Comparison of Three Methods for Semen Preparation for IVF

김선행 ( Sun Haeng Kim ),구병삼 ( Pyong Sahm Ku ) 대한산부인과학회 1989 대한산부인과학회 학술대회 Vol.63 No.-

체외수정 시술을 위한 과배란 유도주기에서 조기 황체호르몬의 상승이 배반포 발달율 및 배반포 이식의 예후에 미치는 영향

김선행(Sun Haeng Kim),이용호(Yong Ho Lee),이낙우(Nak Woo Lee),김탁(Tak Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

목적: 체외 수정 시술을 위한 과배란 유도 주기에서 hCG 투여 당일에 측정한 황체호르몬의 상승이 난자 및 배아의 질 또는 임신율 및 착상율에 미치는 영향을 알아보기 위하여 본 실험을 시도하였다. 연구방법: 1996년 12월부터 1998년 7월까지 25-39세의 환자 70명을 대상으로 IVF-ET 70주기에 대한 결과를 후향적으로 분석하였다. 과배란 유도는 GnRH-a 와 hMG/pFSH를 사용하였고 배반포까지 공배양하여 자궁내로 이식하였으며, 그 결과들을 hCG 투여 직전에 실시한 혈청 황체호르몬 치 0.9 ng/ml를 기준으로 2 군으로 나누어 비교평가하였다. 결과: 수정율, 분할율, 그리고 배반포 발달율은 양 군에서 유사하였지만 임상 임신율, 진행 임신율, 그리고 착상율은 고 황체호르몬 군에서 낮았다. 또한 초기분할 배아 (난자채취 제 2-3일)가 grade 1-2인 경우의 배반포 발달율이 grade 5인 경우에 비하여 유의하게 높았다. 결론: 체외수정시술을 위한 과배란유도 주기에서 조기 황체호르몬 상승이 난자 및 초기배 발달에 영향을 미치지 않고 임신율 및 착상율의 저하를 초래하는 것으로 미루어, 고 황체호르몬 치는 자궁내막의 수용성을 감소시키는 것으로 생각된다. 이와 같은 결과는 조기 황체호르몬 상승 환자에서 자궁내막의 과숙에 의한 착상율의 감소를 피하기 위하여 조기이식(day 2 or 3) 이 바람직할 것으로 기대된다. Objectives: To determine the effect of increased plasma Progesterone(P) level on the day of hCG administration on oocyte /embryo development and implantation after blastocyst transfer in controlled ovarian hyperstimulation (COH) cycle with premature progesterone elevation for IVF-ET. Methods: Seventy controlled ovarian hyperstimulation cycles for IVF-ET were underwent with GnRH agonist and hMG/FSH in 70 women. Embryos were cocultured up to the blastocyst stage and transferred into the uterine cavity. The cycles were devided into two groups depending on the levels of plasma P on the day of hCG administration, and the clinical results in both groups were analysed and compared each other. High P group was defined when the level of plasma P was higher than 0.9 ng/mL. Results: Fertilization rates, cleavage rates and blastulation rates were similar in the low and high P groups. Blastulation rates were increased in high quality (morphological characteristics) D 2-3 preembryo regardless of the P levels during the late follicular phase(p <0.001). However, clinical pregnancy rate, ongoing pregnancy rate and implantation rate were higher in low P group compared with high P group(p <0.01). Conclusions: Premature P elevation did not deteriorate the developmental potential of oocyte, but had a harmful effect on pregnancy rate and implantation rate. So we suggest that early ET on the day 2-3 (after ovum pick-up) without delaying another several days to avoid the advanced maturation of secretory endometrium might be better than blastocyst transfer in patients with premature P elevation.

체외수정시술을 위한 성선자극호르몬 과배란유도에 Poor Response를 나타낸 환자에서 GnRH Analogue의 사용

김선행,이희경,구병삼,Kim, Sun-Haeng,Lee, Hee-Kyung,Ku, Pyong-Sahm 대한생식의학회 1993 Clinical and Experimental Reproductive Medicine Vol.20 No.1

