미수정 및 저수정율의 기왕력을 지닌 체외수정시술 환자에서의 난자 세포질내 정자 주입술을 이용한 미세보조 수정술에 관한 연구

문신용,김석현,채희동,김광례,이재훈,김희선,류범용,오선경,서창석,최영민,김정구,이진용,Moon, Shin-Yong,Kim, Seok-Hyun,Chae, Hee-Dong,Kim, Kwang-Rye,Lee, Jae-Hoon,Kim, Hee-Sun,Ryu, Buom-Yong,Oh, Sun-Kyung,Suh, Chang-Suk,Choi, Young-Min,Kim, 대한생식의학회 1997 Clinical and Experimental Reproductive Medicine Vol.24 No.1

Although IVF-ET is widely applied in the treatment of couples with male factor infertility, it may fail in many infertile couples with normal semen parameters, and certain couples cannot be accepted for standard IVF-ET due to unfertilization or extremely low fertilization rate of oocytes. Recently, several procedures of microassisted fertilization (MAF) using micromanipulation have been introduced, and pregnancies and births have been obtained after partial zona dissection (PZD), subzonal insertion (SUZI), and intracytoplasmic sperm injection (ICSI). This clinical study was performed to develop and establish ICSI as an effective procedure of MAF in infertile couples who could not undergo standard IVF-ET repetitively because of failure in fertilization or extremely low fertilization rate of oocytes with the conventional fertilization technique in the previous IVF-ET cycles. From March, 1995 to May, 1996, 27 cycles of IVF-ET with ICSI in 19 infertile patients were included in study group, and the outcomes of ICSI were analyzed according to fertilization rate, cumulative embryo score (CES), and pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was $10.50{\pm}6.13$ in 30 previous cycles, and $10.57{\pm}5.53$ in 27 ICSI cycles. In ICSI cycles, the number of oocytes optimal for ICSI procedure was $7.89{\pm}4.30$, and the fertilization rate of $67.9{\pm}20.2%$ could be obtained after ICSI. The number of embryos transferred was $1.43{\pm}2.40$ in previous cycles, and $4.36{\pm}1.77$ with the mean CES of $41.8{\pm}27.4$ in ICSI cycles. In ICSI cycles, the overall pregnancy rate was 29.6% (8/27) per cycle and 42.1% (8/19) per patient with the clinical pregnancy rate of 22.2% (6/27) per cycle and 31.6% (6/19) per patient. In conclusion, MAF of human oocytes with ICSI is a promising fertilization method for IVF-ET patients, especially with the past history of failure in fertilization or low fertilization rate of oocytes in the previous IVF-ET cycles, and ICSI using micromanipulation procedures applied to human oocytes will provide a range of novel techniques which may dramatically improve the pregnancy rate in IVF-ET program and contribute much to effective management of infertile couples.

체외수정시술시 배아의 보조부화술을 이용한 임신율 향상에 관한 연구

김석현,김광례,채희동,이재훈,김희선,류범용,오선경,서창석,최영민,김정구,문신용,이진용,Kim, Seok-Hyun,Kim, Kwang-Rye,Chae, Hee-Dong,Lee, Jae-Hoon,Kim, Hee-Sun,Ryu, Buom-Yong,Oh, Sun-Kyung,Suh, Chang-Suk,Choi, Young-Min,Kim, Jung-Gu,Moon, S 대한생식의학회 1997 Clinical and Experimental Reproductive Medicine Vol.24 No.1

