도당 섭취 후 2시간째의 혈당/인슐린 비율을 산출하여 추정하였다. 또한 HOMA beta cell function 및 HOMA IR을 산출함으로써 인슐린 저항성 및 췌장 베타세포 기능을 조사하였다. 결 과: Metformin으로 치료한 후, 75 g 경구 당 부하 후 2시간째 측정한 glucose/insulin 비율은 증가되었으며 (p=0.04), HOMA IR은 치료 후 유의하게 감소가 있었다 (p=0.000). 그러나 혈중 지질 농도는 의미 있는 변화를 보이지 않았다. 혈중 free testosterone 농도는 치료 후 감소하였고 (p=0.001), LH 농도 및 LH/FSH 비도 감소하였다 (p=0.000, p=0.034). 결 론: 본 예비 연구는 metformin이 비만하지 않은 다낭성난소증후군 환자들에게서 인슐린 감수성을 개선하고, 고안드로겐혈증을 완화시키는 효과가 있을 수 있다는 것을 보여준다. Metformin의 역할을 결정하기 위하여 향후 보다 다수의 환자 군을 대상으로 하여 장기적인 추적 관찰을 수반한 심도 있는 연구가 이루어져야 할 것이다.

• 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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• 제25권1호
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• pp.93-102
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• 1998

Normal and abnormal follicular growth and steroidogenesis depend on gonadotropins as well as intraovarian peptides, which may mediate or potentiate gonadotropin action. Inhibin also affect follicular development and steroidogenesis and may play a role in dominant follicle selection and follicular atresia. Therefore, we studied the differences of serum inhibin, gonadotropin and androgen levels in the women with only the ultrasound findings and no disorder, and polycystic ovary (PCO) with ovulatory disturbance. We prospectively analysed forty-three women with PCO. The diagnosis of PCO was based on typical appearance of the ovaries on TVS. Twelve women with regular menstrual cycle and normal ovarian morphology were selected as control. Basal levels of inhibin, luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol $(E_2)$, testosterone (T), androstenedione (ADD), dehydroepiandrosterone-sulfate (DS), prolactin and TSH in serum were determined. There were significant differences in basal LH levels and LH/FSH ratio between the control and the women with PCO. The basal levels of inhibin and $E_2$ in the oligo-amenorrheic PCO (N=34) were significantly higher than those in the control. There was higher negative correlation between the inhibin and T levels in the oligo-amenorrheic PCO, but, not in the regular cycling PCO. Also, there was higher positive correlation between the LH and T levels in the oligo-amenorrheic PCO, but not in the regular cycling PCO. These data presume that the initial event of PCO is elevated pituitary LH secretion. Elevated levels of LH may down-regulate LH receptors on granulosa cells and also cause hypertrophy of the thecal layer. High level of androgen secreted by the hypertrophied thecal layer may stimulate inhibin secretion from granulosa cells and can be converted to estrogen by extraovarian tissues and could serve to augment pituitary sensitivity to GnRH with a resultant secretion of more LH than FSH. Inhibin may inhibit FSH action on granulosa cell in the PCO follicle, impairing follicular development and dominant follicle selection resulted in ovulatory disturbance.

• Clinical and Experimental Reproductive Medicine
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• 제42권3호
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• pp.86-93
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• 2015

Polycystic ovary syndrome (PCOS) is one of the most common hormonal endocrine disorders in women of reproductive age. It consists of a heterogeneous collection of signs and symptoms that together form a disorder spectrum. The diagnosis of PCOS is principally based on clinical and physical findings. The extent of metabolic abnormalities in women with PCOS varies with phenotype, body weight, age, and ethnicity. For general population, the prevalence of hyperandrogenism and oligomenorrhea decreases with age, while complications such as insulin resistance and other metabolic disturbances increase with age. Obese women with PCOS have a higher risk of developing oligomenorrhea, amenorrhea, hyperandrogenemia, insulin resistance, and lower luteinizing hormone (LH) to follicle stimulation hormone (FSH) ratios than non-obese women with PCOS. The LH to FSH ratio is a valuable diagnostic tool in evaluating Taiwanese women with PCOS, especially in the diagnosis of oligomenorrhea. Overweight/obesity is the major determinant of cardiovascular and metabolic disturbances in women of reproductive age.

