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OBJECTIVES: To assess the fertilizing capacity using sperm penetration assay (SPA) to predict the outcome of the in vitro fertilization-embryo transfer (iVF-ET) outcome. MATERIALS AND METHODS: Semen samples were provided by 129 patients undergoing iVF. We attempted to correlate the extent of sperm penetration under enhanced SPA protocol with the results of fertilization, cleavage, preimplantation embryo development, and pregnancy. RESULTS: Univariate analysis demonstrated a statistically significant correlation between fertilizing capacity and motility, kinetics, fertilization, cleavage and embryo development, and pregnancy rate. By logistic regression analysis, fertilizing capacity was found to be the only variable that was statistically significant with respect to pregnancy rate. Fertilizing capacity, cleavage rate and pregnant rate were significantly higher in pregnant group. However, the fertilization rates was comparable with both group. CONCLUSIONS: Lower fertilizing capacity could denote a poorer prognosis for establishing a pregnancy, even after satisfactory fertilization rate is achieved.

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OBJECTiVE We investigate the effects of multiple attempts of embryo transfer because of retained embryos in the catheter and of contaminated mucus on the transferred catheter. MATERiALS AND METHODS: We respectively analysed data between November 1998 and August 2002 from 305 patients of 369 cycles who underwent iVF-ET. Of these patients, 47 patients of 50 cycles (Group 2) were required multiple trial of embryo transfer. They were compared with an age-matched control groups (Group 1) with female factor infertility. Pearson's c2 and Fisher's tests were used to compare proportions between discrete variables. Non-categorical data were compared using t-test. Statistical significance was set at p<0.05. RESULTS: Embryos were significantly more likely to be retained when catheter was contaminated with mucus (Group 1: 22.4%; Group 2: 44.0%). The clinical pregnancy rates, however, for the contaminated mucus or not, were 46.8%, 43.5% respectively. There was no significant difference clinical pregnancy rate between those who had all their embryos transferred at the first attempt (45.4%) and those who required more than one attempt (48.0%). CONCLUSiONS: Contaminated mucus in the catheter is associated with failed embryo transferred at the first attempt. Embryo transfers, however, that are repeated attempts do not adversely affect pregnancy rates following iVF-ET.

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No abstract available.

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OBJECTIVE: The present study was performed to investigate whether apoptosis occur in human embryos by annexin staining and detect the expression of Fas, Fas-ligand (FasL), Bax, and Bcl-2 in human fragmented embryos derived from IVF-ET by immunofluorescence and Western blot analysis. MATERIALS AND METHODS: Using annexin staining, immunofluorescence and Western blot analysis on normal and fragmented embryos, we were able to detect apoptotsis and apoptotic gene products in fragmented embryos. RESULTS: Phosphatidylserine (PS) translocation, the marker for apoptosis, were detected frequently in fragmented embryos. Bcl-2 and Bax protein were detected in both fragmented and non-fragmented embryos. When fragmented embryos compared to normal embryos, immunofluorescent intensity of Bcl-2 tended to be lower in fragmented embryos. Bax gene expression increased in the fragmented embryos compared to the normal embryos. This result supports a model in which the molar ratio of Bcl-2 to Bax determines whether apoptosis induced or inhibited in human embryo. Fas was highly expressed in human preimplantation embryos but not FasL. It suggests that embryo may undergo apoptosis by binding with FasL produced by follicular or immune cells. CONCLUSION: The over expression of Bax and Fas will trigger apoptosis to lead embryo fragmentation and change embryo to be nonviable.

