• Clinical and Experimental Reproductive Medicine
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• 제49권1호
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• pp.70-73
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• 2022

Objective: This study was conducted to assess the efficacy of subcutaneous granulocyte colony-stimulating factor (G-CSF) for treating thin endometrium. Methods: Data from 88 infertile women with thin endometrium (<7 mm) aged 23 to 40 years were evaluated retrospectively over a period of 1 year. In group 1, subcutaneous infusion of G-CSF (300 ㎍/mL) was administered to 44 women along with other supplemental treatments. If the lining did not exceed 7 mm within 72 hours, a second infusion was administered. In group 2, which also had 44 women, only estradiol valerate and sildenafil were administered, while subcutaneous G-CSF infusion was not. Embryo transfers were performed once the lining exceeded 7.5 mm. The efficacy of G-CSF was evaluated by assessing the thickness of the endometrium before embryo transfer, pregnancy rates, and clinical pregnancy rates. Results: There were no differences between the groups regarding demographic variables, egg reserves, sperm parameters, the number of embryos transferred, and embryo quality. The pregnancy rate was significantly higher in group 1 (60%, 24 of 40 cases) than in group 2 (31%, 9 of 29 cases) (p<0.001). The clinical pregnancy rate was also significantly higher in group 1 (55%) than in group 2 (24%) (p<0.001). Conclusion: Subcutaneous G-CSF infusion improved the thickness of the endometrium when it was thin. To the best of our knowledge, this is the first documented study to clearly demonstrate the benefits of subcutaneous G-CSF infusion for treating thin endometrium.

• 대한한방부인과학회지
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• 제28권1호
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• pp.138-146
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• 2015

Objectives: To report the effect of Korean medicine on 39-year-old infertile patient with thin endometrium. Methods: The patient who had thin endometrium was treated with herbal medication, acupuncture, moxibustion and steam bath for 4 months. Results: After the Korean medical treatment, the patient could give a natural birth to a healthy baby. Conclusions: The case report suggests that Korean medicine, especially herbal medicine and acupuncture is effective on thin endometrium.

• 대한한방부인과학회지
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• 제29권3호
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• pp.68-77
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• 2016

Objectives: This paper is to report a spontaneous pregnancy with low AMH level and thin endometrium infertility after Korean medical treatments.Methods: A 38-year old patient who had low AMH level, thin endometrium, sleep disturbance and anxiety happened after anorectal cancer surgery was treated by korean medicine such as herb medications per day for 6 months. And we observed the effects of treatments by improvement of symptoms checking endometrium ultrasonography.Results: After treatments, Symptoms of anxiety and sleep disturbance were improved. The number of ovarian follicle and endometrium thickness were upgraded during artificial pregnancy trials. Finally the patient was a spontaneous pregnancy after failures of one intrauterine insemination and one in vitro fertilization trial.Conclusions: This case shows that the korean medicine has effective option for a patient with low AMH level and thin endometrium infertility. Further ultrasonography would be valid measurements to check the effectiveness of oriental treatments as well as symptoms.

• Clinical and Experimental Reproductive Medicine
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• 제49권3호
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• pp.168-174
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• 2022

Refractory thin endometrium and recurrent implantation failure are among the most challenging infertility-related factors hindering successful pregnancy. Several adjuvant therapies have been investigated to increase endometrial thickness and the pregnancy rate, but the treatment effect is still minimal, and for many patients, these treatment methods can be quite costly and difficult to approach. Platelet-rich plasma (PRP) is an autologous concentration of platelets in plasma and has recently been elucidated as a better treatment option for these patients. PRP is rich in cytokines and growth factors, which are suggested to exert a regenerative effect at the level of the injured tissue. Another advantage of PRP is that it is easily obtained from the patient's own blood. We aimed to review the recent findings of PRP therapy used for patients with refractory thin endometrium and recurrent implantation failure.

