• 한국인구학
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• 제5권1호
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• pp.133-144
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• 1982

One of the primary objectives of Korean family planning program is to assist parents in having the number of children they want, both by providing fertility-en-hancing services to infecund and subfecund women and by providing fertility-limitation services to fecund women. As far as fertility-enhancing services to infecund and subfecund women is concerned, there has been little effort from the national family planning program, So far, there is no any basic data on infertility prevalence rate among the Korean women. Therefore, an attempt has been made to review data of 1976 and 1978 fertility and family planning surveys in order to estimate the level of infertility rate among the Korean women. In the 1978 survey 3. 7 percent of the current married women responded that they were physically infertile while in the 1976 survey physically infer-tile women was calculated as 3 percent of the total ever married women which is similar level of 1978 data of 3.7 percent. Mean age at first marriage of Korean women is 23 and most of the women are married in the high fecund age. Only 0.3 percent of the respondents married age 30. in addition, the rate of women with no children among the ever married women whose married duration is more than 5 year is very low;2. 5 percent among 5-9 years, 1. 4 percent among 10- 14 years; 1.8 precent among 15-19 years; 1.0 percent among 20-24 years; and 0. 7 percent among 25 or more years of marriage duration. If we consider those data shown above, it is manifest that infertility rate of Korean women is less than 5 percent level which is much lower than the 10 percent level of infertility rate in the United States of America. However, this kind of estimation is still not able to show definite data on fertility rate. Therefore, a nationwide planned survey should be carried out as early as possible to figure out the real situation of infertility rate in Korea.

• Clinical and Experimental Reproductive Medicine
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• 제24권2호
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• pp.193-198
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• 1997

To evaluate the efficacy of transabdominal myomectomy in the management of infertile patients, and to analyze on the results of abdominal myomectomy in 38 infertile patients with no other detectable cause except myomas were undertaken at the Department of Obstetrics and Gynecology in Yonsei University Hospital from 1990 to 1996. The results are as follows; 1. Average age of patients was 31.1 years. The infertility duration ranged 12 months to 144 months, and average infertility period of patients was 29.4 months. 2. Fourteen of the 38 patients (8 of 23 patients with primary infertility, 6 of 15 patients with secondary infertility) conceived following myomectomy, with a pregnancy rate of 36.8%. 3. Patients with less than 4 years of infertility showed a higher pregnancy rate after myomectomy than those with more than 4 years of infertility (42.4% vs 0%, p<0.05). 4. Patients younger than 35 years showed significantly higher pregnancy rate than those older than 35 years (46.4% vs 9.0%, p<0.05). 5. The removal of a solitary myoma produced a significantly higher pregnancy rate than that of multiple myomas (47.8% vs 20.0%, p<0.05), and the size of the myomas did not influenced the pregnancy rate after myomectomy (p>0.1). 6. The average time period from operation to conception was 12.1 months. Eight of the 14 patients (57.1%) conceived in the first year after operation and 12 patients (85.7%) condeived within two years. In conclusion myomas are a possible cause of infertility and myomectomy can be strongly recommended with good success expectation for the infertile women if uterine myoma be considered as the main cause of infertility. And factors affecting the pregnancy rate after myomectomy in these patients are the age of the patient, the duration of infertiluty, and the number of myoma.

• 한국발생생물학회:학술대회논문집
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• 한국발생생물학회 2003년도 제3회 국제심포지움 및 학술대회
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• pp.60-60
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• 2003

Embryonic stem (ES) cells have property of self-renewal and can differentiate into the cells of all three primary germ layers. Recently, many growth factors, alteration of culture condition and gene modifications have been used to differentiate mouse and human ES cells into specific cell types. This study was performed to evaluate the differentiation protocol for human ES cells to the endodermal lineage cells. Human ES cells (Miz-hESl ) were cultured on STO feeder layer mitotically inactivated with mitemycin C, and embryoid bodies (EBs) were formed by suspension culture. Differentiation protocol of EBs consisted of three steps: stage I, culture of EBs for 6 days with ITSFn medium; stage II, culture of stage I cells for 8 days with N2 medium ; stage III, culture of stage II cells for 22 days with N2 medium. mRNA levels of the endodermal lineage differentiation genes were analyzed by semi- quantitative RT-PCR. The Oct-4 expression, a marker of the pluripotent state, was detected in undifferentiated human ES cells but progressively decreased after EBs formation. Differentiating human ES cells expressed marker genes of endodermal differentiation and pancreatic islet cells. GATA4, a-fetoprotein, Glut-2, and Ngn3 were expressed in all stages. However, albumin and insulin were expressed in only stage III cells. The human ES cells can be differentiated into endodermal lineage cells by multiple step culture system using various supplements. We are developing the more effective protocols for guided differentiation of human ES cells.

