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Objective: To assess compliance with Korean guidelines for embryo transfer, the possible reasons for non-compliance, and multiple pregnancies according to each specific condition in compliant cycles. Methods: A single-institution, retrospective study was conducted of 256 fresh in vitro fertilization cycles during 2012-2014. To assess compliance with Korean guidelines, the maximum recommended number of embryos transferred (according to criteria of age, transfer day, and presence of favorable conditions) was compared with the actual number of embryos transferred. Clinical pregnancy rate (PR) was assessed as the percentage of pregnant women resulting from each set of transfer conditions, including the number of embryos transferred. The multiple pregnancy rate (MPR) was calculated as the percentage of pregnant women with a multifetal pregnancy. Results: The compliance rate with the Korean guidelines was 96.5% (247/256). Non-compliance occurred in nine cycles owing to poor embryo quality, repeated implantation failure, or hostile endometrium. In compliant cycles, the PR was 31.2% (77/247), and the MPR was 27.3% (21/77; 20 twins and one triplet). Higher MPR was noted in two types of transfer conditions: transfer of three cleavage embryos in women aged 35-39 years with favorable conditions (66.7%; primarily from those aged 35-37 years) and transfer of two blastocysts in women aged ≥40 years with favorable conditions (50%). Conclusion: Under the Korean guidelines, compliance rate was high in our center. Multiple pregnancies occurred primarily in group with favorable conditions. In high-risk groups for multiple pregnancies, reducing number of embryos transferred should be considered than suggested in the guideline. [ABSTRACT FROM AUTHOR]

Objective: To investigate fertilization and embryo quality of dysmorphic mature oocytes with specific morphological abnormalities obtained from intracytoplasmic sperm injection (ICSI). Methods: The fertilization rate (FR) and embryo quality were compared among 58 dysmorphic and 42 normal form oocytes (control 1) obtained from 35 consecutive ICSI cycles, each of which yielded at least one dysmorphic mature oocyte, performed over a period of 5 years. The FR and embryo quality of 441 normal form oocytes from another 119 ICSI cycles that did not involve dysmorphic oocytes served as control 2. Dysmorphic oocytes were classified as having a dark cytoplasm, cytoplasmic granularity, cytoplasmic vacuoles, refractile bodies in the cytoplasm, smooth endoplasmic reticulum in the cytoplasm, an oval shape, an abnormal zona pellucida, a large perivitelline space, debris in the perivitelline space, or an abnormal polar body (PB). Results: The overall FR was significantly lower in dysmorphic oocytes than in normal form oocytes in both the control 1 and control 2 groups. However, embryo quality in the dysmorphic oocyte group and the normal form oocyte groups at day 3 was similar. The FR and embryo quality were similar in the oocyte groups with a single abnormality and multiple abnormalities. Specific abnormalities related with a higher percentage of top-quality embryos were dark cytoplasm (66.7%), abnormal PB (50%), and cytoplasmic vacuoles (25%). Conclusion: The fertilization potential of dysmorphic oocytes in our study was lower, but their subsequent embryonic development and embryo quality was relatively good. We were able to define several specific abnormalities related with good or poor embryo quality. [ABSTRACT FROM AUTHOR]

Objective: Smoking has been reported to harm nearly every organ of the body, but conflicting results have been reported regarding the effects of smoking on assisted conception. In this prospective cohort study, we aimed to investigate the prevalence of positive urinary cotinine tests in infertile couples and whether cotinine positivity was associated with infertility treatment outcomes. Methods: A qualitative urinary cotinine test was administered to 127 couples who underwent in vitro fertilization (IVF, n=92) or intrauterine insemination (IUI, n=35). Results: The overall prevalence of positive urinary cotinine test was 43.3% (55/127) in the male partners and 10.2% (13/127) in the female partners with similar prevalence rates in both genders in the IUI and IVF groups. Semen characteristics, serum markers of ovarian reserve, and number of retrieved oocytes were comparable among cotinine-positive and cotinine-negative men or women (with the exception of sperm count, which was higher among cotinine-positive men). The results of urinary cotinine tests in infertile couples were not associated with IVF and IUI outcomes. Conclusion: The presence of cotinine in the system, as indicated by a positive urinary cotinine test, was not associated with poorer outcomes of infertility treatment. [ABSTRACT FROM AUTHOR]

