• Clinical and Experimental Reproductive Medicine
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• 제46권1호
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• pp.30-35
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• 2019

Objective: Bilateral uterine artery ligation (UAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian function remain unclear. The aim of this study was to investigate whether bilateral UAL compromised ovarian reserve and ovarian blood supply. Methods: This prospective study included 49 women aged between 21 and 36 years who had undergone a cesarean section for obstetric indications. Of these, 25 underwent uterine bilateral UAL to control intractable atonic PPH. The control group consisted of 24 women who had not undergone bilateral UAL. Standard clinical parameters, the results of color Doppler screening, and ovarian reserve markers were assessed in all participants at 6 months after surgery. The clinical parameters included age, parity, cycle history, body mass index, and previous medication and/or surgery. Color Doppler screening findings included the pulsatility index (PI) and resistance index (RI) for both the uterine and ovarian arteries. The ovarian reserve markers included day 3 follicle-stimulating hormone (FSH) levels, antral follicle count, and $anti-M\ddot{u}llerian$ hormone (AMH) levels. Results: There were no significant differences in the ovarian reserve markers of day 3 FSH levels, antral follicle count, and AMH levels between the study and control groups (p> 0.05 for all). In addition, no significant differences were observed in the PI and RI indices of the uterine and ovarian arteries (p> 0.05 for all). Conclusion: In this study, we showed that bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

• Clinical and Experimental Reproductive Medicine
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• 제50권3호
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• pp.170-176
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• 2023

Objective: Autophagy is highly active in ovariectomized mice experiencing hormone deprivation, especially in the uterine mesenchyme. Autophagy is responsible for the turnover of vasoactive factors in the uterus, which was demonstrated in anti-Müllerian hormone receptor type 2 receptor (Amhr2)-Cre-driven autophagy-related gene 7 (Atg7) knockout (Amhr-Cre/Atg7^f/f mice). In that study, we uncovered a striking difference in the amount of sequestosome 1 (SQSTM1) accumulation between virgin mice and breeder mice with the same genotype. Herein, we aimed to determine whether repeated breeding changed the composition of mesenchymal cell populations in the uterine stroma. Methods: All female mice used in this study were of the same genotype. Atg7 was deleted by Amhr2 promoter-driven Cre recombinase in the uterine stroma and myometrium, except for a triangular stromal region on the mesometrial side. Amhr-Cre/Atg7^f/f female mice were divided into two groups: virgin mice with no mating history and aged between 11 and 12 months, and breeder mice with at least 6-month breeding cycles with multiple pregnancies and aged around 12 months. The uteri were used for Western blotting and immunofluorescence staining. Results: SQSTM1 accumulation, representing Atg7 deletion and halted autophagy, was much higher in virgin mice than in breeders. Breeders showed reduced accumulation of several vasoconstrictive factors, which are potential autophagy targets, in the uterus, suggesting that the uterine stroma was repopulated with autophagy-intact cells during repeated pregnancies. Conclusion: Multiple pregnancies seem to have improved the uterine environment by replacing autophagy-deficient cells with autophagy-intact cells, providing evidence of cell mixing.

• Journal of Preventive Medicine and Public Health
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• 제37권2호
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• pp.166-173
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• 2004

