• Clinical and Experimental Reproductive Medicine
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• v.34 no.2
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• pp.87-94
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• 2007

Objective: To examine determinants of successful pregnancy and evaluate COH-IVF outcomes of infertile patients after conservative surgical treatment of borderline ovarian tumor (BOT). Methods: In women of BOT (n=93), from January 1995 to December 1999, 44 of 93 women underwent conservative surgical treatment. From theses 44 women, patients characteristics, surgical and histological parameters were compared between 14 women who conceived and 30 women who failed to conceive. For 5 infertile women of 30 women who failed to conceive, 10 attempt IVF cycles were analysed; clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR). Results: Women who conceived tend to be younger (25.9 vs 27.0 years) and lower serum CA-125 level (59.7 vs 72.9) compared to women who failed to conceive without significant difference. For 8 cycles out of 10 attempt IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range 2$\sim$16) with a mean fertilization rate of 74.4%. The CPR, IR and LBR per embryo transfer were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. During the mean follow-up period after COH-IVF initiation, 29.6 (range 14$\sim$61) months, no recurrence was found. Conclusion: No determinant of successful pregnancy was found after conservative treatment for BOT. COH-IVF may be considered for infertile patients after conservative treatment of BOT. However, larger clinical studies with longer follow-up are necessary to evaluate the safety and efficacy of COH-IVF. All patients should be informed of the potential risks associated with ovarian hyperstimulation and close follow-up is necessary after COH-IVF.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.239-252
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• 2007

Objectives: In the present study, we examined the differentiation potential of human adipose-(HAD) and human umbilical cord-derived mesenchymal like stem cells (HUC) into cardiomyocytes. Methods: Cells were initially exposed to 5-azacytidine for 24h cells and then were cultivated in the presence or absence of activin A, TGF-$\beta$1, or Wnt inhibitor with various combinations of BMP and FGF. Assessment of cardiomyogenic differentiation was made upon the expression of cardiomyocyte-specific genes using RT-PCR. Results: HAD that cultivated in control medium for 4 weeks after 5-azacytidine expose showed new expression of TnT gene and increased expression of Cmlc1 and kv4.3 genes. However, HAD cultivated in the presence of combinations of BMP-4/FGF-4 (B4/F4) and BMP-4/FGF-8 (B4/F8) showed new expression of $\beta$-MHC gene and more increased expression of Cmlc1, TnT, TnI, Kv4.3 genes. Significantly enhanced expression of Cmlc1, TnT, and Kv4.3 genes were also observed compared to that cultivated in the control medium. Treatment of HUC with either 5-azacytidine or combinations of BMP and FGF did not affect the expression profile of these genes. However, when activin A or TGF-$\beta$1 was present in addition to the BMP-2/FGF-8 (B2/F8) after 5-azacytidine exposure, HUC exhibited new expression of $\beta$-MHC gene and increased expression of $\alpha$-CA, TnT and Kv4.3 genes. When Wnt inhibitor was present in addition to BMP and FGF, HUC showed new expression of Cmlc1 gene and increased expression of $\alpha$-CA, TnT, TnI and Kv4.3 genes. Conclusions: Based on these observations, it is suggested that HAD and HUC could differentiate into cardiomyocytes which might be used as therapeutic cells for the heart diseases.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.253-273
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• 2007

Objective: This study was to find ways to let a manager or superintendent rationally and consistently inspect as well as let a embryologist precisely record [The Book of Supernumerary Embryo Preservation] and [The Book of Supernumerary Embryo Donation]. Methods: Based on the data collected between 1994 and 2004 in Clinic 44 (Maria Fertility Hospital), [The Present State about Production and Use of Embryos], [The Preservation of Supernumerary Embryos and Their Thaw State], [The Present State about Thaw and Use of Frozen Embryos], [The Present State about Donation and Charge of Frozen Embryos], [The Book about Frozen Embryo Discard], and [The Summarization Book about Management and Use of Frozen Embryos] were designed and recorded. Results: The production, use, preservation, discard and donation quantity of human embryos, the use and discard quantity of thawed embryos, and the cumulative embryo preservation quantity could be totalized in [The Present State about Production and Use of Embryos in Clinic 44]. Also, [The Preservation of Supernumerary Embryos and Their Thaw State in Clinic 44] supported "the supernumerary embryo preservation quantity" etc. In addition, [The Present State about Thaw and Use of Frozen Embryos in Clinic 44] or [The Book about Frozen Embryo Discard in Clinic 44] supported "the use and discard quantity of thawed embryos" etc. Moreover, "The embryo donation quantity" could be totalized in [The Present State about Donation and Charge of Frozen Embryos in Clinic 44]. Finally, [The Summarization Book about Management and Use of Frozen Embryos in Clinic 44] could be used for rational and consistent management or inspection. Conclusion: The present results suggest that the documents not only be standard data to record [The Book about Supernumerary Embryo Preservation in Clinic] and [The Book about Supernumerary Embryo Donation in Clinic] but can also be preserved as treatment references.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.2
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• pp.95-106
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• 2007