Objective: Elevated serum progesterone (P) levels on triggering day have been known to affect the pregnancy rate of in vitro fertilization (IVF). This study aimed to identify the possible factors influencing serum P levels on triggering day in stimulated IVF cycles. Methods: Three hundred and thirty consecutive fresh IVF cycles were included in the study. All cycles were first attempts and were performed in a single infertility center. The indications for IVF were male factor infertility (n=114), ovulatory infertility (n=84), endometriosis (n=61), tubal infertility (n=59), unexplained infertility (n=41), and uterine factor infertility (n=39). A luteal long protocol of a gonadotropin-releasing hormone (GnRH) agonist (n=184) or a GnRH antagonist protocol (n=146) was used for pituitary suppression. Ovarian sensitivity was defined as the serum estradiol level on triggering day per 500 IU of administered gonadotropins (OS[a]) or the retrieved oocyte number per 500 IU of administered gonadotropins (OS[b]). Results: Univariate analysis revealed that the serum P level on triggering day was associated with the serum estradiol level on triggering day (r =0.379, p<0.001), the number of follicles =14 mm (r =0.247, p<0.001), the number of retrieved oocytes (r =0.384, p<0.001), and ovarian sensitivity (OS[a]: r =0.245, p<0.001; OS[b]: r =0.170, p=0.002). The woman's age, body mass index, antral follicle count, and basal serum follicle stimulating hormone and estradiol levels were not associated with serum P level on triggering day. The serum P level on triggering day did not show significant variation depending on the type or cause of infertility, pituitary suppression protocol, or the type of gonadotropins used. Conclusion: The serum P level on triggering day was closely related to the response to ovarian stimulation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of antifreeze protein (AFP) supplementation on ovarian vitrification and transplantation. Materials and Methods: In this experimental study, we researched a total of 182 ovaries from 4-week-old ICR mice. The equilibration solution included 20% ethylene glycol (EG), and the vitrification solution included 40% EG, 18% Ficoll, and 0.3 M sucrose. Intact ovaries were first suspended in 1 mL of equilibration solution for 10 min, and then mixed with 0.5 mL of vitrification solution for 5 min. Ovaries were randomly assigned to 3 groups and 0, 5, or 20 mg/mL of type III AFP was added into the vitrification solution (control, AFP5, and AFP20 groups, respectively). The vitrified ovaries were evaluated after warming and 2 weeks after autotransplantation. The main outcome measurements are follicular morphology and apoptosis assessed by histology and the TUNEL assay. Results: A significantly higher intact follicle ratio was shown in the AFP treated groups (control, 28.9%; AFP5, 42.3%; and AFP20, 44.7%). The rate of apoptotic follicles was significantly lower in the AFP treated groups (control, 26.6%; AFP5, 18.7%; and AFP20, 12.6%). After transplantation of the vitrified-warmed ovaries, a significantly higher intact follicle ratio was shown in the AFP20 group. The rate of apoptotic follicles was similar among the groups. Conclusion: The results of the present study suggest that supplementing AFP in the vitrification solution has beneficial effects on the survival of ovarian tissue during cryopreservation and transplantation. [ABSTRACT FROM AUTHOR]