Objectives : Cervical cancer is the second most frequent cancer among women in Busan. The Pap smear test could have a significant effect on detecting cervical cancer, and enhancing their rate of use is an important strategy for reducing the incidence and mortality of cervical cancer. This study aimed to evaluate the factors associated with the past use of the Pap smear test in Korean women. Methods : A population-based survey was carried out in Busan between November 1999 and March 2000. 1,673 participants were randomly selected from 2,684 women in Busan, using a 2-stage cluster sampling method, and interviewed in their homes. Their socio-demographic characteristics, smoking, drinking, familial cancer history, Pap smear screening history, reproductive and menstrual factors, sexual habits and use of contraceptive methods data were collected by a trained interviewer using a questionnaire. The use of the screening test was defined by a self-report from the participants on how many times they had had a Pap smear test in their lifetime, and when they had received their latest examination. Results : Of the 1,673 respondents (62.3% response rate), 57.6% had had a Pap smear test during her life (mean number, 2.3). Among the health examination participants(1,064), 961(90.3%) reported having sexual experience and 70.9% of these had had a Pap smear test. In a multiple logistic regression analysis, statistically significant relationships were observed for age groups and the Pap smear test rate (odds ratio, OR for 35-44 years=2.45; OR for 45-54 years=3.41; OR for 55 years=2.60; reference, under 34 years). The married or cohabiting women were more likely to have used the Pap smear test than those separated or widowed (OR=1.73). Among the reproductive behavioral measures, the number of births (OR for 3 births=4.22; OR for 2 births=3.95; OR for 1 births=3.38; reference, 0 births) and husband's extra-marital affairs (OR=1.50) were associated with the rates of use of Pap smear tests. Conclusion : It appears that the most important contributing factors to cervical cancer screening were age, marital status and number of births. A positive association was also observed for the husband's extra-marital affairs. This study enabled us to systematically assess the relationship between Pap smear rates and risk factors for cervical cancer. It is hoped that this study will make a significant contribution to the accumulating scientific evidence on the identification of factors associated with cervical cancer screening in Korea.

• Clinical and Experimental Reproductive Medicine
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• 제4권2호
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• pp.23-34
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• 1977

A study was carried out for the evaluation on family situation of 900 homemakers those who had received tubal sterilization operation (laparoscopic and minilaparotomy) at family planning clinic, Seoul Red Cross Hospital from October 1974 to September 1977. The results obtained are as follows: 1) In age distribution, predominant age group consisted of those $31{\sim}35$ years frequency of 43.2% and average age was 33.3 years. 2) Educational level showed that homemakers who finished primary school accounted for 37.3% of the total and those having middle school education comprised 28.7%, and 24.3% of them were high school graduates, 8.3% of them were college graduates. On the other hand, husband's education level showed that, 37.6% of them were high school graduates, 29.7% were college graduates and 19.9% were middle school graduates, therefor, educational level of husbands was one step higher than wives. 3) In the gravidity at the tubal sterilization, the highest incidence(18.4%) among 853cases was the group of gravida 5, and 16.2% gravida 4, and the gravidity ranged $1{\sim}23$. Average gravidity of clients was 6.0. 4) Among the total number of 900 clients, 778cases (91.3%) had no experience of spontanous abortion, history of 1 abortion in 5.9%, 2 abortions in 1.8%, and it showed the decresed incidence of spontanous abortion recently. Average was 0.15. As regarding induced abortion, in spite of only 142 homemakers (16.7%) had no history of induced abortion, 20.5% had experienced 1 induced abortion before sterilization, 17.7% had 2 induced abortions, 14.6% had 3 abortions, 10.3% had 4 abortions, and 0.2% (2cases) had over 20 abortions. Average was 2.7. 5) In regarding to the number of living children, the greatest number (45.0%) of clients had 3 children, and 26.5% 2 children, 19.7% 4 children. Average number of their living children was 3.03. 6) Sex ratio of living children, among 18 clients those had 1 child, 17 homemakers had 1 boy and no girl, 1 homemaker had no boy and 1 girl only. Sex ratio showed that woman who had 2 boys and no girl accounted for 46.3%, however, those having no boy and 2 girls ocmprised only 1. 8% among 229 clients who had 2 children. Among 389 clients who had 3 children, in spite of woman who had 3 boys and no girl comprised 16.5%, but no boy and 3 girls only 1.5%. Among 170 clients who had 4 children, homemakers with 4 boys and no girl accounted for 4.1%, however, no boy and 4 girls 1.8% of the total. Among 52 clients, who had 5 children, woman with 5 boys and no girl comprised 3.9%, no boy and 5 girls 0%. Among 7 cases who had 6 children, there were 3 cases who had 3 boys and 3 girls, but only 1 cases had 1 boy and 5 girls and so on. These results showed a strong trend of male preference in Korea and this could be one of the inhibit factors for family planning.

