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Aim To evaluate various adverse symptoms during short-term use of ulipristal acetate in women with uterine myomas (n = 90), adenomyosis (n = 3) or both (n = 7). Methods One hundred premenopausal women who received ulipristal acetate for 4-12 weeks during 2016 to 2017 were selected. The medical records were reviewed and the following information was collected; adverse symptoms during medication, presence of menorrhagia or menstrual cramps, blood hemoglobin and liver function test. Adverse symptoms were recorded in the medical records as a checklist form including 76 specific progestin-related symptoms. Results Overall, the most frequent adverse symptom was amenorrhea (43%), followed by weight gain (29%), fatigue (27%), abdominal discomfort (21%), decreased menstrual flow (19%) and dizziness (18%). In 89 symptomatic women (with heavy menstrual bleeding and/or menstrual cramping pain and/or anemia), the most frequent adverse symptom was weight gain (27%) and fatigue (27%), followed by abdominal discomfort (21%), dry eye (18%), facial flushing (17%), dizziness (17%), headache (17%) and increased vaginal discharge (15%). Fourteen women stopped the medication due to unwanted adverse symptoms. Of this discontinuation group, major complaint was fatigue (50%), followed by weight gain (36%) and breast discomfort (35.7%). Conclusion Adverse symptoms were common and discontinuation rate was somewhat higher during short-term course of ulipristal acetate. Information about incidence of various adverse symptoms should be given to women who willing to take ulipristal acetate.

Aim Our purpose was to compare the normal fertilization rate, multi-pronuclei (PN) formation rate, and embryonic development of in vitro-matured oocytes between conventional insemination and intracytoplasmic sperm injection (ICSI). Methods A total of 213 stimulated in vitro fertilization (IVF) cycles were selected, in which at least one immature oocyte was obtained (from 2010 to 2014). Immature oocytes were assigned to germinal vesicle (GV)-stage or metaphase I (MI)-stage oocyte groups. Cycles with obligatory ICSI due to male-factor infertility were excluded. Cycles were divided into two groups according to fertilization method: there were 97 cycles with conventional insemination and 116 cycles with ICSI. After in vitro maturation of 324 GV-stage oocytes and 341 MI-stage oocytes, the fertilization rate, multi-PN formation rate, and embryonic development were compared according to the fertilization method. Results The normal fertilization rate was similar in the conventional insemination and the ICSI both in GV-derived and MI-derived oocytes. Both fertilization methods resulted in a similar multi-PN formation rate in GV-derived oocytes; however, in MI-derived oocytes, the multi-PN formation rate was zero with ICSI and this was significantly lower than that with conventional insemination (9.6%, P = 0.001). Conclusion In non-male-factor infertility, ICSI should be considered when MI oocytes are matured.

Aim The aim of this study was to identify the risk factors of twin gestation in fresh double day-3 embryo transfer cycles. Material and Methods Out of a total of 386 cycles of fresh double embryo transfers on day 3 between 2006 and 2013 at a single center, 72 women with single intrauterine gestational sac (GS) (single-GS group) and 32 women with double GS (double-GS group) were identified. The patients’ clinical characteristics and laboratory results were extracted from electronic medical records and were compared. Results The double-GS group had a significantly younger age (P = 0.012), and higher bodyweight (P = 0.033) compared with the single-GS group. The total number of blastomeres (P = 0.013) and cumulative embryo score (P = 0.012) were higher in the double-GS group. By receiver–operator curve analysis, maternal age ≤ 35 years, maternal bodyweight > 60 kg, total number of blastomeres > 14, and cumulative embryo score > 49 were the cut-off values to predict twin pregnancy. Among eight women with all four risk factors, the twin pregnancy rate was 87.5%. There was no twin pregnancy among seven women with no risk factors. Conclusion Younger age, higher bodyweight, and better embryo quality are all associated with a higher incidence of twin pregnancy after double embryo transfer on day 3. Single embryo transfer might be advisable for couples with risk factors for twin pregnancy.