Purpose: This study attempted to derive an objective and sophisticated definition of poor ovarian response (POR). Materials and Methods: A total of 176 consecutive in vitro fertilization (IVF) cycles (137 patients) with conventional ovarian stimulation during 2009 to 2012 were studied by retrospective analysis. Optimal oocyte number (total or mature) was determined by statistics-based (distribution of oocyte number) and prognosis-based approaches (prediction for IVF outcome). Receiver operating characteristics curve analysis was used to show what number of oocytes could predict IVF pregnancy and whether clinical and laboratory variables could predict newly defined POR. Results: The 25th percentile of the distribution corresponded to total oocytes ≤2 and mature oocyte ≤1. The cut-off values for the prediction of IVF outcomes were total oocytes >5 and mature oocyte >1. Considering the incidence of POR (34.1%), a reasonable definition of POR was decided as total oocytes ≤2 or mature oocyte ≤1. For the prediction of this new definition, the extreme cut-off value (by setting a false positive rate of 5%) of serum anti-Mullerian hormone (AMH) was ≤0.76 ng/mL, which was better than serum follicle stimulating hormone or age. A new simple definition of POR was derived as total oocytes ≤2 or mature oocyte ≤1 in a previous cycle or a serum AMH level of ≤0.76 ng/mL. When this simple criterion was re-applied to our data, the predictive performance was similar to the Bologna criteria. Conclusion: We here propose a new definition of POR, which is simple and supported by statistical and prognostic analyses. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between the severity of endometriosis and the preoperative neutrophil-to-lymphocyte ratio (NLR) and serum level of cancer antigen 125 (CA 125). Methods: Data were obtained from the medical records of 419 patients who underwent laparoscopic conservative surgery for ovarian endometrioma between April 2005 and March 2013. Each patient's preoperative complete blood count was recorded and the endometriosis score was assessed. Results: The endometriosis score was not associated with either the NLR or the serum level of CA 125. The endometriosis score was negatively related to preoperative hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. The only positive association was between NLR and the patients' age. NLR and preoperative serum anti-Müllerian hormone level were found to be negatively related. Conclusion: The severity of endometriosis was not associated with the serum level of CA 125 or the NLR. The presence of a negative correlation between the severity of endometriosis and red blood cell dynamics needs further investigation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this work was to evaluate nuclear histone acetylation level and total histone acetyltransferase (HAT) and deacetylase (HDAC) activity in ejaculated sperm and their relevance to conventional sperm parameters. Materials and Methods: Thirty-three normozoospermic men were included in this study. Semen samples were processed by swim-up and then immunostained by six acetylation antibodies (H3K9ac, H3K14ac, H4K5ac, H4K8ac, H4K12ac, and H4K16ac). Our preliminary study verified the expression of HAT/HDAC1 in mature human sperm. From vitri- fied-warmed sperm samples, total HAT/HDAC activity was measured by commercially available kits. Nuclear DNA integrity was also measured by TUNEL assay. Results: The levels of six acetylation marks were not related with conventional sperm parameters including sperm DNA fragmentation index (DFI) as well as HAT/HDAC activity. However, sperm DFI was positively correlated with HAT activity (r=0.038 after adjustment, p<0.02). HAT activity showed a negative relationship with HDAC activity (r=-0.51, p<0.01). Strict morphology was negatively correlated with acetylation enzyme index (=HAT activity/HDAC activity) (r= -0.53, p<0.01). Conclusion: Our works demonstrated a significant relationship of acetylation-associated enzyme activity and strict morphology or sperm DFI. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association of individual follicular fluid (FF) leptin and adiponectin levels with the quality of the corresponding oocyte and embryo. Methods: We prospectively enrolled 67 women who underwent controlled ovarian hyperstimulation with 89 FF samples. FF and the corresponding oocyte was obtained from a single dominant preovulatory follicle at the time of oocyte retrieval. Concentrations of leptin and adiponectin were measured by enzyme-linked immunosorbent assay in an individual follicle. The oocyte quality, fertilization rate, and corresponding embryo development were assessed. Results: The FF level of leptin was significantly associated with body mass index (r=0.334, p<0.01). The FF adiponectin level was significantly higher in the normal fertilization group than the abnormal fertilization group (p=0.009) in the non-obese women. A lower FF leptin level was associated with a trend toward mature oocytes, normal fertilization, and good embryo quality, although these relationships were not statistically significant. The leptin:adiponectin ratio of FF did not differ significantly according to oocyte and embryo quality. The quality of the oocyte and embryo was not associated with the FF leptin level tertile. However, the normal fertilization rate was positively associated with FF adiponectin level tertile. There was a trend towards improved oocytes and normal fertilization rates with the lowest tertile of the FF leptin:adiponectin ratio, but this difference was not statistically significant. Conclusion: Our results suggest that a high FF adiponectin concentration could be a predictor of normal fertilization. However, the FF leptin concentration and leptin:adiponectin ratio is not significantly related to oocyte maturity and corresponding embryo development. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether preoperative serum anti-mullerian hormone (AMH) levels are lower in women with ovarian endometrioma and in women with mature cystic teratoma of the ovaries. Materials and Methods: In a tertiary university hospital, a retrospective case-control study was performed. Serum AMH levels between an advanced (stage III and IV) endometrioma group (n=102) and an age- and body mass index (BMI)-matched control group were compared. Serum AMH levels between an ovarian mature cystic teratoma group (n=48) and age- and BMI-matched controls were also compared. Results: Absolute serum AMH and multiples of the median for AMH (AMH-MoM) relevant to Korean standards were lower in the endometrioma group than controls, but this was not statistically significant (mean±SEM, 2.9±0.3 ng/mL vs. 3.3±0.3 ng/mL, p=0.28 and 1.3±0.1 vs. 1.6±0.1, p=0.29, respectively). Specifically, the stage IV endometriosis group (n=51) exhibited significantly lower serum AMH and AMH-MoM (2.1±0.3 vs. 3.1±0.4 ng/mL, p=0.02 and 1.1±0.1 vs. 1.7±0.2, p=0.03, respectively). Serum AMH and AMH-MoM levels were similar between stage III endometriosis and controls (3.7±0.5 vs. 3.4±0.5 ng/mL and 1.6±0.2 vs. 1.5±0.2, respectively), as well as between the mature cystic teratoma group and controls (4.0±0.5 ng/mL vs. 4.0±0.5 ng/mL and 1.6±0.2 vs. 1.6±0.3, respectively). Interestingly, AMH-MoM level was negatively correlated with endometriosis score with statistical significance (r2=0.13, p<0.01). Conclusion: In women with advanced ovarian endometrioma, preoperative serum AMH values tended to be lower than those for age and BMI-matched controls. Notably, stage IV endometrioma appeared to be closely associated with decreased ovarian reserve, even before operation. Clinicians should keep this information in mind before undertaking surgery of ovarian endometrioma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the correlation between serum levels of anti-Müllerian hormone (AMH) and ovarian response to mild stimulation in normoovulatory women and anovulatory women with polycystic ovary syndrome (PCOS). Methods: Seventy-four cycles of mild stimulation (clomiphene citrate+gonadotropin followed by timed intercourse or intrauterine insemination) performed in normoovulatory women (57 cycles) and anovulatory women with PCOS (17 cycles). Ovarian sensitivity was defined by the number of mature follicles (≥14 mm) on triggering day per 100 IU of gonadotropin. A correlation between ovarian sensitivity and the baseline serum AMH level (absolute or multiples of the median [MoM] value for each corresponding age) was calculated. Correlation between ovarian response and serum AMH level was evaluated. Results: Ovarian sensitivity to mild stimulation was positively correlated with absolute serum AMH (r=0.535, p<0.001) or AMH-MoM value (r=0.390, p=0.003) in normoovulatory women, but this correlation was not observed in anovulatory women with PCOS (r=0.105, p>0.05, r=-0.265, p>0.05, respectively). Conclusion: Ovarian response to mild stimulation is possibly predicted by the serum AMH level in normoovulatory women, but not in anovulatory women with PCOS. [ABSTRACT FROM AUTHOR]