Objective: We previously identified differentially expressed genes (DEGs) between germinal vesicle (GV) and metaphase II (MII) mouse oocyte. The present study was accomplished as a preliminary study to elucidate the role of ribose 5-phosphate isomerase A (Rpia), the essential enzyme of the pentose phosphate pathway (PPP), in oocyte maturation. We observed expression of Rpia in the mouse and porcine oocytes. Methods: Expression pattern of the 11 MII-selective DEGs in various tissues was evaluated using RT-PCR and selected 4 genes highly expressed in the ovary. According to the oocyte-selective expression profile, we selected Rpia as a target for this study. We identified the porcine Rpia sequence using EST clustering technique, since it is not yet registered in public databases. Results: The extended porcine Rpia nucleotide sequence was submitted and registered to GenBank (accession number EF213106). We prepared primers for porcine Rpia according to this sequence. In contrast to the oocyte-specific expression in the mouse, Rpia was expressed in porcine cumulus and granulosa cells as well as in oocytes. Conclusion: This is the first report on the characterization of the Rpia gene in the mouse and porcine ovarian cells. Results of the present study suggest that the mouse and porcine COCs employ different mechanism of glucose metabolism. Therefore, the different metabolic pathways during in vitro oocyte maturation (IVM) in different species may lead different maturation rates. It is required to study further regarding the role of Rpia in glucose metabolism of oocytes and follicular cell fore exploring the regulatory mechanism of oocyte maturation as well as for finding the finest culture conditions for in vitro maturation.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.285-291
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• 2007

Objective: To evaluate the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in women over 40 years of age. Methods: A total of 170 patients (271 cycles) over 40 years of age who underwent IVF-ET at Seoul Women's Hospital (Incheon, Korea) were analyzed in this study retrospectively. The patients were grouped into the women <44 years old group and the women $\geq$44 years old group. Statistical analysis was performed using Student's t-test and Fisher's exact test as appropriate. Results: An overall clinical pregnancy rate per retrieval was 11% (30/271). Of these, clinical miscarriage rate were 33% (10/30) and the overall delivery rate was 7.4% (20/271) per retrieval, respectively. The women $\geq$44 years old group had significantly higher cancellation rate (13% vs. 25%), lower number of retrieved oocytes (6.17$\times$4.62 vs. 4.13$\times$4.07), decreased number of 2PN (4.83$\times$3.61 vs. 3.46$\times$3.12), and reduced embryos for transfer (3.52$\times$1.72 vs. 2.81$\times$1.83) than the women <44 years old group. We found significantly lower clinical pregnancy rate (13.0% vs. 2.1%) and live birth rate (9.0% vs. 0.0%) in the women $\geq$44 years old group than the women <44 years old group. Conclusion: The present study has shown that IVF outcome is seriously impaired in the women $\geq$44 years old.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.293-303
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• 2007