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OBJECTIVE: We performed this study to determine the safety and danger of preterm delivery at gestational age 34-36 weeks through antenatal profiles, neonatal conditions, neonatal morbidities. METHODS: We reviewed our antenatal and neonatal data between December 1999 and April 2001 to determine the morbidities of infants delivered at gestational age 34-36 weeks using x2test and Fisher's exact test. RESULTS: 1. Mean age was 30.8+/-4.58yrs and mean gravida was 2.68+/-1.56. Preterm premature rupture of membrane was higher in preterm delivery at gestational age 34 and 35weeks(respectively 58.6%, 50%). There was no difference in using tocolytics but, antenatal steroid treatment for prevention of respiratory distress syndrome(RDS) was most frequent in gestational age 34weeks.(20.68%). 2. There was no difference in the risk factor of preterm labor at each group. 3. 1-minute Apgar score<7 was significantly more frequent in neonates at gestational age 34weeks but neonatal weight and meconium staining were not different. 4. The rate of neonatal intensive care unit(NICU) admission was significantly higher in neonates delivered at gestational age 34weeks(93.1%), and RDS occurred in 3 cases delivered at gestational age 34weeks(10.34%). 2 cases delivered at gestational age 34 weeks needed the use of ventilator. CONCLUSION: Our study shows significant differences in neonatal morbidities between 34weeks and the others. In particular, all cases of Respiratory distress syndrome(n=3) occur in neonates delivered at 34weeks gestation not receiving antenatal steroid treatment and neonatal morbidities at 35 and 36weeks of gestation were not different with full term gestation.

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OBJECTIVE: To access the pregnancy tendency and delivery in women aged 35 years and older. METHODS: From December 1999 to May 2001, 954 deliveries were in Ilsan Paik Hospital. Among them we compared 89 cases of pregnant women aged 35 years and older with under 30 year of age as control group 99 cases. The statistical analysis was performed using Chi-square tests, Mantel-Haenszel trend test, and statistical significance was defined as p value<0.05. RESULTS: The preterm delivery was higher in women aged 35 years and older (study group) (31.5%) than control group (8.1%) and cesarean birth (C/SEC) rate also higher in study group (61.8%) than control group (36.3%). In antenatal complications, there are no differences in both groups, but in postpartum complications, 4 cases hysterectomy were in study group compared with control group 1 case. In comparison of neonatal outcomes, neonatal intensive care unit (NICU) admission and congenital anomalies are higher in study group. Especially, in comparison of nulliparous women, study group (n=21) have higher C/SEC rate and preterm delivery than control group (n=63), but in pregnancy outcome there was no differences in both groups. CONCLUSION: There are no significant differences in pregnancy outcomes in both group, although preterm delivery and C/SEC rate are higher in elderly gravida. So elderly gravida is no more than high risk group, if appropriate management will be done.

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Incompetent internal os of cervix is treated with McDonald or Shirodkar cerclage after 14 weeks of gestation. In rare case, after 20 weeks of gestation fetal membrane is bulging into vaginal cavity, but cerclage in that period is risk factor for preterm labor and preterm premature rupture of membranes. So many complications are reported in that period. So many experiences for reducing fetal membranes into uterine cavity were performed. We report a case of amnioreduction in prolapsed fetal membranes after McDonald cerclage, and delivered in 33 weeks of gestation with brief review of literature.

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Heterotropic pregnancy is defined as coexistent intrauterine and ectopic pregnancy. The natural incidence is 1 per 30,000 pregnancies, but in case of ovulation induction and in vitro fertilization, it is 1 per 100 pregnancies. Heterotropic pregnancy is increased with pelvic inflammatory disease and the use of various ovulation induction method. Because heterotropic pregnancy is clinically difficult to early diagnosis, close monitoring of pregnancy is important to prevent a deleterious delay in the treatment of ectopic pregnancy, maternal morbidity, and fetal loss. We experienced a case of heterotropic pregnancy diagnosed by ultrasonography in a 32-year-old woman, who complained of vaginal spotting and low abdominal pain after in vitro fertilization and report the case with brief review of literature.

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No abstract available in English.

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In case of intrauterine pregnancy with an intrauterine device(IUD), it is recommended, to remove the device because of the risk of abortions or septic complications. If the thread of the IUD is not visible, which often occurs because of growth of the uterus in pregnancy, it is advisible, to perform extraction with hysteroscopy and ultrasonic guidance. We report on one case with hysteroscopic IUD removal in early pregnancy, which pregnancy is continuing without complications.