• 정신신체의학
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• 제30권2호
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• pp.99-111
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• 2022

번식은 진화의 핵심 요인이면서, 동시에 의학의 중요한 관심사다. 특히 생물학적 적합도 최대화에 반하는 현대 산업 사회의 낮은 출산율에 대해 진화학자들이 다양한 이론과 가설을 제안했다. 출산은 번식 적합도에 미치는 가장 중요한 요인이기 때문에 출산 행동 및 의도와 관련된 다양한 심리적 모듈이 진화했을 것으로 추정된다. 성적 욕구, 사회적 지위 욕구, 양육 욕구, 출산 욕구(또는 아기 갈망)등이 번식과 관련된 진화 심리적 모듈로 제안되었다. 과거 진화적 적응 환경과 현대 산업 사회 환경의 불일치로 인해 과거에는 적응적이었던 심리적 모듈이 지금은 부적응적으로 발현될 수도 있다. 현대 사회에서 출산 의사에 영향을 미치는 진화생태학적 요인은 크게 개인의 성격적 요인, 유년기 생애사적 경험, 가임기 사회생태적 경험이 있다. 본 연구는 출산 의사 결정에 영향을 미치는 진화정신의학적 요인에 관한 가설과 모델을 고찰하고, 현대 산업 사회의 저출산 현상과 관련된 심리적 요인을 진화의학적 관점에서, 정신적, 사회적, 생태적 요인을 중심으로 개괄한다.

• Journal of Nutrition and Health
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• 제40권4호
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• pp.334-346
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• 2007

본 연구에서는 대구${\cdot}$경북 지역의 103명의 유방암 환자 와 159명의 대조군을 대상으로 생식적 특성과 식품섭취패턴이 유방암 위험에 미치는 영향을 분석하였다. 조사는 설문지와 식품섭취빈도조사지, 개인 면담을 통하여 실시하였다. 식품섭취패턴에 따른 유방암의 상대적 위험도는 일반특성과 생식특성에서 환자군과 대조군간에 유의한 차이를 보인 요인들을 혼란변수로 통제한 후 산출되었다. 본 연구의 결과 유방암 환자군의 평균 BMI는 대조군에 비해 유의적으로 높았으며 이 차이는 특히 폐경 후 여성에서 현저하였다. 환자군은 유방암 가족력이 유의하게 높았으며 유산경험이 유의적으로 많았고, 모유수유 경험과 총 모유수유기간이 유의적으로 낮았다. 경구피임약과 호르몬 대체요법 등의 외인성 호르몬의 사용과 유방암 사이에는 유의적인 관련성이 나타나지 않았다. 식품섭취패턴과 관련하여서는 찜조리 선호군에 비해 튀김, 구이 조리 선호군에서 위험도가 유의적으로 높게 나타났다. 과일류와 해조류의 섭취 빈도가 높을수록 상대적 위험도가 유의적으로 낮았고, 녹황색 및 담색 채소류와 콩류는 섭취빈도가 많을수록 위험도가 낮은 경향을 보였지만 유의적인 결과는 아니었다. 생선류, 육류, 유지류, 유제품류의 섭취빈도에 따른 위험도의 관련성은 나타나지 않았으며, 녹차 커피의 경우는 일주에 2${\sim}$3회 섭취가 위험도를 낮추는 경향을 보였다. 본 연구의 결과 유방암의 위험과 관련된 요인으로는 높은 BMI, 유방암 가족력, 높은 유산 경험과 낮은 모유수유 경험, 짧은 모유수유 기간으로 나타났고, 식품섭취관련 인자로는 튀김 및 볶음, 구이 등의 조리법 선호와 과일과 해조류의 낮은 섭취 빈도가 위험요인으로 나타났다.

• Clinical and Experimental Reproductive Medicine
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• 제29권4호
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• pp.269-278
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• 2002