In spite of much progress in vitro fertilization and embryo transfer (IVF-ET) program, the pregnancy rate remains at 20-30%, and the endometrial implantation rate per embryo transferred at 10-15%. As a result, about 90% of embryos may fail to implant to the endometrium, and many attempts such as optimization of follicular development, improvement of in vitro culture system including coculture, and micromanipulation of zona pellucida have been made to improve embryonic implantation after IVF-ET. Recently, several procedures of assisted hatching (AH) using micromanipulation have been introduced, and pregnancies and births have been obtained after AH. To develop and establish AH as an effective procedure to improve embryonic implantation, AH with partial zona dissection (PZD) was performed in 116 cycles of 89 infertile couples who had previous repeated failures of standard IVF-ET more than two times (Group I: 71 cycles in 54 patients), or who had implantation failure of embryos with good quality (Group II: 15 cycles in 13), or who had undergone AH without specific indication (Group III: 30 cycles in 22) from January, 1995 to Februry, 1996, and the outcomes of AH were analyzed according to pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was $9.9{\pm}7.1$ in Group I, $11.5{\pm}4.5$ in Group II, and $7.9{\pm}6.4$ in Group III. The number of embryos transferred after AH was $4.7{\pm}1.8$ in Group I, $5.3{\pm}1.3$ in Group II, and $3.5{\pm}2.4$ in Group III. The mean cumulative embryo score (CES) was $56.8{\pm}30.0$ in Group I, $76.1{\pm}35.9$ in Group II, and $38.5{\pm}29.9$ in Group III. The overall clinical pregnancy rate per cycle and per patient was 12.7% (9/71) and 16.7% (9/54) in Group I, 33.3% (5/15) and 38.5% (5/13) in Group II, and 6.7% (2/30) and 9.1% (2/22) in Group III, respectively. There were significant differences in the numbers of oocytes retrieved and embryos transferred, CES, and the clinical pregnancy rate per cycle among three groups. There was a significant inverse correlation between basal serum FSH level and CES, and no pregnancy occurred in patients with CES less than 20. In conclusion, AH of human embryos with PZD prior to ET has improved the implantation and pregnancy rates in IVF-ET patients with the past history of repeated failures, especially in spite of transfer of embryos with good quality, and AH will provide a range of novel techniques which may contribute much to effective management of infertile couples.

난자 세포질내 정자 주입술을 이용한 체외수정시술시 누적임신율에 관한 연구

김석현(Seok Hyun Kim),심순섭(Soon Sup Shim),지병철(Byung Chul Jee),최성미(Sung Mi Choi),김희선(Hee Sun Kim),류범용(Buom Yong Ryu),오선경(Sun Kyung Oh),서창석(Chang Suk Suh),최영민(Young Min Choi),배광범(Kwang Bum Bai),김정구(Jung Gu 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.3

N/A Objective : To evaluate the cumulative pregnancy rate(CPR) of in vitro fertilization and embryo transfer(IVF-ET) with intracytoplasmic sperm injection(ICSI). Methods : Medical records of 260 infertile patients undergoing 519 cycles of IVF-ET with ICSI from January, 1994 to December, 1999 were retrospectively reviewed. The CPR beyond 12 weeks of gestation was estimated by Kaplan-Meier method. The CPRs were compared by log-rank test between groups divided by age of patients, indication of ICSI, and method of sperm retrieval for ICSI. Results : As 70 patients achieved an on-going pregnancy after IVF-ET with ICSI, the PR was 26.9% per patient and 13.5% per cycle. The overall CPR was 54.9% after 6 cycles of IVF-ET with ICSI. As expected, age had a significant strong effect on the CPR; CPRs afer 4 cycles of ICSI were 61.8% in the age group of 30 years(n=81), 43.7% in 31-35 years(n=106), and 15.3% in 36 years(n=73). There was no significant difference in the CPR between abnormal semen analysis group(n=184) and prior low fertilization rate group(n=66). In abnormal semen analysis group, the CPR of surgically retrieved sperm subgroup(n=60) was not significantly different from that of ejaculated sperm subgroup(n=124). Conclusions : The CPR of IVF-ET with ICSI was presented, and it could be of much help in the clinical counseling of IVF-ET patients. ICSI technique could be used successfully for IVF-ET in infertile couples who had the male factor infertility or the past history of low fertilization rate in the previous cycles.