• Clinical and Experimental Reproductive Medicine
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• 제32권3호
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• pp.223-230
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• 2005

Objective: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination. Methods and Material: Total 219 infertile patients were retrospectively analyzed between January 1, 2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal. Results: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity 88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II). Conclusion: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.

• Clinical and Experimental Reproductive Medicine
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• 제48권2호
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• pp.174-183
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• 2021

Objective: The aim of this study was to compare the pregnancy outcomes of in vitro fertilization with embryo transfer between embryos cultured in a time-lapse monitoring system (TLS) and those cultured in a conventional incubator (CI). Methods: The medical records of 250 fertilized embryos from 141 patients undergoing infertility treatment with assisted reproductive technology at a tertiary hospital from June 2018 to May 2020 were reviewed. The study population was divided into TLS and CI groups at a 1 to 1 ratio (125 embryos per group). The primary outcome was the live birth rate. Results: The TLS group had a significantly higher clinical pregnancy rate (46.4% vs. 27.2%, p=0.002), implantation rate (27.1% vs. 12.0%, p=0.004), and live birth rate (32.0% vs. 18.4%, p=0.013) than the CI group. Furthermore, subgroup analyses of the clinical pregnancy rate and live birth rate in the different age groups favored the TLS group. However, this difference only reached statistical significance in the live birth rate in women aged over 40 years and the clinical pregnancy rate in women aged 35-40 years (p=0.048 and p=0.031, respectively). The miscarriage rate, cleavage rate, and blastocyst rate were comparable. Conclusion: TLS application improved the live birth rate, implantation rate, and clinical pregnancy rate, particularly in the advanced age group in this study, while the other reproductive outcomes were comparable. Large randomized controlled trials are needed to further explore the ramifications of these findings, especially in different age groups.

• 여성건강간호학회지
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• 제17권2호
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• pp.178-186
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• 2011

Purpose: The purpose of this study was to identify effects of guided imagery on stress including cognitive, affective, marital and social, and anxiety among women receiving in vitro fertilization (IVF). Methods: Data were collected between April, 21 and June, 17, 2008. The participants in this study were 57 women (26 for the experimental group, 31 for the control group) receiving IVF for primary or secondary infertility in one of the outpatient infertility centers in Seoul. The guided imagery (Suk, 2001) was provided through audio CD to the experimental group by themselves 8 minutes per day for 2 weeks. Data were analyzed by SPSS 12.0 windows program. Results: After guided imagery, the experimental group showed significantly lower affective stress and total stress scores. Anxiety scores increased significantly in the control group, but not in the experimental group after treatment. Conclusion: The findings suggest that guided imagery is an effective nursing intervention for reducing stress especially affective stress and anxiety among infertile women receiving IVF in outpatient infertility center.

• 대한한의학회지
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• 제36권2호
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• pp.1-7
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• 2015

Objectives: To report on the result of infertility treatment with Korean medicine in clinical settings. Methods: This study was single arm, retrospective observational study. Analysis of the medical records on thirty four infertile women who were treated by acupuncture, moxibustion, herbal medicine(Jokyungjongoktang-gagambang, Sutaehwan-gagambang). Pregnancy rate(PR) and Live birth rate(LBR) were analyzed as the primary outcomes. Changes of AMH, FSH, LH, $E_2$, $P_4$, endometrial thickness, fat mass, and BMI were also analyzed as the secondary outcomes. Results: A total of 34 patients were treated in the traditional Korean medical clinic. Nine patients were dropped, and 25 subjects completed the final examination at the end of this treatment schedule. Five of 25 subjects conceived during treatment, reaching 20% PR and LBR was also 20%. Except for FSH level, the results of the remaining outcome measures, including LFT, showed no significant changes. No serious adverse event has been reported. Conclusion: Although no significant changes in bio-markers were observed, complex treatment using Korean medicine has shown effectiveness on women's infertility. In addition, the safety of the treatment has been verified.

• Clinical and Experimental Reproductive Medicine
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• 제45권1호
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• pp.1-9
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• 2018

Objective: To determine the localization, expression, and function of Toll-like receptors (TLRs) in fallopian tube epithelial cells. Methods: The localization of TLRs in fallopian tube epithelial cells was investigated by immunostaining. Surprisingly, the intensity of staining was not equal in the secretory and ciliated cells. After primary cell culture of fallopian tube epithelial cells, ring cloning was used to isolate colonies of ciliated epithelial cells, distinct from non-ciliated epithelial cells. The expression of TLRs 1-10 was examined by quantitative real-time polymerase chain reaction, and protein localization was confirmed by immunostaining. The function of the TLRs was determined by interleukin (IL)-6 and IL-8 production in response to TLR2, TLR3, TLR5, TLR7, and TLR9 ligands. Results: Fallopian tube epithelial cells expressed TLRs 1-10 in a cell-type-specific manner. Exposing fallopian tube epithelial cells to TLR2, TLR3, TLR5, TLR7, and TLR9 agonists induced the secretion of proinflammatory cytokines such as IL-6 and IL-8. Conclusion: Our findings suggest that TLR expression in the fallopian tubes is cell-type-specific. According to our results, ciliated cells may play more effective role than non-ciliated cells in the innate immune defense of the fallopian tubes, and in interactions with gametes and embryos.