• 대한생식의학회:학술대회논문집
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• 대한불임학회 2002년도 제43차 추계학술대회
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• pp.89-90
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• 2002

• 대한한방부인과학회지
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• 제34권3호
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• pp.175-191
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• 2021

Objectives: This study aims to analyze the medical record of eight cases of polycystic ovary syndrome (PCOS) in a local Korean medicine clinic, in order to provide evidence on Korean medicine treatment of PCOS and to suggest the direction of future studies. Methods: The medical records of eight cases diagnosed with PCOS based on 2003 Rotterdam Criteria and whose total testosterone level was 0.53 ng/ml and over were retrospectively analyzed. The primary outcome was total testosterone level, and the secondary outcomes included luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, LH/FSH ratio, weight, last mentrual period (LMP), numerical rating scale (NRS) score of dysmenorrhea, and other associated symptoms pre- and post-treatment. Korean medicine treatment consists of the complex herbal prescription consisting of Yukmijihwang-tang, Baekho-tang, Daesiho-tang, and Gyejibokryeong-hwan, modified according to symptoms; acupuncture and electroacupuncture on 中脘 (CV12), 下脘 (CV10), 關元 (CV4), 石門 (CV5), 合谷 (LI4), 太衝 (LR3), 三陰交 (SP6), and 懸鍾 (GB39); and indirect moxibustion on 神闕 (CV8). Results: The average total testosterone level lowered statistically significantly after the treatment. The average FSH and LH levels lowered with insignificance, while the average LH/FSH ratio and weight lowered statistically significantly. During the treatment period of three to six months, every patient had the menstrual cycle shortened except for one case; and two cases with infertility problem succeeded in being pregnant. There was no adverse event. Conclusions: The Korean medicine treatment was found effective in treating PCOS, especially regarding hyperandrogenism, amenorrhea or oligomenorrhea, and infertility.

• 대한한방부인과학회지
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• 제31권3호
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• pp.33-49
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• 2018

Objectives: The purpose of this study was to investigate the correlation between Pattern identification instrument and biomarkers in polycystic ovary syndrome patients. Methods: Pattern identification instrument questionnaire, Sasang constitutional test, body composition test, pulse analyzing test, laboratory test were performed and the results were analyzed. Correlation analysis was performed between pattern identification and laboratory test results. Results: Testosterone, SHBG, $17{\alpha}$-OH-progesterone, AMH were highest in the Kidney-Yang Deficiency (腎陽虛) group. LH, FSH, LH/FSH ratio were the highest in the Endogenous Heat due to Yin Deficiency (陰虛內熱) group. DHEA-S was the highest in the Dampness-Heat in Liver Meridian (肝經濕熱) group. E2, Prolactin, Cholesterol, Triglyceride, HDL-Cholesterol, LDL-Cholesterol, Glucose (FBS), Insulin, HOMA-IR ratio, HbA1c were the highest in the Phlegm-Dampness (痰濕) group. Conclusions: In this study, we obtained basic data analyzing the correlation between pattern identification instrument and biomarkers in polycystic ovary syndrome patients. If further studies are performed, we expect to be able to obtain clues to study the mechanism of polycystic ovary syndrome.

• Clinical and Experimental Reproductive Medicine
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• 제50권3호
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• pp.200-205
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• 2023