Purpose: During stimulated in vitro fertilization (IVF) cycle, up to 30% of the recovered oocytes are immature ones which have poor fertilization capacity; however, the precise influencing factors are largely unknown. Here, we analyzed the association of oocyte immaturity with woman's age in IVF cycles stimulated by single regimen. Materials and Methods: A total of one-hundred ninety five IVF cycles stimulated by recombinant FSH and GnRH antagonist protocol between 2003 and 2009 were analyzed retrospectively. The mean age of women was 34.2±4.0 (26-45 years). After triggering by exogenous hCG, an ultrasound-guided retrieval of oocytes was performed 35-36 hours later. All clinical data were stratified by woman's age; group I: =30 (n=36), II: 31-35 (n=83), III: 36-40 (n=57), and IV: =41 (n=19). Results: The total retrieved oocytes, as well as immature oocytes, were significantly lower in group IV, however, the mean % of immature oocytes was significantly higher in group IV than other age groups. Oocyte immaturity tended to decrease as increasing age in women aged 40 years or less. Conclusion: In stimulated IVF cycle, much higher oocyte immaturity was noted in women aged 41 years or more. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the direct relationship between the follicular fluid (FF) level of soluble human leukocyte antigen G (HLA-G) and fertilizability of the corresponding oocyte as well as the morphological quality of the corresponding embryo. Materials and Methods: Sixty-three patients were stimulated with recombinant FSH combined with gonadotropin-releasing hormone (GnRH) agonist long (n=5) or antagonist protocol (n=58) for standard in vitro fertilization (IVF). At the time oocyte retrieval, follicular fluid was obtained from single dominant follicle in 63 patients, and the level of soluble HLA-G was measured by sandwich enzyme-liked immunosorbent assay (ELISA). Normal fertilization and individual embryo quality were evaluated, and were graded to four categories by morphological criteria (the embryo with symmetrical blastomeres and no fragmentation were assigned as grade A). Good-quality embryo was defined as those with grade A or B. Results: Soluble HLA-G was not detected in 15 FF samples. In the group with positive FF soluble HLA-G (sHLA-G) (n=48), high levels of sHLA-G (>117.758 U/mL) could predict the failure of fertilization with statistical significance {area under the curve (AUC) 0.676, 95% confidence interval (CI) 0.525-0.804}. However, the FF sHLA-G level was not related with the formation of good-quality embryo. Conclusion: High level of FF sHLA-G could predict the fertilization failure of the corresponding oocyte, but was not related with the formation of good-quality embryo. [ABSTRACT FROM AUTHOR]

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. 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 (+)]. For the IVF-IVF cycles, the E 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 < 0.001), while these outcome variables did not differ when the former and latter cycles in Groups A and D were compared. These trends were observed in the ICSI-ICSI cycles. An increased responsiveness, based on the higher E and greater number of retrieved oocytes, may be associated with the presence of 3PN in both conventional IVF and ICSI cycles. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to compare the outcomes of controlled ovarian stimulation (COH) and IVF between women with PCOS and those with sonographic PCO-only in GnRH antagonist cycles. Methods: This was a retrospective study of women with PCOS (n = 42) and those with sonographic PCO-only (n = 54) undergoing IVF. Responses to COH, adverse events such as severe ovarian hyperstimulation syndrome (OHSS), embryological and pregnancy outcomes were compared between the two groups using GnRH antagonist cycles and between GnRH agonist and antagonist protocols in the two groups, respectively. Results: There were no differences in the duration of stimulation, dose of gonadotropins used, E(2) level on hCG day, numbers of retrieved oocytes, and incidence of sever OHSS between PCOS and sonographic PCO-only groups, which was also observed both in GnRH agonist and antagonist subgroups. Pregnancy rates between PCOS and sonographic PCO-only groups in GnRH agonist (21.7 vs. 34.4%, P = 0.238) and antagonist (26.3 vs 22.7%, P = 0.537) subgroups did not differ. In regard to COH regimen, GnRH agonist long protocols showed higher responses than antagonist protocols both in PCOS group [number of retrieved oocytes (13.2 +/- 5.8 vs. 8.2 +/- 3.2, P < 0.001)] and sonographic PCO-only group [number of retrieved oocytes (13.7 +/- 5.2 vs. 9.2 +/- 6.7, P = 0.008); E(2) level on hCG day (3,005.1 +/- 1,317.1 vs. 1,525.9 +/- 738.6 pg/mL, P < 0.001)]. Conclusions: Women with PCOS and sonographic PCO-only may have similar outcome during COH cycle for IVF. [ABSTRACT FROM AUTHOR]