• Clinical and Experimental Reproductive Medicine
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• 제46권4호
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• pp.173-177
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• 2019

Objective: We investigated the clinical characteristics of men with testosterone replacement therapy (TRT)-induced hypogonadism and its effect on assisted reproductive technology (ART) in infertile couples. Methods: This study examined the records of 20 consecutive male patients diagnosed with azoospermia or severe oligozoospermia (< 5 × 10⁶/mL) who visited a single infertility center from January 2008 to July 2018. All patients were treated at a primary clinic for erectile dysfunction or androgen deficiency symptoms combined with low serum testosterone. All men received a phosphodiesterase 5 inhibitor and TRT with testosterone undecanoate (Nebido^®) or testosterone enanthate (Jenasteron^®). Patients older than 50 years or with a chronic medical disease such as diabetes were excluded. Results: The mean age of patients was 37 years and the mean duration of infertility was 16.3 ± 11.6 months. At the initial presentation, eight patients had azoospermia, nine had cryptozoospermia, and three had severe oligozoospermia. Serum follicle-stimulating hormone levels were below 1.0 mIU/mL in most patients. Three ongoing ART programs with female factor infertility were cancelled due to male spermatogenic dysfunction; two of these men had normal semen parameters in the previous cycle. After withholding TRT, serum hormone levels and sperm concentrations returned to normal range after a median duration of 8 months. Conclusion: TRT with high-dose testosterone can cause spermatogenic dysfunction due to suppression of the hypothalamic-pituitary-testicular axis, with adverse effects on infertility treatment programs. TRT is therefore contraindicated for infertile couples attempting to conceive, and the patient's desire for fertility must be considered before initiation of TRT in a hypogonadal man.

• Clinical and Experimental Reproductive Medicine
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• 제7권1_2호
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• pp.11-20
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• 1980

Hysterosalpingograms (H.S.G.) have been done for several decades to determine causative factors in female infertility. However, the H.S.G. only reverals uterine cavity and tubal patency or inpatency. The author prefers to find more details in regard to the status and condition of the female reproductive organs and their surrounding tissue as they pertain to infertility. H.S.G. in combination with laparoscopic examination reveals the following results. Preparation and method of performance of H.S.G. during laparoscopy in a healthy reproductive age women are as follows. When laparoscopy is not contraindicated, NPO is ordered with routine bowel preparation. Analgesics administered by injection prior to procedure are valium 10mgs and pethidine 50-100mgs. The radiographic procedure is the same as for any HSG technique. During laparoscopy a solution of 3 to 10 ccs. of 60% hypaque sodium is used. Fluroscopic scout films are obtained A-P and oblique views as well as a delayed check film. 1. Age distribution of primary and secondary infertility in this studies involving tubal factors was as follows: 20-29 age group showed 46% incidence and in the 30-39 age group, 50% incidence. Duration of infertility in this study group was the following: 1-2 years showed 26.7%, 3-5 years 53.8%, and 6-9 years 13.3%. 2. Indications of laparoscopic examination were as follows: Secondary infertility in 35% of the cases, obscure tubal occlusion on previous H.S.G. in 25%, unknown origin in 11.7%, and the remaining cases included pelvic pain, small masses, dysmenorrhea, and uterine anomaly. The laparoscopic examination showed clearly the reproductive organs and the surrounding tissues in the pelvic cavity. The abnormal tubal findings there revealed were tuberculous salpingitis and hydrosalpinx in 10% each, endometriosis and peritubabl adhesions in 6.7% each, biconuate uterus in 3.3%. The remaining 58.3% of the cases showed normal findings. Laparoscopic observation for possible myoma nodules, streak ovary, and peritubal adhesions was also done at this time. 3. Comparative tubal findings in combined H.S.G. and laparoscopic examination revealed the following. Bilateral tubal occlusion was present in 14% (7cases) on laparoscopic examination but on H.S.G. 38% (19 cases) were noted. However, tubal occlusion and peritubal adhesions were found in 26% (13 cases) upon laparoscopy and only 8% (4 cases) on H.S.G. examination alone. Normal pelvic findings were present in 60% (27 cases).