• The Journal of Korean Obstetrics and Gynecology
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• v.37 no.2
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• pp.109-119
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• 2024

Objectives: This study is aimed to survey public's experience of medical use for developing Korean medicine clinical practice guideline of female infertility. Methods: The study engaged women who had experienced infertility despite regular conjugal relations, selected from an online survey company's national panel. Participants were surveyed from November 3 to 8, 2021. The questionnaire, developed from prior studies on Korean medicine, was emailed to 29,465 adults; 550 responses were analyzed after exclusions. The study received an IRB exemption from Pusan National University Korean Medicine Hospital and utilized Microsoft Excel for statistical analysis. Results: Among 550 respondents, 32.2% had experienced infertility, predominantly due to unexplained causes (52%). About half had received medical treatment (49.3%), primarily at hospitals and general hospitals (54.2%) and obstetrics and gynecology clinics (49.4%), with Korean medicine facilities also utilized (24.7% for clinics, 14.4% for hospitals). The most common treatments included herbal medicine in Korean medicine and ovulation induction in Western medicine, with most treatments lasting less than six months (71.4%) and costing between 1 to 5 million won (50.5%). Efforts to conceive included lifestyle adjustments such as maintaining a warm lower abdomen, supplement intake, and avoiding alcohol and tobacco. Conclusions: It is necessary that the guidelines be revised to address female infertility and to integrate recommendations for combining Korean medical treatments and Western medical treatments, which will enhance patient care in managing female infertility.

• Journal of Korean Academy of Nursing
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• v.29 no.6
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• pp.1379-1391
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• 1999

The purpose of this study was to investigate loneliness in infertile women and determine how loneliness related to personal characteristics, cause of infertility, family composition, and family conflicts. It also provides basic data for nursing strategies concerning infertile women.A total of 182 subjects were selected at an infertile clinic in Seoul, Korea. Data were collected from May 2 to June 21, 1997 by questionaire. It consisted of questions concerning general characteristics, items relating to infertility, and the Loneliness Scale. The UCLA Loneliness scale was used(more specifically, the Korean version of the Revised UCLA Scale by Kim Ok Soo.) The data were analyzed by using SPSS/PC computer program. The result are as follows : 1. The mean age of infertile women was 32.4 years old, and the mean age of souses was 34.8 yerars old. 30.2% of women had a marital duration of 3-5 years, and 25.8% had a marital duration of 5-10 years. 23.1% reported the main etiology of infertility as unexplained, 18.1% reported ovulation disturbances, and 26.4% reported complex causes. 3.8% of the couples had sexual relationship difficulty 83% lived in nuclear families, while 17% lived in large families. 2. The mean loneliness scores of infertile women was 35.53(SD=8.66). The total loneliness score of this study was 80. 3. There were significant differences in loneliness scores according to ages(F=6.893, p=.001), education background(t=4.418, p=.000), and the educational background of husband(t=2.339, p=.020). 4. Loneliness scores related to family situations were significantly different according to several male nephews in husbands' family(F=2.822, p=.027). 5. Loneliness scores related to conflicts were significantly different according to husbands and their family(F=11.465, p=.000). Nurses should acknowlege the fact that some infertile women may experience loneliness. In conclusion, nurses can provide infertile women with information about ways to decrease loneliness and create support groups for themselves, assisting infertile women to adjust to the experience of infertility through positive methods.

• Clinical and Experimental Reproductive Medicine
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• v.12 no.1
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• pp.47-70
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• 1985