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OBJETIVE: To assess the effects of progesterone and acetyl-L-carnitine used after treated with IsolateR gradient before semen cryopreservation-thawing on sperm parameters and membrane integrity. MATERIALS AND METHODS: From April 2001 to July 2001, ten normal male partner of couples who were visited in vitro fertilization (IVF) clinics. the semens were treated with IsolateR gradient before cryopreservation, spermatozoa was incubated with progesterone (1, 5 and 10 micrometer), acetyl-L-carnitine (2.5, 5 and 10 micrometer), or both (progesterone, 1 micrometer; and acetyl-L-carnitine, 5 micrometer) for 30 min. RESULTS: There were no differences in sperm parameters and vital stain among isolate only treated group, progesterone (1, 5 and 10 micrometer), acetyl-L-carnitine (2.5, 5 and 10 micrometer) and both (progesterone, 1 micrometer; and acetyl-L-carnitine, 5 micrometer). But, in high concentration of acetyl-L-carnitine (10 micrometer) treated group, sperm parameters and vital stain were decreased. The statistical method was used ANOVA (Kruskal-Wallis test) and p value was <0.01. CONCLUSIONS: Neither progesterone nor acetyl-L-carnitine show to be protective effect on the cryodamage assessed by sperm parameters and vital stain (eosin-Y stain) in normal sperm. High concentration of acetyl-L-carnitine (10 micrometer), however, was harmful effect on cryoprevention.

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OBJETIVE: The aim of this study was to evaluate the outcome the GnRH antagonist (Cetrotide) short protocol in controlled ovarian hyperstimulation comparing with GnRH agonist long protocol. MATERIALS AND METHOD: From July 2000 to November 2001, 26 patients, 28 cycles were performed in controlled ovarian hyperstimulation by GnRH antagonist and GnRH agonist. GnRH antagonist (Cetrotide) was administered in 12 patients (14 cycles, Group 1) and GnRH agonist (Lucrin, Sub Q, Group 2) in 14 patients (14 cycles). Ovulation induction was performed by hMG (Pergonal) in group 1, and by Combo (Metrodine HP + Pergonal) in group 2. We compared the fertilization rate, good quality embryo, and clinical pregnancy rate between the two groups. Student-t test and Chi-square were used to determine statistical significance. Statistical significance was defined as p<0.05. RESULTS: Ovarian hyperstimulation syndrome did not occurred in which estradiol (E2) level was 3874+/-809 pg/ml and the number of retrieved oocytes was 18.4+/-2.4. The number of used gonadotropin ampules was significantly decreased in Group 1 (26.0 vs. 33.1, p<0.04). There were no significant difference in the number of preovulatory oocyte (10.6+/-6.9 vs. 10.0+/-6.1), fertilization rate (74.8+/-23.4 vs. 72.2+/-21.8), good quality embryo (58.7+/-23.6 vs. 38.7+/-36.6), and embryo transfer (4.3+/-1.6 vs. 4.4+/-1.6). Although the age of the group 1 was older than the group 2 (34.4 vs. 30.8), there was no significant difference in clinical pregnancy rate (50.0% vs. 57.1%). CONCLUSIONS: We suggest that GnRH antagonist was a safe, effective, and alternative method in the controlled ovarian hyperstimulation, especially in PCOD patients who will be develop the ovarian hyperstimulation syndrome.

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OBJECTIVE: The objective of this study is to nfluence of sequential embryo transfers in an invitro fertilization was examined. METHOD: After in vitro fertilization, a maximum of 6 fertilized oocytes was enrolled in this study. At day 3 after an oocytes retrieval, embryos with good quality were transferred (mean 4.9), remaining embryos (mean 2.0/cycle) were cryopreserved at blastocyst stage (Group 1). At day 5 after oocytes collection, second a embryos had reached the blastocyst stage (Group 2) using P1 supplemented with 10 SSS and 30% Follicular fluid. No statistical difference in the pregnancy rate could be seen between the group without a second embryo transfer (n=21; 28.6%) and the group with a second transfer (n=52; 28.8%). RESULTS: The incidence of multiple pregnancy rate per embryo transfer was not statistically different between both group and no high-rank multiple pregnancy (greater than triplete) were observed (o.9%, 15.4%, respectively, p=0.74, chi2). Out of 114 cycles (506 embryos) cultured embryos in group 2, 52 cycles (159 embryos, 29.8%) reached the blastocyst stage. CONCLUSION: The second transfer did not have a significant effect on the pregnancy rate. The most important factor for the pregnancy seems to be the quality of the embryos transferred on day 3 following oocyte retrieval. We recommend embryo transfer is performed only one, day 2~3 or D5.