• Clinical and Experimental Reproductive Medicine
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• 제43권4호
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• pp.240-246
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• 2016

Objective: The study aimed to investigate the efficacy of intrauterine instillation of granulocyte colony-stimulating factor (G-CSF) on the day of ovulation triggering or oocyte retrieval in infertile women with a thin endometrium. Methods: Fifty women whose endometrial thickness (EMT) was ${\leq}8mm$ at the time of triggering during at least one previous in vitro fertilization (IVF) cycle and an index IVF cycle were selected. On the day of triggering (n = 12) or oocyte retrieval (n = 38), $300{\mu}g$ of G-CSF was instilled into the uterine cavity. Results: In the 50 index IVF cycles, the mean EMT was $7.2{\pm}0.6mm$ on the triggering day and increased to $8.5{\pm}1.5mm$ on the embryo transfer day (p< 0.001). The overall clinical pregnancy rate was 22.0%, the implantation rate was 15.9%, and the ongoing pregnancy rate was 20%. The clinical pregnancy rate (41.7% vs. 15.8%), the implantation rate (26.7% vs. 11.7%), and the ongoing pregnancy rate (41.7% vs. 13.2%) were higher when G-CSF was instilled on the triggering day than when it was instilled on the retrieval day, although this tendency was likewise not statistically significant. Aspects of the stimulation process and mean changes in EMT were similar in women who became pregnant and women who did not. Conclusion: Intrauterine instillation of G-CSF enhanced endometrial development and resulted in an acceptable pregnancy rate. Instillation of G-CSF on the triggering day showed better outcomes. G-CSF instillation should be considered as a strategy for inducing endometrial growth and good pregnancy results in infertile women with a thin endometrium.

• Clinical and Experimental Reproductive Medicine
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• 제48권3호
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• pp.268-272
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• 2021

Bone marrow-derived cell (BMDC) therapy has numerous applications as potential biological cells for use in regenerative medicine. Here, we present an original case of endometrial atrophy associated with genital tuberculosis in a woman who achieved a live birth with BMDC. This 27-year-old woman came to our center with endometrial atrophy and primary infertility. She had a past history of genital tuberculosis and amenorrhea. Her husband's semen quality was normal. The patient was counseled for hysteroscopy due to thin endometrium and advised in vitro fertilization (IVF) with donor eggs in lieu of poor ovarian reserve. Several attempts of IVF with hormone replacement therapy (HRT) were made, but the desired thickness of the endometrium was not achieved. Uterine artery injection of BMDC through interventional radiology was given, followed by HRT for three months, which resulted in improved endometrium. This was subsequently followed by IVF with donor egg. The treatment resulted in the conception and delivery of a 3.1-kg baby boy through lower segment caesarean section with no antenatal, intranatal or postnatal complications. Recently, there has been massive interest in stem cells as a novel treatment method for regenerative medicine, and more specifically for the regeneration of human endometrium disorders like Asherman syndrome and thin endometrium, which was the reason behind using this strategy for treatment.

• Clinical and Experimental Reproductive Medicine
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• 제36권2호
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• pp.111-119
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• 2009