Increased responsiveness may be associated with tripronuclear embryos in both conventional <i>in vitro</i> fertilization and intracytoplasmic sperm injection cycles using gonadotropin‐releasing hormone agonist long protocols: A self‐matched

Kim, Yong Jin,Ku, Seung‐,Yup,Jee, Byung Chul,Suh, Chang Suk,Kim, Seok Hyun,Choi, Young Min,Kim, Jung Gu,Moon, Shin Yong Blackwell Publishing Asia 2011 JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH -TO Vol.37 No.1

<P><B>Abstract</B></P><P><B>Aims: </B> In this self‐matched observational study, the factors associated with the presence of tripronuclear (3PN) embryos, in conventional <I>in vitro</I> fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles using gonadotropin‐releasing hormone agonist long protocols, were investigated.</P><P><B>Material & Methods: </B> 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 (+)].</P><P><B>Results: </B> For the IVF‐IVF cycles, the E<SUB>2</SUB> 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, <I>P</I> = 0.016; 10.4 ± 9.1 vs 7.2 ± 5.7, <I>P</I> = 0.010) and C (2382.7 ± 1214.5 pg/mL vs 1553.0 ± 1119.6 pg/mL, <I>P</I> = 0.004; 13.1 ± 9.1 vs 9.1 ± 7.0, <I>P</I> < 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.</P><P><B>Conclusions: </B> An increased responsiveness, based on the higher E<SUB>2</SUB> and greater number of retrieved oocytes, may be associated with the presence of 3PN in both conventional IVF and ICSI cycles.</P>

체외수정 생쥐 배아에서의 배아 줄기세포 확립

문신용,박용빈,김희선,오선경,천대우,서창석,최영민,김정구,이진용,김석현,Shin, Yong-Moon,Park, Yong-Bin,Kim, Hee-Sun,Oh, Sun-Kyung,Chun, Dae-Woo,Suh, Chang-Suk,Choe, Young-Min,Kim, Jung-Gu,Lee, Jin-Yong,Kim, Seok-Hyun 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.1

Objective: In order to acquire the technique for the establishment of human embryonic stem cells (ESe) derived from the human frozen-thawed embryos produced in IVF-ET program, this study was performed to establish mouse ESC derived from the in vitro fertilized embryos. Materials and Methods: After Fl hybrid (C57BL female $\times$ CBA mael) female mice were superovulated with PMSG and hCG treatment, their oocytes were retrieved and inseminated, and the fertilized embryos were cultured for 96-120 hours until the expected stages of blastocysts were obtained. To isolate the inner cell mass (ICM), either the blastocysts were treated with immunosurgery, or the whole embryos were cultured for 4 days. Isolated ICMs were then cultured onto STO feeder cell layer, and the resultant ICM colonies were subcultured with trypsin-EDTA treatment. During the subculture process, ESC-like cell colonies were observed with phase contrast microscopy. To identify ESC in the subcultured ESC-like cell colonies, alkaline phosphatase activity and Oct-4 (octamer-binding transcription factor-4) expression were examined by immunohistochemistry and RT-PCR, respectively. To examine the spontaneous differentiation, ESC-like cell colonies were cultured without STO feeder cell layer and leukemia inhibitory factor (LIF). Results: Seven ESC-like cell lines were established from ICMs isolated from the in vitro fertilized embryos. According to the developmental stage, the growth of ICMs isolated from the expanded blastocysts was significantly better than that of ICMs isolated from the hatched blastocysts (80.3% vs. 58.7%, p<0.05). ESC-like cell colonies were only obtained from ICMs of expanded blastocysts. However, the ICMs isolated from the embryos treated with immunosurgery were poorly grown and frequently differentiated during the culture process. The established ESC-like cell colonies were positively stained with alkaline phosphatase and expressed Oct-4, and their morphology resembled that observed in the previously reported mouse ESC. In addition, following the extended in vitro culture process, they maintained their expression of cell surface markers characteristic of the pluripotent stem cells such as alkaline phosphatase and Oct-4. When cultured without STO feeder cell layer and LIF, they were spontaneously differentiated into the various types of cells. Conclusion: The findings of this study suggest that the establishment of mouse ESC can be successfully derived from the in vitro fertilized embryos. The established ESC-like cells expressed the cell surface markers characteristic of the pluripotent stem cells and spontaneously differentiated into the various types of cells.