Objective To determine age-specific reference values for anti-Mullerian hormone (AMH) and to set up an optimal model for AMH changes by age for infertility investigations. Design Prospective study. Setting Several infertility clinics and two university hospitals. Sample A total of 21 226 AMH samples were obtained. Methods Data on patients' age, race/ethnicity, and AMH levels were available from the laboratory center data registry between November 2008 and January 2011. Main outcome measures The distribution of AMH levels by age. From 16 972 women aged between 25 and 45 years, we established and validated five AMH-age regression models. Results The overall mean AMH level was 4.09 ± 3.71 ng/mL (median: 3.13 ng/mL). There was an inverse relation between AMH level and age. Among multiple regression models, the quadratic model was most appropriate to describe AMH-age relation (log AMH = 0.205 × age - 0.005 × age(2) - 0.047). Conclusions AMH levels show a progressive decline with increasing age. Age-specific AMH values may provide more specific information useful for patients and clinicians. AMH-age models could play a role as a basic step to approach more accurate ovarian reserve estimation.

Aim: In order to find the optimal exposure time of cryoprotectant, we performed a comparison of vitrification versus slow freezing according to the degree of normal morphology and apoptosis of human ovarian follicles. Materials and Methods: Eleven patients aged 20–41 years who underwent operative laparoscopy for benign ovarian cysts or cesarean section were enrolled in this study. We carried out a prospective parallel comparison of survival and morphology of follicles after freezing (slow freezing and vitrification) and thawing. The ovarian strips were vitrified with two-step exposure to equilibration and vitrification solutions at room temperature. After various exposure times of cryoprotectant solution (5 min, 10 min, and 20 min, respectively), cryoprotectant-filled cryovials with pretreated cortical tissues were immediately plunged into liquid nitrogen. Results: In total, 336 follicles were analyzed by light microscopy to assess the morphology. The distribution of follicles was as follows: primordial, primary, and secondary follicles were 55.7% (187/336), 36.9% (124/336), and 7.4% (25/336), respectively. Vitrification in the 10-min exposure group preserved the follicles most effectively (ratio of grade 1 follicle: 3.6%, 34.7%, 13.8%, and 20.0% in the 5-min, 10-min, 20-min, and slowfreezing groups, respectively). Fewer terminal-deoxynucleotidyl-transferase-dUTP-nick-end-labeling-positive cells were found in vitrification in the 10-min equilibrium group compared with the other cryopreserved– thawed groups (52.1%, 31.5%, 53.1%, and 46.7% in the 5-min, 10-min, 20-min, and slow-freezing groups, respectively). The stromal cells were also better preserved in the 10-min group than the others (P < 0.05). Conclusions: The 10-min exposure group for vitrification showed better results compared with other conditions and the slow-freezing group.

Aims: In this self-matched observational study, the factors associated with the presence of tripronuclear (3PN) embryos, in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles using gonadotropin-releasing hormone agonist long protocols, were investigated. Material & Methods: Clinical parameters were analyzed in 202 consecutive IVF-IVF or ICSI-ICSI matched cycles. The differences between the former and latter cycles were evaluated and compared according to the presence of 3PN embryos: group A [3PN (−) followed by 3PN (−)]; group B [3PN (−) followed by 3PN (+)]; group C [3PN (+) followed by 3PN (−)]; group D [3PN (+) followed by 3PN (+)]. Results: For the IVF-IVF cycles, the E2 on human chorionic gonadotropin injection day and the number of retrieved oocytes were increased in the 3PN (+) cycles compared to the 3PN (−) cycles of Groups B (2165.2 ± 1423.3 pg/mL vs 1468.2 ± 796.2 pg/mL, P = 0.016; 10.4 ± 9.1 vs 7.2 ± 5.7, P = 0.010) and C (2382.7 ± 1214.5 pg/mL vs 1553.0 ± 1119.6 pg/mL, P = 0.004; 13.1 ± 9.1 vs 9.1 ± 7.0, P