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OBJECTIVE: To report three cases of monozygotic twinning after IVF-ET transfer. METHODS: Private practice in two different assisted reproductive technology clinics. RESULTS: Three intrauterine monozygotic twin pregnancies occurred after IVF-ET. One of them was complicated by cord entanglement, another is progressing normal pregnancy without complication and the other was had a normal pregnancy without complication and delivered twin by cesarean section. CONCLUSION: The reported prevalence of multiple gestations in IVF-ET is a approximately 30%, and it is only 2.7% to be monozygotic twinning in IVF-ET. We report three cases of monozygotic twining after IVF-ET.

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OBJECTIVE: The purpose of this study was to evaluate outcome of intracytoplasmic sperm injection (ICSI) using epididymal and testicular sperm in patients with azoospermia. METHODS: From March, 1993 to May, 1999, a retrospective clinical analysis was done of a total of 140 cycles in 112 patients who underwent ICSI. Subjects were divided into three group: ejaculated-ICSI group included 42 cycles in 34 patients with ejaculated sperm who underwent ICSI due to severe oligospermia and past history of failed or poor fertilization in the previous in vitro fertilization and embryo tranfer (IVF-ET) cycles, microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection (MESA-ICSI) group included 50 cycles in 42 patients with congenital absence of the vas deferens (CAVD) or unreconstructable obstructive azoospermia and testicular sperm extraction and intracytoplasmic sperm injection (TESE-ICSI) group included 48 cycles in 36 patients with no spermatozoa which can be retrieved from epididymis or non-obstructive azoospermia. RESULTS: Normal two-pronuclear fertilization rates were similar in three groups: 64.4% for ejaculated-ICSI group, 59.4% for MESA-ICSI group and 60.4% for TESE-ICSI group. The pregnancy rates were 26.2%, 26.0% and 25.0% respectively. There were no significant differences in the fertilization, cleavage, and clinical pregnancy rates among ICSI cycles using ejaculated, epididymal and testicular sperm. CONCLUSION: Epididymal and testicular sperm obtained in azoospermic patients can fertilize oocyte successfully and may lead to be similar fertilization rates and clinical pregnancy rates to ejaculated sperm.

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OBJECTIVE: This study was performed to compare the clinical response to controlled ovarian hyperstimulation (COH) of in vitro fertilization and embryo transfer (IVF-ET) according to the size of baseline ovarian cyst. METHOD: From February 1992 to March 1999, a retrospective analysis was done of 272 cases who underwent COH using mid-luteal phase long protocol of gonadotropin-releasing hormone agonist (GnRH-a) for IVF-ET. These cases were divided into four group; group 1 (n=63) had cysts with mean diameters between 20.2 and 29.0 mm on their baseline ultrasound on cycle day 3, group 2 (n=57, 30.0~49.0mm), group 3 (n=68, >50.0mm) and control group (n=84). Cases were excluded according to the following criteria; pure male factor infertility, the presence of only one ovary, high CA-125 level and previous endometriosis. RESULTS: There were no statistically significant differences between cases with baseline ovarian cyst 50.0 mm in mean diameter needed more amount of human menopausal gonadotropin (hMG), showed significantly lower estradiol (E2) level, the number of follicle >15.0 mm on the day of human chorionic gonadotropin (hCG) administration, the number of oocytes retrieved, the number of mature oocytes, and pregnancy rate compared with control group. CONCLUSION: This study suggests that cases with baseline overian cyst 50.0 mm in diameter had adverse effects on various parameters. Therefore, to improve the outcome of IVF-ET in these cases, ovarian cyst aspiration prior to initiating COH may be required.