This study was presented of the 1,872 cases of infertile couples who visited and examined at the sterility clinic of Department of Obstetrics & Gynecology, Seoul National University Hospital from Sept., 1980 to Dec., 1983. Age, duration of infertility, past medical history, and other general factors were analyzed, and the factors responsible for infertility were classified and discussed. Mode of treatment, outcome of pregnancy, pregnancy rate responsible for each factor were also presented. The results were as follows: 1) The infertility was primary in 1,128, or 60.3% and secondary in 744, or 39.7%. 2) The age between 26 and 30 years of age comprised about one half of the total patients. 3) The duration of infertility between 1 and 4 years comprised about three quarters of the total patients, and the mean duration was 3.8 years. 4) The most common medical history in primary infertility was tuberculous disease, and that in secondary infertility was history of previous laparotomy. 5) About two thirds of antecedent pregnancies were abortion. 6) The major etiologic factor of infertility were male factor in 12.3%, tubal factor in 38.8%, ovulatory failure in 25.4%, uterine factor in 8.8%, cervical factor in 5.2%, peritoneal factor in 9.5%, and no demonstrable cause in 11.3%. 7) The types of male factor were azoospermia in 61.6%, oligospermia in 25.8%, low motility in 11.6%, and other abnormality in 1.0%. 8) The types of ovulatory failure were ovarian failure in 7.4%, hypothalamo-pituitary failure in 8.1 %, hypothalamo-pituitary dysfunction (including Polycystic ovarian syndrome) in 30.2%, and hyperprolactinemia in 22.4%. 9) The types of uterine factor were endometrial tuberculosis in 27.5%, uterine synechia in 33.8%, uterine anomaly in 19.7%, myoma and polyp in 9.1 %, and luteal phase defect in 9.9%. 10) The types of peritoneal factor were pelvic adhesion in 80.9% and endometriosis in 19.6%. 11) Surgeries were done in 408 patients, and they were salpingolysis, lysis of extraadnexal adhesion, salpingostomy, fimbrioplasty, ovarian wedge resection for polycystic ovarian disease, tubo-tubal anastomosis, and tubo-uterine implantation in orders. 12) 243 pregnancies were achieved during the infertility work-up, of which livebirth was 46.5%, ectopic pregnancy was 7.4%, spontaneous abortion was 7.8%, and on-going pregnancy or lost to follow-up was 36.2%. 13) Pregnancy rates in various factors were male factor in 18.7%, ovulatory factor in 31.7%, tubal factor in 24.2%, uterine factor in 34.6%, cervical factor in 19.0%, peritoneal factor in 29.0%, combined factors in 10.5%, and unexplained infertility in 37.1%. Pregnancy rate in whole patients was 25.2%.

• Clinical and Experimental Reproductive Medicine
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• v.45 no.1
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• pp.31-37
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• 2018

Objective: To evaluate the pregnancy rate and time to pregnancy after timed coitus with or without superovulation in infertile young women younger than 35 years old with low serum $anti-M{\ddot{u}}llerian$ hormone (AMH) levels ( < 25th percentile). Methods: A total of 202 patients younger than 35 years old were recruited retrospectively between 2010 and 2012. Ninety-eight women had normal serum AMH levels (25-75th percentile), 75 women had low serum AMH levels (5th ${\leq}$ & < 25th percentile) and 29 women had very low serum AMH levels ( < 5th percentile), according to reference values for their age group. Results: The clinical pregnancy rate was positively associated with AMH levels, but this trend did not reach statistical significance (43.9% vs. 41.3% vs. 27.6% in the normal, low, and very low AMH groups, respectively). The time to pregnancy was longer in the very low AMH group than in the normal AMH group ($13.1{\pm}10.9months$ vs. $6.9{\pm}6.1months$, p= 0.030). The cumulative live birth rate over 18 months was lower in the very low AMH group than in the normal AMH group, with marginal significance (20.0% vs. 55.9%, p= 0.051). The duration of infertility was negatively correlated with achieving pregnancy (odds ratio, 0.953; 95% confidence interval, 0.914-0.994; p= 0.026). Conclusion: Conservative management, such as timed coitus with or without superovulation, should be considered in young patients who have low ovarian reserve without any infertility factors. However, for women with a long duration of infertility or very low serum AMH levels, active infertility treatment should be considered.