Purpose: The association between tenaculum application to the cervix just before embryo transfer and lower pregnancy rate has been reported. However, studies on the use of tenaculum in intrauterine insemination (IUI) cycles are not available. This study attempted to investigate whether the use of tenaculum affects the clinical outcomes of IUI. Materials and Methods: Two hundred and thirty three CC/hMG/ IUI cycles of one hundred and forty three couples were recruited at Seoul National University Hospital from October 2006 to December 2008. Mock insemination and IUI with or without tenaculum application to the cervix were also performed, and clinical pregnancy rate was compared. Results: The incidence of difficult mock insemination at the beginning of cycle was higher in the tenaculum use group (p < 0.001). No significant statistical difference in the clinical pregnancy rate was observed between the groups with or without tenaculum application (12.1% vs. 18.5%; p = 0.175), which was not influenced by the difficulty of mock insemination. Conclusion: The use of tenaculum during IUI may not affect the pregnancy outcome. Our results need to be confirmed by a prospective study in a larger population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anti-Müllerian hormone (AMH) has been suggested as a marker of ovarian reserve and predictor of ovarian response to controlled ovarian hyperstimulation (COH). Several studies have demonstrated AMH changes during follicular and luteal phases during COH, but not after human chorionic gonadotrophin (hCG) administration. The objectives of this study were to investigate changes in AMH levels during the entire COH cycle and to clarify the regulatory mechanism of AMH secretion. In addition, we analyzed the COH outcome parameters to determine the optimal timing for AMH measurement to predict outcome. [ABSTRACT FROM AUTHOR]

Background/Aims: To compare the effectiveness of highly purified hMG (Menopur) with recombinant FSH (Gonal-F) in IVF/ICSI patients who underwent ovarian hyperstimulation with pituitary suppression. Methods: A literature search of the National Library of Medicine and the National Institutes of Health (PubMed), Medline and Cochrane Controlled Trials Register was performed using the key words ‘highly purified hMG’ and ‘recombinant FSH.’ Only prospective randomized controlled trials were included when they compared IVF/ICSI outcomes after administration of Menopur versus Gonal-F. Five studies met the inclusion criteria and were reviewed. The primary outcome measure was ongoing pregnancy/live birth. Results: Ongoing pregnancy rate per started cycle (RR: 1.10, 95% CI: 0.96–1.26) or per embryo transfer (RR: 1.13, 95% CI: 0.99–1.29), as well as live birth rate per embryo transfer (RR: 1.14, 95% CI: 0.98–1.33), is similar between the Menopur and the Gonal-F group. Conclusion: The combined data presented in this meta-analysis do not support a clinical superiority of Gonal-F over Menopur. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aim: The aim of this meta-analysis was to evaluate whether IV albumin infusion around the time of oocyte retrieval prevents ovarian hyperstimulation syndrome (OHSS) and affects the pregnancy rate. Methods: A meta-analysis of data from 9 randomized controlled trials including 1,613 women at high risk for developing OHSS in in vitro fertilization cycles was performed. Results: The combined incidence of severe OHSS was 6.0% in the IV albumin group and 7.9% in saline or no treatment groups. These rates were statistically not different (RR = 0.80, 95% CI = 0.57–1.12). Treatment with IV albumin significantly lowered the pregnancy rates (RR = 0.85, 95% CI = 0.74–0.98). Conclusions: The combined data presented in this meta-analysis do not support a benefit for IV albumin around the time of oocyte retrieval in preventing OHSS and even showed a deleterious effect on the pregnancy rate. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims: The aim of this meta-analysis was to determine whether frozen embryo transfer (ET) increases ectopic pregnancy (EP) rate compared with fresh ET. Methods: A meta-analysis was performed of data from seven comparative studies including 13,059 pregnancies that resulted from nondonor in vitro fertilization cycles. Results: The EP rate was 2.31% (49/2,125 pregnancies) for frozen ET and 1.48% (162/10,934 pregnancies) for fresh ET. These rates were statistically not different when assessed either by random (OR 1.66, 95% CI 0.62–4.41) or fixed effect model (OR 1.17, 95% CI 0.84–1.63). Conclusions: The combined data presented in this meta-analysis do not support an increased risk of EP following frozen ET compared with fresh ET. However, as there was a substantial heterogeneity among the studies analyzed, the authors consider that further well-designed studies controlling for several potential biases which could affect the EP risk should be conducted. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: To evaluate the efficacies of the estrogen receptor-α (ER-α) gene polymorphisms and of the intrafollicular insulin-like growth factor (IGF) system for predicting pregnancy in in vitro fertilization and embryo transfer (IVF-ET) patients. Methods: A total of 96 patients undergoing IVF-ET were included in this study. Genotyping for the ER-α gene PvuII and XbaI polymorphisms was performed using polymerase-chain reaction and single base extension method. Follicular fluid (FF) IGF-I, IGF-II, and IGFBP-3 concentrations were measured by RIA, and IGFBP-4 by ELISA. We compared, between pregnant (n = 28) and non-pregnant groups (n = 68), the allele frequency, genotype distribution and haplotype distribution of PvuII and XbaI polymorphisms, and then FF IGF-I, IGF-II, IGFBP-3, IGFBP-4 concentrations and their ratios. Results: No significant differences were found between the two groups in terms of allele, genotype or haplotype distributions of the ER-α gene PvuII and XbaI polymorphisms between the two groups. The mean FF IGF-I/IGFBP-3 ratio was significantly higher in the pregnant group (5.9 ± 1.5 vs. 4.8 ± 1.5 ×10–2). Conclusions: The intrafollicular IGF-I/IGFBP-3 ratio of the FF of the dominant follicle during oocyte retrieval appears to be related to the establishment of pregnancy in IVF-ET patients, whereas the ER-α gene PvuII and XbaI polymorphisms do not. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Problem The aim of this study was to investigate the relationship between the polymorphisms of the tumor necrosis factor-α (TNF-α) and TNF receptor (TNFR) genes and serum levels of TNF-α and its soluble receptor (sTNFR) in Korean women with endometriosis. Method of study The TNF-α 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-α, 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 TNF-α level was noted. Single polymorphisms of TNF-α and TNFR genes were not significantly different between the two groups. The frequencies of the TNF-α 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 TNF-α and TNFR2 gene polymorphisms are genetic factors associated with endometriosis, and circulating sTNFR rather than TNF-α, may be involved in the development of endometriosis in Korean women. [ABSTRACT FROM AUTHOR]