Objective: Previously, we identified differentially expressed genes between GV and MII stage mouse oocytes using ACP technology. When we study one of GV selective genes, Obox family, we found Obox4 mRNA expression in ovaries that has been reported as expressed exclusively in testis. Therefore, this study was conducted for characterization and functional analysis for Obox4. Methods: Expression of Obox4 mRNA was examined in gonads and oocytes by RT-PCR. To determine the role of Obox4 in oocyte maturation, Obox4 dsRNA was microinjected into the cytoplasm of GV oocytes followed by 16 h of incubation in the plain medium or by 24 h of incubation in the medium containing IBMX. After RNAi, phenotypes and maturation rates were observed, change in mRNA expression was evaluated, and chromosomal status was confirmed by orcein staining. Results: Obox4 has minimal expression in the ovary compared to that of the other family members. When oocytes were cultured for 16 h in M16 medium after RNAi, maturation rate was not changed significantly, compared with that of non-injected or buffer-injected control oocytes. Surprisingly, however, when oocytes were cultured for 24 h in M16 containing IBMX, in which oocytes were supposed to arrest at GV stage, Obox4 RNAi oocytes were advanced to MI and MII. Spindle structure was disappeared and the chromosomes were condensed in the oocytes after Obox4 RNAi. Conclusions: This is the first report on the expression of Obox4 in the ovary and oocytes. Results of the study suggest that Obox4 plays a crucial role in spindle formation and chromosome segregation during meiosis in oocytes. In addition, Obox4 may play an important role in cAMP-dependent signal cascades of GV-arrest in mouse oocytes.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.4
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• pp.305-312
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• 2007

Objective: To evaluate the efficacy of split insemination method in treatments for non-male factor infertility. Method: Laboratory and clinical data were collected from 505 cycles of split insemination during 2002$\sim$2005 in our center. The subjects were non-male factor infertility such as endometriosis, tubal, uterine, PCOS and idiopathic infertility without any sperm defects. Retrieved oocytes were randomly divided, and inseminated by conventional IVF or ICSI. Fertilized zygotes were cultured for 2$\sim$5 days to ET date, and surplus zygotes and embryos were frozen for subsequent frozen-thawed ET cycles. Clinical outcomes according to insemination method were compared by statistical analysis. Results: The overall fertilization per retrieved oocytes was significantly higher in ICSI than that of conventional IVF in sibling oocytes (62.5$\pm$22.3% vs 52.9$\pm$28.0%, p<0.01). Total fertilization failure occurred only in 2 of 505 cycles (0.4%) in split insemination cycles. Incidence of fertilization failure and poor fertilization rate less than 30% by ICSI were significantly lower than those of conventional IVF (1.1% and 7.5% vs 8.5% and 22.0%, p<0.01). Delivery rates after transfer of fresh and thawed embryos from split insemination cycles were 40.0% (185/462) and 35.0% (55/157), respectively. There was no significant difference in the implantation and delivery rates of ET with embryos from conventional IVF or ICSI. Conclusion: Taken together, the split insemination method improves poor fertilization rates resulting in successful clinical outcomes and thus could be used for non-male factor infertile couples in human ART program.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.2
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• pp.107-115
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• 2007

Objective: A quality management system of international standardization organization (ISO) 9001:2000 has been proposed to properly evaluate and improve the quality of productions and services. The purpose of this article was to describe on successful introduction and application of the ISO system to human assisted reproductive technology (ART) center. Methods: Center for reproductive medicine and infertility of Cheil General Hospital started the action for ISO 9001:2000 certification at January-2004. The ISO system of our center was monitored by measuring the customer satisfaction index and periodical internal and external audit. Reports of non-conformity described corrective and preventive actions for problems and occurrences that were not consistent with the standard process and operation of our center. Continuous management and improvement were performed on the project of customer dissatisfaction. Results: Our center has got the certification of ISO 9001:2000 for "Research and development of IVF-ET program for infertility treatment" from Korean Foundation for Quality at June-2004. The policy of ISO was "To establish the best center of reproductive medicine and infertility" and "To establish the best quality management system". We found 140 cases and 7 cases of non-conformity in internal and external audit for three years, respectively, and performed corrective action. Conclusion: Improvement of customer satisfaction, systemic documentation and transparency and efficacy of working procedure were achieved by application and operation of the ISO system to our center. This ISO system could be used as a basic institutional management system for the national guideline to the human ART center.