인공생식에 관한 가족법상의 문제점

맹광호(Kwang-Ho Maeng) 한국가족법학회 2007 가족법연구 Vol.21 No.3

  Today’s reality is that most of the family law related issues regarding artificial reproduction can only be solved through interpretation of the current civil code or precedent cases. This dissertation discusses the legal issues related to artificial insemination and in vitro fertilization-embryo transfer(IVF-ET), and the following are the main contents.<BR>  First of all, the child resulting from artificial insemination by the semen derived from donor(AID) without the consent of the father and out of marriage should be regarded as the legal child of the father, and the father should have the right to choose whether or not to file a suit to overthrow such an interpretation. However, in cases where there is no family interest to be protected as, for example, when the legal parents of the artificially reproduced child are already divorced, it should be the child should not be assumed to be the legal child of the father and other persons of interest should be allowed to contradict the legal relationship between father and child through a lawsuit.<BR>  In cases where the father has agreed to artificial reproduction between persons that are not married, the child should be recognized as the legal child of the father as the well being and family of the child is more important than the actual blood relations. Also, regarding whether a father who consented to artificial reproduction between non-married persons can file a suit denying the father-child relationship on the basis that there are no blood ties, this should not be allowed due to Estoppel’s principle or for the protection of the child. Such logic should apply to the wife who, in agreement with the father, bore the child through artificial reproduction between non-married persons, and therefore the wife cannot deny the legal relationship between the father and son through lawsuits.<BR>  Regarding cases in which the legal relationship between the artificially reproduced child and the father is not recognized, the child should not be able to file a suit contending that the semen donor is the legal father as it is not just to burden the donor, who had no wish to form a father-child relationship, with the responsibility of supporting the child and leaving the child inheritance. Also this would make people refrain from making semen donations.<BR>  Secondly, with regards to in vitro fertilization-embryo transfer(IVF-ET), the form of this procedure that doesn’t utilize the egg nor the semen of the couple wishing to have a baby but just the reproductive cells of a 3rd party should be legally barred. In the case where a woman had a child by IVF-ET through egg donation it is only right that the woman who went through the pregnancy and had the child become the legal mother as the egg donor had no wish to form a legal mother-child relationship and protect and raise the child. This is also better for the well being of the child as it is more desirable that the parents who wanted to give birth to the child become its legal parents.<BR>  Therefore, a law regarding such legal issues raised related to artificial reproduction should be enacted. Also, when such a law is established clauses such as “a child born, in agreement or with the consent of the husband, by the wife through artificial methods using the semen of a man who is not the husband is deemed to be the child of the husband," and “when the husband consents to and the couple therefore agrees to artificial reproduction between non-married persosn, the wife and husband can not file a lawsuit denying the legal father-child relationship on the basis that there is no blood relations" should be included regarding the legal status of the artificially reproduced child in cases where the father has agreed to artificial insemination or in vitro fertilization-embryo transfer(IVF-ET). There should also be a clause regarding the relationship of the semen donor and artific

한국의 시험관아기 시술 30년, 거버넌스의 부재와 위험의 증가: 전문가 역할을 중심으로

하정옥 ( Ha Jung Ok ) 한국과학사학회 2014 한국과학사학회지 Vol.36 No.1

This paper examines the 30-year history of in vitro fertilization (IVF) in Korea in terms of the role and social responsibility of experts. International comparison studies on IVF have consistently ranked South Korea as one of the countries with highest average number of embryo transferred. The continuous rise of IVF treatments in South Korea has increased the multiple births in the country almost twice over the last 20 years. However, multiple births can be risky to the health of newborn babies. In general, countries, which have established national registries and conducted follow-up surveys on the children conceived via IVF treatments, show substantial decreases in the number of embryos transferred. In South Korea’s case, there are no accurate records or follow-up surveys on babies born via IVF. Though there are clearly many reasons why this situation exists, this study approaches the subject rather from the standpoint of the role and social responsibility of experts. In countries where expert organizations were actively involved in establishing governance for IVF, it was possible to prevent increases in multiple pregnancies and lower the health risk of newborns. This strongly shows that the proper control of these technologies is possible when expert organizations take full responsibility and make active and dedicated efforts to institutionalize the outcomes of their work.