Objective: Polycystic ovary (PCO), a diagnostic component of polycystic ovary syndrome (PCOS), requires either an ovarian volume (OV) criterion or a follicle number per ovary (FNPO) criterion. This study investigated the association of OV and FNPO criteria with various manifestations of PCOS. Methods: This cross-sectional study was conducted at a university hospital among 100 patients newly diagnosed with PCOS (according to the revised Rotterdam criteria). Fasting blood samples were collected to measure glucose, total testosterone (TT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), lipid, insulin, and hemoglobin A1c levels. An oral glucose tolerance test was performed. Transabdominal or transvaginal ultrasound of the ovaries was done, depending on patients' marital status. All investigations were conducted in the follicular phase of the menstrual cycle. OV >10 mL and/or FNPO ≥12 indicated PCO. A homeostasis model assessment of insulin resistance (IR) value ≥2.6 indicated IR, and metabolic syndrome (MS) was defined according to the international harmonization criteria. Results: Seventy-six participants fulfilled the OV criterion, 70 fulfilled the FNPO criterion, and 89 overall had PCO. Both maximum OV and mean OV had a significant correlation with TT levels (r=0.239, p=0.017 and r=0.280, p=0.005, respectively) and the LH/FSH ratio (r=0.212, p=0.034 and r=0.200, p=0.047, respectively). Mean OV also had a significant correlation with fasting insulin levels (r=0.210, p=0.036). Multivariate binary logistic regression analysis showed that IR (odds ratio [OR], 9.429; 95% confidence interval [CI], 1.701 to 52.271; p=0.010) and MS (OR, 7.952; 95% CI, 1.821 to 34.731; p=0.006) had significant predictive associations with OV alone, even after adjustment for age and body mass index. Conclusion: OV may be more closely related to the androgenic and metabolic characteristics of PCOS than FNPO.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.367-370
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• 2007

Objective: Pituitary adenomas are common neurological lesions believed to account for 10% to 15% of all primary brain tumors. There can be diagnostic confusion due to discordance of the preoperative endocrine and the postoperative immunohistochemical diagnosis. In this study, the rate of discordance between preoperative and postoperative findings and their clinical implications were investigated. Methods: From March 2005 to March 2006, 26 patients who underwent surgery for a pituitary adenoma were enrolled in this study. The preoperative pituitary hormone level and postoperative immunohistochemical results were compared and analyzed. Results: The median age of the patients was 38 years [range 15-66 years]. The male to female ratio was 8 to 18. The endocrine evaluation showed 16 hormonally-active and 10 hormonally-inactive adenomas. The immunohistochemical findings showed : 13 prolactin-positive, 1 GH-positive, 1 FSH-positive, 8 pleurihormone-positive and 3 stain-negative adenomas. The percentage of discordance observed between the preoperative endocrine and postoperative immunohistochemical diagnosis was 54%. Nine of 10 endocrine non-functioning adenomas showed : 3 PRL positive, 1 GH positive, 2 PRL+GH positive, 1 TSH+FSH positive, 1 FSH+ACTH+PRL positive and 1 FSH+LH+PRL positive adenomas by immunohistochemistry. Three endocrine PRL+GH secreting adenomas showed 2 PRL positive and 1 FSH+GH positive by immunohistochemistry. One endocrine PRL secreting and 1 GH secreting adenoma showed 1 PRL+ TSH positive and 1 GH+PRL positive by immunohistochemistry, respectively. The diagnosis of the other 12 pituitary adenomas showed concordance. Conclusion : The results of this study showed 54% discordance rate between the preoperative endocrine and postoperative immunohistochemical diagnosis for pituitary adenomas.

• Clinical and Experimental Reproductive Medicine
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• 제18권2호
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• pp.201-208
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• 1991

Recently the application of gonadotropin-releasing hormone (GnRH) agonist to superovulation in previous poor responders has resulted in the improved outcomes after in vitro fertilization (IVF) outcome. However, poor responders with poor estradiol $(E_2)$ rise or single dominant follicle are a particularly challenging group. Recent reports have also shown that patients with higher basal serum follicle stimulating hormone (FSH) level, result in poorer ovarian response and lower pregnancy rate. Analysis of the differences of superovulation outcomes according to the different protocols of GnRH agonist, long (L, n = 18) and short (S, n = 16) protocols, in patients with high basal FSH levels (>20mIU/ml) were undertaken at Seoul National University Hospital from June to October 1990. The administration of GnRH agonist was begun on day 21 of the cycle in long protocol, and on day 2 in short protocol. Ages of patients and husbands, basal FSH and luteinizing hormone (LH) levels and FSH/LH ratio did not differ significantly. Types and causes of infertility were evenly distributed. Whereas the duration of stimulation and the amounts of gonadotropins administered were significantly reduced in short protocol, the numbers of oocytes retrieved and cleaved, the cleavage rate and the number of embryos transferred were higher in long protocol without statistical signifieance. The pregnancy rate per ET was 16.7% (2/12) in short protocol, and 17.6% (3/17) in long protocol. These data suggest that both protocols result in the similar superovulation outcomes in patients with higher basal serum FSH levels.