• Clinical and Experimental Reproductive Medicine
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• v.17 no.2
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• pp.137-144
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• 1990

Seventy-two patients initiated intrauterine insemination between March 1989 and March 1990. Indication for the intrauterine insemination included abnormal semen, poor cervical mucus, presents of sperm antibody, unexplained, poor postcoital test and endometriosis. During this time period, 216 inseminations were performed and resulted in twenty four pregnancies in the 72 patients receiving artificial insemination by homologous donor for an overall pregnancy rate of 33.3%. Where pergonal treatment was followed by insemination, a significantly greater pregnancy per cycle was achieved. It is therefore suggested that a trial if induction of multiple follicular development be performed on coulpes with male-related or unexplained infertility before inclusion in protocols for invasive procedures, such as IVF or GIFT.

• The Journal of Korean Medicine
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• v.43 no.3
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• pp.122-138
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• 2022

Objectives: This study was conducted to develop a Korean Medicine(KM) Clinical Practice Guidelines(CPG) of female infertility. We conducted this questionnaire survey to reflect the experiences of Korean Medicine doctors(KMD) and clinical field in Korea. Method: We sent a questionnaire survey to KMD belonging to the Association of Korean Medicine by e-mail. We received 665 responds, and analyzed the answers. Results: 51.2% of respondents knew the previously developed CPG of female infertility, and 18.3% actually used. 83.3% agreed about the necessity of CPG of female infertility, and 80.3% had practical use plan. 90.2% of respondents treated less than 5 infertility woman for a month. 22.7% of respondents treated 50% of patients with collaborative treatment of KM and Western medical treatments. The main age group of patients was '35~40 years'(54.7%), and the most common cause was unexplained infertility(61.7%). The most common pattern identification of female infertility patients was Kidney deficiency(55.4%). KMD used 'a combination of decoction of herbal medicine, acupuncture and moxibustion treatment' the most(43%), and 'a decoction of herbal medicine treatment alone' was next(35%). 84.2% conducted lifestyle modification education about diet, stress, exercise etc. Conclusion: We figured out Korean Medicine doctors' recognition about CPG of female infertility, preference of treatments, and also characteristics of patients visiting Korean Medical clinics to make a practical CPG reflecting clinical situation.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.3
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• pp.198-202
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• 2021

Considerable disagreement exists regarding whether endometrial polyps should be removed before attempting natural pregnancy and before pregnancy via intrauterine insemination (IUI) or in vitro fertilization (IVF). Through a literature review, we obtained information on the impact of endometrial polyps and polypectomy on fertility outcomes. Several observational studies have suggested that women with unexplained infertility may benefit from endometrial polypectomy for a future natural pregnancy. A few studies reported benefits from endometrial polypectomy in infertile women who plan to undergo IUI. However, no strong evidence supports polypectomy as a way to improve the pregnancy rate in infertile women who plan to undergo IVF or polypectomy during controlled ovarian stimulation for IVF. Although no studies have defined criteria for the polyp size that should be removed in infertile women, clinicians should be aware that small endometrial polyps (<10 mm) sometimes regress spontaneously. Endometrial polypectomy is currently justified in patients with repeated IVF failure, but more studies are needed to verify that endometrial polypectomy itself will eventually increase the pregnancy rate. Although several mechanisms by which endometrial polyps exert a negative effect on fertility have emerged, there is no consensus about the proper management of endometrial polyps in infertile women. Therefore, the management of endometrial polyps should be individualized depending on the patient's situation and clinician's preference.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.2
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• pp.150-155
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• 2021

Objective: Oxidative stress (OS) plays a key role in the etiology of unexplained male infertility. Coenzyme Q10 (CoQ10) is a potent antioxidant that may improve semen quality and OS in infertile men with idiopathic oligoasthenoteratospermia (OAT), but the underlying mechanism is unknown. Therefore, the present study was undertaken to investigate the effect of CoQ10 on OS markers and sperm DNA damage in infertile patients with idiopathic OAT. Methods: This prospective controlled study included 50 patients with idiopathic OAT and 50 fertile men who served as controls. All patients underwent a comprehensive medical assessment. Patients and controls received 200 mg of oral CoQ10 once daily for 3 months. Semen and blood were collected and analyzed for sperm parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity, catalase, sperm DNA fragmentation (SDF), and serum hormonal profile. Results: The administration of CoQ10 to patients with idiopathic OAT significantly improved sperm quality and seminal antioxidant status and significantly reduced total ROS and SDF levels compared to pretreatment values. Conclusion: CoQ10, at a dose of 200 mg/day for 3 months, may be a potential therapy for infertile patients with idiopathic OAT, as it improved sperm parameters and reduced OS and SDF in these patients.