한국 출산정책에 대한 비판적 검토

이연숙(Lee, Yeon Sook),구인회(Ku, In Hoe) 서강대학교 생명문화연구소 2015 생명연구 Vol.38 No.-

이 연구는 한국의 출산정책에서 나타난 문제점들 가운데 피임수단 보급 수단에서 체외수정(IVF) 시술비 지원까지의 문제를 중심으로 한 비판적 검토이다. 연구를 수행한 결과 생명과 직결괴는 출산의 문제에 정부가 개입해 문제를 중심으로 한 비판적 검토이다. 연구를 수행한 결과 생명과 직결괴는 출산의 문제에 정부가 개입해 인위적인 방법을 동원함으로써 생명경시 현상과 저출산을 부채질하는데 한 몫을 했음을 알 수 있었다. 정부는 출산억제 시기에는 미국에서 막 개발된 자궁내장치(IUD)를 도입해 피임 효과를 알아보는 실험장으로 한국을 전락시켰고, 출산억제를 강화하기 위해 모자보건법을 제정해 낙태를 만연시켰으며, 영구피임술도 확산시켰다. 아이러니하게도 영구피임술의 한 방법인 복강경 기술은 IVF 성장의 디딤돌이 되어 난임부부를 위해 활용되고 있다. 피임은 이제 보편화되었고, 성과 혼인, 출산을 분리시키는 피임 사고방식은 우리 삶에 젖어들었다. 난임부부 증가와 저출산 현상도 그 연장선의 하나로 봐야한다. 출산정책 초기부터 생명을 수단화하지 말라며 비판의 목소리를 냈던 가톨릭교회의 주장은 타당했다. 가톨릭은 자연적 방법을 권장하고 있다. 정부는 출산정책을 다시 검토해야한다. This study examines problems that emerged from the procreation policy in korea. Korean government have tried to regulate korean population both diffusion of means of contraception and funding for in vitro fertilization(IVF) treatments throughout history. The procreation policy in korea was arbitrary and temporary that has resulted in life neglect and low fertility. During the period of controlling birth rate, the government tumbled the country as a testing lab to find out the contraceptive effect by introducing newly developed intrauterine device(IUD) in the US. It also enacted the Mother and Child Health Act to strengthen the birth control which resulted in prevailing abortion and spreaded sterilization. Ironically, IVF treatment technique based on laparoscopy surgery, a method of permanent contraception techniques, has been used for infertility couples. Contraception has been popularized now in Korea, and contraceptive mentality that separates sex, marriage, and procreation has been melt into our lives. Growing infertility couples and low fertility rate is one of phenomena which reflect contraceptive mentality. Catholic church in Korea has objected to birth control policy of Korean government and warned of using life as means of population policy. This is the time that Korean government should reexamine the procreation policy carefully.

Urinary bisphenol A versus serum bisphenol A concentration and ovarian reproductive outcomes among IVF patients: Which is a better biomarker of BPA exposure?

Seung Hee Cho,Yohan Choi,Sean Hyungwoo Kim,김상진,Jongwha Chang 대한독성 유전단백체 학회 2017 Molecular & cellular toxicology Vol.13 No.4

Bisphenol A (BPA) is an endocrine-disrupting compound (EDC) that is used widely in commercial products in the production of polycarbonate plastics for baby and water bottles, epoxy resins for lacquer lining of food and beverage cans and water pipes, dental sealants, dental composites and thermal receipts paper. There is inhibitory effect of BPA on nuclear estrogen (E2) production in granulosa cells of developing follicles that disrupt normal development to the antral follicles via suppression of E2 in granulosa cells of developing follicles during the menstrual cycle followed by reduction in the number of oocytes retrieved in in-vitro fertilization (IVF) patients. Several studies corroborate an inverse association between serum and/or urinary BPA concentration and the IVF outcome: Peak E2 levels and the number of oocytes retrieved. Upon oral ingestion, 99.5% of unconjugated parent BPA (free BPA) is metabolized to either BPA glucuronide (BPA-G) or BPA sulfate (BPA-S). The unconjugated BPA can bind to the estrogen receptors(ER) while conjugated BPA (biologically inactive BPA) do not bind the estrogen receptor(ER). The challenge is to assess the relationship between BPA exposure among infertile patients with respect to follicular response and health during IVF. The establishment of temporal sequence between BPA exposure and infertility would be the research question to answer: Which route is a better biomarker? The advantages of urine BPA collection would provide pragmatic advantages for clinicians in order to practice cost-effective medicine. However, unconjugated BPA measurement (compared to total BPA) introduces challenges in measurement accuracy since unconjugated BPA requires higher magnitude of limit of detection (LOD) with higher risk of contamination from the medical equipment. The difference in route of BPA assessment could introduce bias in the interpretation of results in terms of the association between BPA levels and the number of oocytes. Fujimoto et al. and Bloom et al. analyzed the relationship between serum BPA and IVF outcome in infertile women. It may sound hypothetically justified due to utilizing serum unconjugated BPA, this strategy is not successful in choosing a practical biomarker of BPA exposure due to toxicokinetic properties of BPA metabolism and excretion in humans.