Abstract  We investigated the relationships between the IGF-I receptor gene G3174A polymorphism, serum IGF-I levels, and bone mineral density (BMD) in postmenopausal Korean women. The IGF-I receptor gene G3174A polymorphism was analyzed in 367 postmenopausal Korean women. Serum levels of IGF-I, bone turnover markers (osteocalcin, bone alkaline phosphatase, carboxy-terminal cross-linking telopeptide of type I collagen), and BMD at the lumbar spine and proximal femur were measured. The frequencies of the AA, GA, and GG genotypes were 10.9%, 44.1%, and 45.0%, respectively. BMD at the lumbar spine was significantly higher for the AA genotype than the other genotypes and showed an A allelic dose effect; however, no significant differences in BMD were observed at the proximal femur with respect to genotype. No differences were noted between the three genotypes in terms of serum levels of IGF-I or bone turnover markers. Women with low BMD showed a lower prevalence of the AA genotype and A allele than age-matched women with normal BMD. Women with the AA genotype were found to have about half the risk of a low BMD than women with other genotypes. In conclusion, IGF-I receptor gene G3174A polymorphism is associated with lumbar spine BMD in postmenopausal Korean women. [ABSTRACT FROM AUTHOR]

Background: It has not been established whether the clinical outcomes of tubal heterotopic pregnancy resulting from assisted conception are different to those of spontaneous conception. The aim of this study was to compare the clinical course and the outcome of intrauterine gestation following surgical treatment for tubal heterotopic pregnancy according to the method of pregnancy. Methods: Medical records of 13 cases of tubal heterotopic pregnancy experienced in Seoul National University Hospital during 1990–2004 and 30 case reports of tubal heterotopic pregnancy published in the Korean Journal of Obstetrics and Gynecology during 1980–2004 were reviewed retrospectively. The clinical outcomes were compared between the assisted (n = 23) and spontaneous conception groups (n = 20). Results: The assisted conception group had a significantly higher preoperative systolic blood pressure and a previous history of pelvic pathology. The spontaneous group had a higher incidence of tubal rupture and hemoperitoneum. The assisted conception group had a higher live birth rate than the spontaneous group (47.8 vs. 20%, p = 0.056). Conclusions: In tubal heterotopic pregnancy, the assisted conception group had a more favorable clinical course and intrauterine gestation outcome following surgical treatment when compared with the spontaneous conception group. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