• Clinical and Experimental Reproductive Medicine
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• v.23 no.3
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• pp.311-318
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• 1996

Mycoplasmas have long been suspected of contributing to involuntary infertility in couples. However considerable disagreement exits concerning the role of genital mycoplasma infection in human infertility. Several investigators have noted abnormalities in the semen analysis of men with positive mycoplasma cultures, and early epidemiologic studies indicated that Ureaplasma urealyticum was linked to human reproductive failure on the basis of higher frequencies of isolation from infertile versus fertile couples and successful pregnancies in infertile couples after doxycycline therapy. However, subsequent investigators have questioned these findings because there are many studies in which treatment for mycoplasma in the male or female did not demonstrate an improved pregnancy rate, and semen samples from unexplained infertile men containing ureaplasmas have not revealed poorer motility, fewer spermatozoa and more aberrant forms. The objective of this study were to investigate the incidence rate of mycoplasma in semen and to investigate whether the presence of mycoplasma in semen makes significant difference to the semen volume, sperm motility and sperm counts. The results were that the rate of isolation of mycoplasma species was 70.3%. Semen volume is $2.84{\pm}1.01ml$ for culture negative and $3.15{\pm}1.42ml$ for culture positive group. Sperm motility is $46.23{\pm}15.80%$ for culture negative and $50.09{\pm}15.69%$ for culture positive group, and sperm count is $95.47{\pm}47.14({\times}(P)10^6/ml)$ for culture negative and $86.73{\pm}47.59({\times}10^6/ml)$ for culture positive group. In conclusion, we suggest that the presence of mycoplasma in semen makes no significant differences to the sperm parameters.

• Clinical and Experimental Reproductive Medicine
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• v.21 no.1
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• pp.21-29
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• 1994

Subzonal insemination(SUZI) has been proposed for patients with severe male factor and previous fertilization failure. However, very low fertilization rates still persisted. The aims of this study were firstly, to examine the relationships between the fertilization rate and sperm parmeters, sperm incubation media and time, secondly, to evaluate the outcome of 119 cycles of SUZI applied the modified sperm preparation method. The fertilization rates were influenced more sensitively by sperm preincubation media and time than by sperm parameters. According to preincubation media and time, the fertilization rates were 43.3% in 50% follicular fluid (HFF), 36.6% in 10% fetal cord serum(FCS), and with the time, increased in FCS, but decreased in HFF. In regrd with sperm parameters, the fertilization rates were 42.9% in normal and 37.6% in subnormal group. The best results were obtained from SUZI by the spermatozoa incubated in 50% HFF for 6-8 hours. So we tried 119 cycles of SUZI(normal; 39 cycles, subnormal; 80 cycles) using the preparation method of 6-8 hour incubation in 50% HFF. There were no signigicant differences in the fertilization rates between normal(125/269, 46.4%) and subnormal sperm(264/635, 41.6%). Contrary to the fertilization rates, pregnancy outcomes were different between both groups. Better results obtained from the subnormal group than the normal in the number of transferred embryos, that of good embryos, and developmental rate of the fertilized eggs. The pregnancy rates per transfer were totally 13.3%(13/98),20.0%(13/65) in subnormal group. In the normal group, 2 patients showed ${\beta}$-hCG positive, but resulted in chemical pregnancy. Of 13 clinical pregnancies, two aborted, 6 on-going, and 5 delivered. In conclusion, SUZI is an effective technique to overcome fertilization failure for male factor and unexplained. The fertilization rate is influenced by sperm parameters, sperm incubation media and time. Also the quality of oocytes might be important for pregnancy as same as that of sperm.