목 적: 클로미펜을 사용한 배란유도시 얇은 자궁내막을 보였던 환자들에서 성선자극호르몬에 클로미펜 또는 레트로졸을 병합 투여하는 과배란유도 방법의 임상적 효용성을 비교 분석하고자 하였다. 연구방법: 이전의 클로미펜을 사용한 배란유도 주기에서 8 mm 미만의 얇은 자궁내막을 보였던 불임 환자들에서 시행된 성선자극호르몬 병합 과배란유도/인공수정 51주기가 연구에 포함되었다. 월경주기 제3일째부터 5일 동안 클로미펜+성선자극호르몬 군은 일일 클로미펜 100 mg을 투여하였고 (n=26) 레트로졸+성선자극호르몬 군은 일일 레트로졸 2.5 mg 또는 5 mg을 투여하였다 (n=25). 양 군에서 월경주기 제5~7일째부터 우성난포의 크기가 18 mm 이상에 도달할 때까지 이틀에 한 번씩 성선자극호르몬은 75~150 IU를 투여하였다. 양 군에서 성선자극호르몬 총 사용량, 자궁내막의 두께, 자궁내막의 형태, hCG 투여일의 14 mm 이상 난포의 수, hCG 투여일, 임신율, 다태 임신율을 비교하였으며 통계 분석은 Mann-Whitney U test or Fisher's exact test 등을 이용하였다. 결 과: 연령, 불임기간, 이전 인공수정 횟수, 기저 혈중 LH, FSH, $E_2$ 농도, 불임의 원인 등의 임상적 특성은 양 군간 차이가 없었다. 성선자극호르몬 병합 과배란유도시 배란전 자궁내막의 두께는 이전의 클로미펜을 사용한 주기와 비교하여 유의하게 증가되었다. 성선자극호르몬 총 사용량, hCG 투여일, 자궁내막의 삼중선 비율, 임신율 및 다태 임신율은 유의한 차이가 없었다. 클로미펜+성선자극호르몬 군에 비하여 레트로졸+성선자극호르몬 군에서 14 mm 이상 난포의 개수는 유의하게 적었고 ($3.7{\pm}1.7$ vs. $2.8{\pm}1.7$, p=0.03). 배란 전 자궁내막 두께는 유의하게 두꺼웠다 ($7.7{\pm}1.5\;mm$ vs. $9.1{\pm}1.7\;mm$, p<0.05). 결 론: 배란유도를 위하여 클로미펜 사용시 얇은 자궁내막을 보였던 환자들에서 인공수정을 위한 과배란유도시클로미펜 또는 레트로졸을 성선자극호르몬과 병합하여 사용하는 방법은 클로미펜의 자궁내막에 대한 부정적인 효과를 피할 수 있는 것으로 사료된다. 적절한 자궁내막의 발달 및 적절한 난포의 성장 측면에서 성선자극호르몬에 레트로졸을 병합하는 과배란유도 방법이 클로미펜을 병합하는 방법에 비하여 더 유용할 수 있으나 추가적인 대규모 전향적 연구가 필요할 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제32권1호
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• pp.27-32
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• 2005

Objective: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. Material and Methods: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. Results: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (${\geq}15mm$) was lower in the AI group ($1.08{\pm}0.45$ vs. $1.64{\pm}0.75$) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group ($10.35{\pm}1.74$ vs. $9.23{\pm}1.61$) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group ($116.9{\pm}75.8$ vs. $479.5{\pm}300.8$) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed $10.6{\pm}1.6mm$ in the endometrial thickness and $106.6{\pm}66.8pg/ml$ in $E_2$ concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number ($1.25{\pm}0.5$) compared to prior CC cycle. Conclusions: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.

• 대한생식의학회:학술대회논문집
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• 대한불임학회 2001년도 제40차 춘계학술대회
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• pp.45.2-46
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• 2001

• Clinical and Experimental Reproductive Medicine
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• 제26권1호
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• pp.1-8
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• 1999

In order to study the implantation mechanism various methods for culture of endometrial cells in vitro have been attempted. However, a disadvantage is that primary cultures of stromal and epithelial cells do not have the ability to differentiate, and therefore cannot be reproduced in the same manner as in vivo endometrium. The object of this study is to establish a three dimensional culture of endometrial cells which are both morphologically and functionally identical to in vivo endometrium. Endometrial tissues obtained after hysterectomies were cut into thin slices and treated with collagenase and trypsin-EDTA. The stromal cells and the epithelial cells were separated by centrifugation and cultured for 24 hours in DMEM media containing 10% FCS, 100 nM progesterone, and 1 nM estradiol. The cultured stromal cells were mixed with collagen gel and solidified, after which it was covered with matrigel. Epithelial cells were inoculated on the top and then cultured for 3 days. The three dimensionally cultured endometrial cells were stained for integrin ${\alpha}1,\;{\alpha}4,\;{\beta}3$, and cyclooxygenase-l, -2 by immunohistochemistry, which all showed strong expression. The cultured epithelial cells showed the formation of microvilli, tight junctions and pinopodes by electron microscopy. Studies are currently under way utilizing this three dimensional culture model to ascertain the interaction between the embryo and human endometrial cells at the time of implantation, and it is thought that further studies into a new culture environment which would allow longer periods of culture will be necessary.