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OBJECTIVE: This study was performed to investigate whether 1) estrogen induces the change of vascular tone in endothelium-denuded human uterine artery, and 2) endothelium-independent vascular reactivity may be mediated by intracellular calcium ion modulation. METHODS: The uterine arteries from 34 premenopausal women were obtained at the time of hysterectomy due to various indications and endothelium was denuded. Vascular reactivity was monitored by using Isometric force transducer and recorded by physiograph. Endothelial integrity was assessed by sequential administration of 1micrometer norepinephrine(alpha-adrenergic stimulant) and 10 micrometer acetylcholine (endothelium -dependent vasorelaxant). Integrity of smooth muscle was measured by administration of 10 micrometer sodium nitroprusside (endothelium - independent vasorelaxant) and 10 micrometer tamsulosin(alpha-adrenergic blocker). A dose-dependent action of estrogen was measured on denuded uterine arteries, pretreated with norepinephrine and potassium chloride. In media contained denuded uterine arteries pretreated with 70mM potassium chloride and estradiol(3X10-5M), nitric oxide and its inhibitor, N-nitro-L-arginine methyl ester(L-NAME) was administered, respectively, in order to verify the vasodilation effect. Statistical tests were performed at the 5% level of significance using the SPSS PC+ package. RESULTS: Acethylcholine has little effect but sodium nitroprusside & talmsulosin showed marked relaxation, which suggested loss of endothelial function and adequacy of smooth muscle function. The contraction by norephinephrine(1 M) revealed estrogen induced relaxation which was concentration-dependent from 3 10-8M to 3 10-5M in concentration of 17 -estradiol. The contraction by high potassium solution 70mM was also inhibited by estrogen in concentration-dependent manner. This vasorelaxant effect of estrogen on endothelium-denuded uterine artery was not affected by addition of nitric oxide(NO) precursor, L-arginine and nitric oxide synthase(NOS) inhibitor, L-NAME. CONCLUSION: The results of this study revealed that estrogen has vasorelaxant effect on endothelium endothelium-denuded uterine artery by calcium antagonistic property through direct inhibitory effect on receptor- and voltage dependent calcium ion channels of smooth muscles. This vasorelaxant effect of estrogen on endothelium-denuded uterine artery was NO independent.

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OBJECTIVE: To investigate the positive or negative effect of delaying embryo transfer(ET) one day in IVF-ET. METHODS: From May to July, 1997, a total of 64 patients was emolled in this prospective randomized case-controlled study. When the timing of oocyte retrieval was decided, random allocation of patients was made to one of the two groups: day 2 transfer or day 3 transfer. In day 3 transfer group, embryos were cultured in M3 media(Medi-Cult) for further 24 hours. RESULTS: There were no significant differences in age of patients, infertility factor, basal serum FSH level, and serum E2 level on hCG day between two poups, but number of previous IVF-ET cycles was significantly higher in day 3 transfer group(p 0.042). Number of oocytes retrieved, fertilization rate, cleavage rate, and number of embryos transferred had no significant difference, but cumulative embryo score(CES) was significantly higher in day 3 transfer group(p 0.0001). Clinical pregnancy and implantation rates were bigher in day 3 transfer group, but without significance(34.4% vs. 21.9%; 8.7% vs, 5.4%). There were also no significant differences in spontaneous miscarriage and multiple pregnancy rates. Especially in patients over 35 years of age, clinical pregnancy and implantation rates were more higher in day 3 transfer group, but without significance(41.7% vs, 8.3%; 8.5% vs. 1.6%). CONCLUSION: Considering the higher number of previous cycles in day 3 transfer group, it is at least likely that delaying ET one day may be clinically beneficial in IVF-ET, especially in patients with old age or repeated failure of previous cycles.

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OBJECTIVE: To investigate the intluence of previous tuberculous epididymitis in infertile males with obstructive azoospermia on the outcome of sperm retrieval and intracytoplasmic sperm injection(ICSI) in IVF-ET propam. METHODS: Retrospective analysis was paformed in 26 patients with obstructive azoospermia undergoing sperm retrieval and ICSI at Seoul National University Hospital from January, 1996 to August, 1997; 12 cycles in 5 patients with tuberculous obstructive azoospermia(Group A), and 40 cycles in 21 patients with non-tuberculous obstructive azoospermia(Group B). RESULTS: There was no significant difference in the clinical pregnancy rate(PR) per fresh transfer between Groups A and B(20.0%[2/10] vs. 26.8%(11/41)). The rates of embryo implantation and clinical miscarriage were also comparable in both groups(6.3% vs. 11.1%, 50.0% vs. 9.1%). This tendencies were also similar after including five cryopreserved-thawed transfer cycles. CONCLUSION: Embryo quality and pregnancy outcome in sperm retrieval and ICSI were comparable in both the tuberculous and non-tuberculous obstructive azoospermia patients. Our results suggest that previous history of tuberculous epididymitis in patients with obstructive azoospermia does not affect the outcome of sperm retrieval and ICSI.

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