Objective s: Chromosome aneuploidy is associated with recurrent abortion and congenital anomaly and genetic diseases occur repeatedly in the specific families. Preimplantation genetic diagnosis (PGD) can prevent aneuploidy or genetic disease by selecting normal embryos before implantation and is an alternative to prenatal diagnosis. The aim of this study is to assess the outcome of PGD cycles by using FISH or PCR, and to determine the clinical usefulness and values in patients with risk of chromosomal aneuploidy or genetic disease. Materials and Methods: From 1995 to Apr. 2001, a total of 108 PGD cycles in 65 patients with poor reproductive outcome were analyzed. The indications of PGD were translocation (n=49), inversion (n=2), aneuploidy screening (n=7), Duchenne muscular dystrophy (n=5) and spinal muscular atrophy (n=2). PGD was applied due to the history of recurrent abortion, previous birth of affected child or risk of aneuploidy related to sex chromosome aneuploidy or old age. Blastomere biopsy was performed in 6$\sim$10 cell stage embryo after IVF with ICSI. In the single blastomere, chromosome aneuploidy was diagnosed by using FISH and PCR was performed for the diagnosis of exon deletion in DMD or SMA. Results: The FISH or PCR amplification was successful in 94.3% of biopsied blastomeres. The rate of transferable balanced emb ryos was 24.0% in the chromosome translocation and inversion, 57.1% for the DMD and SMA, and 28.8% for the aneuploidy screening. Overall hCG positive rate per transfer was 17.8% (18/101) and clinical pregnancy rate was 13.9% (14/101) (11 term pregnancy, 3 abortion, and 4 biochemical pregnancy). The clinical pregnancy rate of translocation and inversion was 12.9% (11/85) and abortion rate was 27.3% (3/11). In the DMD and SMA, the clinical pregnancy rate was 33.3% (3/9) and all delivered at term. The PGD results were confirmed by amniocentesis and were correct. When the embryos developed to compaction or morula, the pregnancy rate was higher (32%) than that of the cases without compaction (7.2%, p<0.01). Conclusions: PGD by using FISH or PCR is useful to get n ormal pregnancy by reducing spontaneous abortion associated with chromosome aneuploidy in the patients with structural chromosome aberration or risk of aneuploidy and can prevent genetic disease prior to implantation.

• Clinical and Experimental Reproductive Medicine
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• 제35권1호
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• pp.83-88
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• 2008

보조생식술 시행 후 혈전색전증의 발생은 매우 드물기는 하나 치명적인 합병증이다. 과배란 유도시 중증 난소 과자극 증후군은 $0.1{\sim}0.5%$에서 발생하며, 중증 난소 과자극증후군 환자의 128명 중 한 명에서 혈전색전증이 발생하는 것으로 알려져 있다. 발병기전으로는 과배란 유도에 따른 고에스트로젠 혈증에 의한 혈액응고인자의 변화, 혈관 투과성의 증가에 따른 혈액농축 및 순환혈액의 감소 등을 원인으로 추정하고 있으나 그 정확한 기전은 알려진 바가 없다. 또한 thrombophilia나, 혈전색전증의 과거력 및 가족력이 있는 경우 발병율이 증가한다. 혈전증의 발생 부위는 정맥이 67%이나, 33%는 동맥에 발병하며 주로 뇌동맥에 발생된다고 보고되었다. 본 예는 3년간의 이차성 불임을 주소로 내원하여 시험관 아기시술을 시행하였으며 hCG 투여 8일 후 난소 과자극증후군이 중등도로 발생하였다. hCG 투여 후 11일째 갑작스런 의식 소실 및 우측 상지의 운동장애가 발생하여 시행한 MRI상 뇌바닥동맥 (basilar a.) 혈전증으로 진단되었으며, 혈관내 혈전 용해술 및 풍선 확장술 시행후 재관류에 성공하였다. 시술 2일 후 의식 및 운동장애는 완전히 회복되었으며 시술 7일 후 말더듬증 역시 회복되어 후유장애 없이 건강한 상태이다. Thrombophilic study상 Protein S결핍 소견을 보였고, 또한 vWF-associated Ag.이 증가된 양상을 보였다. 지금까지 국내에서 난소 과자극증후군 이후에 발생한 뇌경색은 5예가 보고되었으며, 이중 4예에서 protein S deficiency 소견을 보였으므로 선별 검사로 유용할 것으로 사료된다. 저자 등은 3년간의 이차성 불임을 주소로 내원한 33세 환자에서 시험관 아기시술시 hCG 투여 11일째에 발생한 뇌바닥동맥 혈전증을 간단한 문헌 고찰과 함께 보고하는 바이다.