BACKGROUND: Age at menarche is known to be regulated by genetic and environmental factors. To date, no menarcheal data are available on North Korean women. In this cross-sectional survey, we investigated age at menarche and its possible influencing factors in North Korean refugees. METHODS: Four hundred and eleven North Korean refugees were surveyed at a North Korean female refugee camp using a structured questionnaire within 3 months of immigration. Menarcheal age was requested and the data obtained were analysed with respect to age at interview, region of residence in North Korea, education, food preference and sleep duration. RESULTS: Mean age at menarche was 16.0 ± 2.1 years (mean ± SD). Univariate analysis demonstrated a significant difference in the menarcheal age among the different food preference groups (P = 0.0236). Sleep duration was found to be significantly and negatively correlated with age at menarche (R = −0.23, P < 0.0001). However, generalized linear model (GLM) analysis revealed that region of residence at menarche (P = 0.0209) and sleep duration (P = 0.0007) were significant determinants. Food preference played a role as an effect modifier in the relationship between the region of residence at menarche and age at menarche. CONCLUSION: Age at menarche seemed to be delayed in North Korean refugees. GLM analysis showed that sleep duration and region of residence at menarche were significant influencing factors of age at menarche in this study population. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study was carried out to compare spindle locations and their developmental competencies both in vivo and in vitro in matured mouse oocytes. Spindle locations were identified using a polscope. Since meiotic spindles in living oocytes are highly birefringent, their structures can be viewed non-invasively by using a polscope. METHODS: In vivo matured metaphase II oocytes were collected from the oviducts of mice. Immature oocytes were collected from mouse ovaries, and then cultured in YS medium until the first polar body (PB) extrusion. In vitro and in vivo matured oocytes were classified into four categories according to their spindle positions relative to the first PB (0, 090, 90180 and without a spindle image), and rates of fertilization and blastocyst formation were assessed. In vivo matured oocytes with a 0 spindle disposition relative to PB were cultured in vitro for 24?h, and then their spindle positions were re-assessed. RESULTS: Most in vivo matured oocytes (89.1%) had a 0 spindle position. Only 6 and 3% of oocytes had spindle positions of 090 and 90180, respectively. No spindle image was observed in 2%. However, most in vitro matured oocytes (83.1%) had a 090 spindle position and, in contrast, only 6.5% of these oocytes had a 0 spindle position. The rate of fertilization and blastocyst rate were significantly higher for in vivo matured oocytes than in vitro matured oocytes (87.1 versus 64.9% and 76.1% versus 66.0%, respectively, P<0.05 for each). We also observed that 71.7% of the in vivo matured oocytes with the 0 spindle position showed a spindle position change to 090 after 24?h of culture. These oocytes had a poor fertilization rate (43%) and a zero blastocyst rate. CONCLUSION: In vitro matured mouse oocytes showed quite different spindle positions compared with in vivo matured oocytes. Moreover, in vivo matured oocytes cultured for 24?h had a spindle position distribution that was similar to that of in vitro matured oocytes. The different spindle positions observed in in vivo and in vitro matured oocytes may reflect differences in their cytoplasmic maturation processes. These findings have implications regarding the lower developmental competency of in vitro matured oocytes. [ABSTRACT FROM AUTHOR]

Background: Present human data reveal that gonadotropin stimulation for in vitro fertilization and embryo transfer (IVF-ET) is detrimental to uterine receptivity. Heparin-binding epidermal growth factor-like growth factor (HB-EGF) is important in the early stage of mouse embryonic implantation since it is expressed in the murine endometrium before the attachment reaction. Gonadotropin receptors have been found on the murine endometrium. In this study, we assessed the expression of HB-EGF mRNA on the gonadotropin-stimulated murine endometrium and sought evidence of whether the gonadotropin-induced, altered uterine receptivity is associated with a change in the HB-EGF expression. Methods: Quantitative, competitive reverse-transcription polymerase chain reaction (PCR) and immunohistochemistry were performed to evaluate the expression of HB-EGF mRNA on the stimulated murine endometrium from pregnant uteri of gestation day (g.d.) 5.0 after injection of saline, or pregnant mare serum gonadotropin (PMSG) 5 or 10 IU. Results: The expression of HB-EGF mRNA showed no significant increase or decrease in the endometrial expression in PMSG groups, compared to the control group (natural coitus with saline injection), on g.d. 5.0. This finding was consistent with the immunostaining of HB-EGF protein, and there was no significant difference in the staining intensity among the 3 groups. Conclusion: This study reveals that ovarian stimulation by gonadotropin may not influence the expression of HB-EGF in the murine endometrium. Further investigations are necessary to elucidate whether embryonic HB-EGF receptor status relative to endometrial HB-EGF expression is affected by ovarian stimulation. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We investigated the cumulative probability of ongoing pregnancy in intracytoplasmic sperm injection (ICSI) cycles. During a period of 6 years, 519 ICSI cycles were performed in 260 infertile couples at the Seoul National University Hospital. The cumulative rate of ongoing pregnancy (≥12 weeks of gestation) was estimated by the Kaplan–Meier method. The cumulative ongoing pregnancy rate was 54.9% after six consecutive cycles of ICSI. The age of the female had a significant impact; after five consecutive cycles, cumulative ongoing pregnancy rate was 61.8% in ≤30 years of age, 51.7% in 31–35, and 15.3% in ≥36. There was no significant difference in the cumulative ongoing pregnancy rate between groups with severe male factor and previous unexplained low fertilization rate (≤20%). Among the severe male factor group, cumulative ongoing pregnancy rate was not different according to the methods of sperm retrieval (surgically retrieved or ejaculated). Intracytoplasmic sperm injection could be applied successfully both to severe male factor and patients with previous unexplained low fertilization rate. The origin of spermatozoa does not affect ICSI outcome in terms of cumulative probability of ongoing pregnancy. [ABSTRACT FROM AUTHOR]