• Clinical and Experimental Reproductive Medicine
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• v.34 no.2
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• pp.125-131
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• 2007

Objective: The aim of this study was to compare GnRH antagonist and agonist flare-up treatment in the management of poor responder patients. Methods: One hundred forty-four patients from Jan. 1, 2002 to Aug. 31, 2005 undergoing IVF/ICSI treatment who responded poorly to the previous cycle (No. of oocyte retrieved$\leq$5) and had high early follicular phase follicle stimulating hormone (FSH>12 mIU/ml were selected. Seventy-five patients received agonist flare-up protocol and 71 patients received antagonist protocol. We analyzed the number of oocytes retrieved, number of good embryos (GI, GI-1), total dose of hMG administered, implantation rate, cycle cancellation rate, pregnancy rate, live birth rate. Results: The cancellation rate was high in antagonist protocol (53.5% vs. 30.1%). The number of oocyte retrieved, the number of good embyos were high in agonist flare-up group. There was no statistical difference between GnRH agonist flare up protocol and GnRH antagonist protocol in implantation rate (14.5%, 10.1%), clinical pregnancy rate per transfer (29.4%, 21.2%) and live birth rate per transfer (21.6%, 18.2%). Although the result was not statistically significant, GnRH agonist flare up group showed a nearly doubled pregnancy rate and live birth rate per initial cycle than GnRH antagonist group. Conclusions: The agonist flare-up protocol appears to be slightly more effective than the GnRH antagonist protocol in implantation rate, pregnancy rate, live birth rate but shows statistically no significance. Agonist flare-up protocol improved the ovarian response in poor responders. However, based of the result of the study, we can expect improved ovarian response in poor responders by GnRH agonist flare up protocol.

• Trans-
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• v.3
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• pp.55-86
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• 2017

This study begins with the necessity of the concept of reincarnation of film media and the inclusion of specific tendencies of contemporary films as post - cinema comes. Variable movements around recent films Challenging and experimental films show aesthetics that are difficult to approach with the analysis of classical mise en scene and montage. In this way, I review the dispositif proposed by Martin in films that are puzzling to criticize with the classical conceptual framework. This is because the concept of dispositive is a conceptual pile that extends more than a mise en scene and a montage. Dispositif films tend to be non-reproducible and non-narrative, but not all non-narrativef tendencies are dispositif films. Only the dispositif film is included in the flow. Dispositif movement has increased dramatically in the modern environment on which digital technology is based, but it is not a tendency to be found in any particular age. The movement has been detected in classical films, and the dispositif tendency has continued to exist in avant-garde films in the 1920s and some modernist films. First, for clear conceptualization of cinematic dispositif, this study examines the sources of dispositif debates that are being introduced into film theory today. In this process, the theory of Jean Louis Baudry, Michel Foucault, Agamben, Flusser, and Deleuze will help. The concept of dispositif was discussed by several scholars, including Baudry and Foucault, and today the notion of dispositif is defined across all these definitions. However, these various discussions are distinctly different from the cinematic dispositif or dispositif films that Martin advocates. Martin's proposed concept reminds us of the fundamentals of cinematic aesthetics that have distinguished between the mise-en-scene and the montage. And it will be able to reconsider those concepts and make it possible to view a thing a new light or create new films. The basic implications of dispositif are apparatus as devices, disposition and arrangement, the combination of heterogeneity. Thus, if you define a dispositif film in a word, it is a new 'constraint' consisting of rearrangement and arrangement of the heterogeneous elements that make up the conditions of the classical film. In order for something to become a new design, changes must be made in the arrangement and arrangement of the elements, forces, and forces that make up it. Naturally, the elements encompass both internal and external factors. These dispositif films have a variety of possibilities, such as reflection on the archival possibilities and the role of supervision, the reestablishment of active and creative audience, the reason for the film medium, and the ideological reflection. films can also 'network' quickly and easily with other media faster than any medium and create a new 'devised' aesthetic style. And the dispositif film that makes use of this will be a key keyword in reading the films that present the new trend of modern film. Because dispositif are so comprehensive and have a broad implication, there are certainly areas that are difficult to sophisticate. However this will have a positive effect on the future activation of dispositif studies end for end. Dispositif is difficult to elaborate the concept clearly, so it can be accessed from a wide range of dimensions and has theoretically infinite extensibility. At the beginning and end of the 21st century film, the concept of cinematic dispositif will become a decisive factor to dismantle old film aesthetics.