• Clinical and Experimental Reproductive Medicine
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• 제25권2호
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• pp.115-122
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• 1998

The maintenance of a viable pregnancy has long been viewed as an immunological paradox. The deveolping embryo and trophoblast are immunologically foreign to the maternal immune system due to their maternally inherited genes products and tissue-specific differentiation antigens (Hill & Anderson, 1988). Therefore, speculation has arisen that spontaneous abortion may be caused by impaired maternal immune tolerance to the semiallogenic conceptus (Hill, 1990). Loss of recall antigen has been reported in immunosuppressed transplant recipients and is associated with graft survival (Muluk et al., 1991; Schulik et al., 1994). Progesterone $(10^{-5}M)$ has immunosuppressive capabilities (Szekeres-Bartho et al., 1985). Previous study showed that fertile women, but not women with unexplained recurrent abortion (URA), lose their immune response to recall antigens when pregnant (Bermas & Hill, 1997). Therefore, we hypothesized that immunosuppressive doses of progesterone may affect proliferative response of lymphocytes to trophoblast antigen and alloantigen. Proliferative responses using $^3H$-thymidine ($^3H$-TdR) incorporation of peripheral blood mononuclear cells (PBMCs) to the irradiated allogeneic periperal blood mononuclear cells as alloantigen, trophoblast extract and Flu as recall antigen, and PHA as mitogen were serially checked in 9 women who had experienced unexplained recurrent miscarriage. Progesterone vaginal suppositories (100mg b.i.d; Utrogestan, Organon) beginning 3 days after ovulation were given to 9 women with unexplained RSA who had prior evidence of Th1 immunity to trophoblast. We checked proliferation responses to conception cycle before and after progesterone supplementation once a week through the first 7 weeks of pregnancy. All patients of alloantigen and PHA had a positive proliferation response that occmed in the baseline phase. But 4 out of 9 patients (44.4%) of trophoblast antigen and Flu antigen had a positive proliferative response. The suppression of proliferation response to each antigen were started after proliferative phase and during pregnancy cycles. Our data demonstrated that since in vivo progesterone treated PBMCs suppressed more T-lymphocyte activation and $^3H$-TdR incorporation compare to PBMCs, which are not influenced by progesterone. This data suggested that it might be influenced by immunosuppressive effect of progesterone. In conclusion, progesterone may play an important immunological role in regulating local immune response in the fetal-placental unit. Furthermore, in the 9 women given progesterone during a conception cycle, Only two (22%) repeat pregnancy losses occured in these 9 women despite loss of antigen responsiveness (one chemical pregnancy loss and one loss at 8 weeks of growth which was karyotyped as a Trisomy 4). These finding suggested that pregnancy loss due to fetal aneuploidy is not associated with immunological phenomena.

• 근관절건강학회지
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• 제6권1호
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• pp.37-50
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• 1999

The purpose of this study was to identify the risk factors of osteoporosis. The data were collected from women who visited Physical Examination Center of a university hospital located in Taejon during the period of September 1997-August 1998. The sample was divided into two groups(the osteoporosis group of 44 cases and the control group of 66 cases). The results were summarized as follows ; 1. Sociodemographic characteristics(education and family income) and BMI showed no significant difference between the osteoporosis group and the control group. 2. There was no significant difference in coffee, unbalanced diet, diet method and meal habit between the osteoporosis group and the control group. 3. The osteoporosis group reported more incidence of operative menopause due to hysterectomy and oophorectomy, but this was not statistically significant. There was no significant difference in use of oral pill use, past disease and family history of fracture between the osteoporosis group and the control group, but the odds ratio(OR 3.11, 95% CI : 1.30-7.41) of present illness was statistically significant in the osteoporosis group. 4. There was no significant difference in the reproductive history including number of delivery and abortion and feeding method between the osteoporosis group and the control group. 5. The osteoporosis group showed significant results of lower menopausal age, shorter duration of menstruation and longer duration after menopause compared to the control group. 6. The osteoporosis group reported significantly lower level of physical activity in such variables as work activity and walking time. 7. A logistic analysis showed that shorter period of menstruation, lower level of physical activity, non-alcohol drinking group, and presence of disease were related to the possibility of occurring of osteoporosis.