BACKGROUND Insulin resistance is a core feature of polycystic ovary syndrome (PCOS). Phosphatidylinositol (PI) 3-kinase is an important enzyme in the early insulin signaling cascade and plays a key role in insulin-mediated glucose transport. In its regulatory subunit, p85α, there is a common amino acid substitution (the Met326Ile polymorphism), and this amino acid may be crucial for the function of the p85α regulatory subunit and PI3-kinase. METHODS Analysis of the Met326Ile polymorphism was carried out on DNA samples from 256 PCOS patients and 283 controls. Clinical and biochemical profiles of participants were also compared. RESULTS The genotype distribution of the Met326Ile polymorphism in the PCOS group was not different from that of the controls (Met326Met/Met326Ile/Ile326Ile rates were 73.4%/23.4%/3.2% and 70.3%/26.1%/3.6% for the PCOS and control groups, respectively, P = 0.72). The PCOS group was divided into two subgroups according to the presence of the variant 326Ile allele. Compared with those carrying at least one variant 326Ile allele, carriers with the Met326Met genotype had higher serum 17-hydroxyprogesterone (17-OHP) {1.1 [95% confidence interval (CI) 1.1–1.3] ng/ml in those with the Met326Met genotype versus 0.8 (95% CI 0.7–1.0) ng/ml in those with Ile326Ile and Met326Ile genotypes, P = 0.0073} and free testosterone levels [1.2 (95% CI 1.1–1.4) pg/ml for Met326Met genotype versus 0.9 (95% CI 0.6–1.3) pg/ml for Ile326Ile and Met326Ile genotypes, P = 0.038]. CONCLUSIONS Our results suggest that the PI3-kinase gene Met326Ile polymorphism may not be a major determinant for the development of PCOS, but it may modulate the concentrations of serum 17-OHP or free testosterone in PCOS patients. [ABSTRACT FROM AUTHOR]

BACKGROUND A cryopreservation protocol for human amnion-derived mesenchymal stem cells (HAMs) is required because these cells cannot survive for long periods in culture. The aim of this study was to determine whether vitrification is a useful freezing method for storage of HAMs. METHODS HAMs were cryopreserved using vitrification method. The morphology and viability of thawed HAMs was evaluated by Trypan Blue staining. The expression of several embryonic stem cell (ESC) markers was evaluated using flow cytometry, RT–PCR and immunocytochemistry. Von Kossa, Oil Red O and Alcian Blue staining were used to asses the differentiation potential of thawed HAMs. RESULTS The post-thawing viability of HAMs was 84.3 ± 3.2% (Mean ± SD, n = 10). The thawed HAMs showed morphological characteristics indistinguishable from the non-vitrified fresh HAMs. The expression of surface antigens (strong positive for CD44, CD49d, CD59, CD90, CD105 and HLA-ABC; weak positive for HLA-G; negative for CD31, CD34, CD45, CD106, CD117 and HLA-DR) and the expression of ESC markers [CK18, fibroblast growth factor-5, GATA-4, neural cell adhesion molecule, Nestin, Oct-4, stem cell factor, HLA-ABC, Vimentin, bone morphogenetic protein (BMP) 4, hepatocyte nuclear factor 4α (HNF-4α), Pax-6, alpha-fetoprotein, Brachyury, BMP-2, TRA-1-60, stage-specific embryonic antigen (SSEA-3, SSEA-4)] were maintained in the vitrified-thawed HAMs. The thawed HAMs retained ability to differentiate into osteoblasts, adipocytes and chondrocytes under appropriate culture conditions. CONCLUSIONS Our results suggest that vitrification is a reliable and effective method for cryopreservation of HAMs. [ABSTRACT FROM AUTHOR]

BACKGROUND We investigated the differences in anthropometrical, hormonal and insulin resistance parameters according to the subtype of polycystic ovary syndrome (PCOS) in Korean women. METHODS We recruited 166 women with PCOS and retrospectively recruited 277 controls. PCOS was diagnosed by irregular menstruation (IM), polycystic ovary (PCO) and hyperandrogenism (HA). Subjects were divided into four subgroups: the IM/HA/PCO group (n = 87, 52.4%), the IM/PCO group (n = 52, 31.3%), the IM/HA group (n = 23, 13.9%) and the HA/PCO group (n = 4, 2.4%). Clinical and biochemical variables were compared among the PCOS subgroups. RESULTS The IM/HA/PCO and IM/HA groups showed higher body mass index (P P P P P P P = 0.004), diastolic BP (P = 0.001), fasting insulin (P P P P CONCLUSIONS Women with PCOS without HA are common in Korea and are less likely to have metabolic dysfunction, insulin resistance and elevated BP. PCOS without HA may be a mild phenotype of PCOS. Therefore, women with PCOS in Korea could have a reduced likelihood of having metabolic syndrome compared with women of other ethnicities. [ABSTRACT FROM AUTHOR]