Aim: To compare the clinical outcomes of a vitrified blastocyst stage embryo transfer (ET) program among natural, ovulation induced and artificial cycles. Material & Methods: The clinical outcomes were retrospectively analyzed in three groups according to endometrial preparation (natural cycle group [n = 34], ovulation induced [n = 21], and artificial cycles [n = 70]) among women that underwent vitrified blastocyst stage ET. Results: The overall pregnancy rate was 48.8%. There were no significant differences in the duration of endometrial preparation, endometrial thickness on the day of progesterone or human chorionic gonadotropin administration, implantation and clinical pregnancy rates among the three groups. Triple-line endometrial patterns were more frequently observed in the natural and ovulation induced groups than in the artificial cycle group (85.3% vs 64.3%, P = 0.021; 90.5% vs 64.3%, P = 0.016). Conclusion: Our findings suggest that the types of endometrial preparation may have no significant effect on the clinical outcomes of vitrified blastocyst ET. Hormonal priming does not appear to be a prerequisite for endometrial preparation for vitrified blastocyst ET.

PROBLEM: The aim of this study was to investigate the relationship between the polymorphisms of the tumor necrosis factor-alpha (TNT-alpha) and TNF receptor (TNFR) genes and serum levels of TNF-alpha and its soluble receptor (sTNFR) in Korean women with endometriosis. METHOD OF STUDY: The TNF-alpha C(-857)T, C(-863)A and T(-1031)C, and TNFR1 A(36)G. TNFR2 T(676)G, A(1663)G, T(1668)G and C(1690)T polymorphisms, and serum levels of TNF-alpha, sTNFR1, and sTNFR2 were analyzed in women with (n = 105) and without endometriosis (n = 101). RESULTS: Serum sTNFR1 and sTNFR2 levels were significantly higher in women with endometriosis than in those without endometriosis, whereas no difference in serum TNT-alpha level was noted. Single polymorphisms of TNT-alpha and TNFR genes were not significantly different between the two groups. The frequencies of the TNF-alpha T/C/C haplotype allele and the TNFR2 G/G/T haplotype allele were significantly decreased in women with endometriosis compared to women without endometriosis. Women carrying at least one copy of the TNFR2 T/G/T and /or G/G/C haplotype allele had an approximately two times higher risk of endometriosis than women without these haplotype alleles. CONCLUSION: The haplotype alleles of the TNT-alpha and TNFR2 gene polymorphisms are genetic factors associated with endometriosis, and circulating sTNFR rather than TNT-alpha, may be involved in the development of endometriosis in Korean women.

Aim: To assess the clinical efficacy and safety of the gonadotropin-releasing hormone (GnRH) antagonist, ganirelix (Orgalutran), treatment in women undergoing controlled ovarian hyperstimulation (COH) for in vitro fertilization and embryo transfer (IVF-ET) in Korean women. Methods: This was a non-comparative, open-label, single-center trial carried out on 31 infertile Korean women. A daily dose of 0.25 mg of the GnRH antagonist, ganirelix, was given, beginning on the sixth day of recombinant follicle-stimulating hormone (FSH) treatment. If the ovarian response was low, ganirelix treatment was delayed until the leading follicle reached a mean diameter of 14 mm. The ganirelix treatment was continued until the day of human chorionic gonadotropin (hCG) injection. Descriptive statistics were recorded for all parameters. Results: The median duration of ganirelix treatment was 4 days (range: 2–6 days) and the median total recombinant FSH dose was 1350 IU (900–2350 IU). During ganirelix treatment, the incidence of luteinizing hormone (LH) rises (LH = 10 IU/L) was 3.2% (one of 31 cases). On the day ovulation was triggered by hCG, the mean number of follicles ≥11 mm in diameter was 12.4 ± 4.5, and the median of serum estradiol concentration was 4289.9 (1893.7–8268.5) pmol/L. The mean number of oocytes per retrieval was 10.9 ± 6.1. The fertilization rate was 61.5%, and the mean number of replaced embryos was 2.8 ± 0.6. The mean implantation rate was 10.0%, and the clinical pregnancy rate per transfer was 23.3% (seven of 30 cases) and the ongoing pregnancy rate per transfer was 20.0% (six of 30 cases). Conclusion: The results of the present study support ganirelix as a safe, short, convenient and effective treatment for patients undergoing COH for IVF in Korean women.