자궁내막증 또는 자궁선근증에 의한 불임환자에서 장기간 GnRH analogue ( Long - term Down DRegulation ) 사용 후 과배란 및 체외 수정 시술의 결과

양광문(K . M . Yang),유근재(K . J . Yoo),최범채(B . C . Choi),김계현(K . H. Kim),이홍복(H . B . Lee),이재훈(J . H . Lee),송인옥(I . O . Song),송지홍(J . H . Song),궁미경(M . K . Koong),전종영(J . Y . Jun),강인수(I . S . Kang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.10

목적 : 자궁내막증 또는 자궁선근증을 가진 불임 환자의 치료에 있어 GnRH analogue를 사용한 LTDR의 과배란 유도시 그 효과를 알아보았다. 방법 및 재료 : 복강경과 질식 초음파를 이용하여 자궁내막증 또는 자궁선근증을 진단 받은 불임 여성 43명의 47 LTDR cycles이 연구 대상이 되었다. GnRH analogue를 3개월 이상 장기간 사용하여 down regulation 시킨 후 gonadotropin을 이용하여 과배란 유도를 시행한 경우를 LTDR로 정의하였으며 임신을 위해 자궁강 내 정자 주입술 또는 체외 수정 및 배아 이식이 시행되었다. 결과 : 환자의 평균 연령(meanSD)은 33.83.8이었고 자궁선근증이 10cycles였으며 자궁내막증은 34cycles(1기:12cycles, 2기:9cycles, 3기 :5cycles, 4기:8cycles)이었다. 체외 수정 시 이식된 배아는 평균(meanSD) 3.70.3개였다. 자궁내막증을 가진 34cycles중 17.6%(6/34), 자궁선근증을 가진 10cycles중 40.0%(4/10)의 임신율을 보였다.결론 : 이 연구에서 LTDR은 자궁내막증과 자궁선근증에 의한 불임 환자의 치료에 효과적인 것으로 보이나 연구 대상군의 확대 조사가 필요하리라 사료된다. Objective : To assess the clinical efficacy of long term down regulation (LTDR) for in vitro fertilization (IVF) in infertile patients with endometriosis or adenomyosis.Materials and methods : Analysis were made from data collected from 45 paients who had endometriosis or adenomyosis diagnosed using pelvic laparoscopy and ultrasonography and had undergone intrauterine insemination or in vitro fertilization. LTDR was defined as long term, as long as three months down regulation of ovarian function followed by induction of ovulation using gonadotropins. Of these patients, 43 had undergone LTDR followed by IVF-ET, whereas 30patients in control group had undergone short or long protocol as an ovarian stimulation regimen.Results : The multiple independent parameters such as plasma basal estradiol (E2), plasma E2 level on day of hCG administration, number of oocytes retrived, number of good quality oocytes, number of embryo and number of transfered embryos were not significantly different between LTDR treated group and other control group. The clinical pregnancy rate in women treated with LTDR (17.6% in endometriosis, 40% in adenomysis, and 33.3% in endometriosis combined with adenomyosis) were comparable with those of control group (15.4% in endometriosis, 33.3% in adenomyosis and 40% in endometriosis combined with adenomyosis). Conclusions : In this study the LTDR as a ovarian stimulation regimen for IVF does not seems efficienct in infertile patients having endometriosis or adenomyosis than other protocols such as short or long, however further study with large number may be needed.