In 27 patients with the past history of poor response to the gonadotropin superovulation induction due to poor follicular growth or permature surge of endogenous luteinizing hormone, the effectiveness of pituitary supperssion with the gonadotropin releasing hormone agonist(GnRH-a) in in vitro fertilization(IVF) program was evaluated in 43 cycles using a combination regimen of D-Trp-6 LHRH(Decapeptyl, Ferring)and FSH/hMG from June, 1989 to August, 1990 at Korea University Hospital IVF Clinic. At midluteal phase of menstrual cycle, Decapeptyl-CR was administered by long-term protocol to minimize initial agonistic effect of endogenous gonadotropins. After the confirmation of pituitary suppression, about 2-3 weeks after GNRH-a administration, ovarian follicle growth was stimulated with FSH/hMG and followed by transvaginal ultrasonic measurement of follicle size and by monitoring of serm E2 and LH if necessary. When compared with the control group stimulated with gonadotropin regimen only, the cancellation rate and occurrence rate of premature LH surge during gonadotropin treatment were significantly lower in study group(11.6% and 2.4%, respectively). There is no significant differences in the mean number of aspirated oocytes, fertilization/cleavage rate, embryo transfer(ET) rate, and mean number of embryos transferred between the two groups. The pregnancy rate per treatment cycle, 16.3%, and per ET cycle, 23.3%, were significantly higher in the study group compared with those of control group. These data suggest that GnRH-a therapy is effective for previous poor responder In gonadotropin superovulation induction for IVF.

GnRh Analogue를 이용한 과배란유도

김선행,Kim, Sun-Haeng 대한생식의학회 1991 Clinical and Experimental Reproductive Medicine Vol.18 No.1

남성불임증과 체외수정시술

김선행,정래환,구병삼,Kim, Sun-Haeng,Jung, Rae-Hwan,Ku, Pyong-Sahm 대한생식의학회 1992 Clinical and Experimental Reproductive Medicine Vol.19 No.1

In vitro fertilization and embryo transfer (IVF & ET) is widely used for the males with subnormal or abnormal semen quality, as this was recommended in view of the relatively small numbers of spermatozoa required for fertilization and subsequent pregnancies could be obtained. The aim of this study is to know how the various functional parameters of spermatozoa in semen analysis affect the outcome IVF. This study was carried out between 1988-1989, with male factor patients selected on the basis of the semen quality. The selection criteria was based upon the mean values of concentration,% motility and % normal morphology from at least two semen analysis. There is a significant decrease in the fertilization and embryo transfer rates in the study group compared with control group (35.9% vs. 68% and 48.6% vs. 85.5% respectively), however, there was no significant difference in the pregnancy or delivery rates (19.6% vs. 21.4% and 60.0% vs. 62.5% respectively) per embryo transfer cycles. Fertilization rate is variously affected by the type and degree of sperm defect. No pregnancy was occurred in triple defect group and asthenoteratospermia group. There is no significant increase in the abortion rate in the male factor group. Improvement have to be made with the fertilization rate, as the pregnancy rate per OPU cycle in male factor group is still lower than that of normal group (9.5% vs. 18.3%). In conclusion, IVF can be used as a treatment for male factor infertility and the preparation of the semen sample can be modified to improve sperm recovery and obtain fertilization from abnormal semen samples.

남성에서 Mycoplasma 감염이 정액검사소견에 미치는 영향에 관한 연구

김선행,김영호,김탁,허준용,박용균,구병삼,Kim, Sun-Haeng,Kim, Young-Ho,Kim, Tak,Hur, Jun-Yong,Park, Yong-Kyun,Ku, Pyung-Sham 대한생식의학회 1996 Clinical and Experimental Reproductive Medicine Vol.23 No.3

Mycoplasmas have long been suspected of contributing to involuntary infertility in couples. However considerable disagreement exits concerning the role of genital mycoplasma infection in human infertility. Several investigators have noted abnormalities in the semen analysis of men with positive mycoplasma cultures, and early epidemiologic studies indicated that Ureaplasma urealyticum was linked to human reproductive failure on the basis of higher frequencies of isolation from infertile versus fertile couples and successful pregnancies in infertile couples after doxycycline therapy. However, subsequent investigators have questioned these findings because there are many studies in which treatment for mycoplasma in the male or female did not demonstrate an improved pregnancy rate, and semen samples from unexplained infertile men containing ureaplasmas have not revealed poorer motility, fewer spermatozoa and more aberrant forms. The objective of this study were to investigate the incidence rate of mycoplasma in semen and to investigate whether the presence of mycoplasma in semen makes significant difference to the semen volume, sperm motility and sperm counts. The results were that the rate of isolation of mycoplasma species was 70.3%. Semen volume is $2.84{\pm}1.01ml$ for culture negative and $3.15{\pm}1.42ml$ for culture positive group. Sperm motility is $46.23{\pm}15.80%$ for culture negative and $50.09{\pm}15.69%$ for culture positive group, and sperm count is $95.47{\pm}47.14({\times}(P)10^6/ml)$ for culture negative and $86.73{\pm}47.59({\times}10^6/ml)$ for culture positive group. In conclusion, we suggest that the presence of mycoplasma in semen makes no significant differences to the sperm parameters.

체외수정시술을 위한 성선자극호르몬 과배란유도에 Limited Ovarian Reserve를 갖는 환자에서 성장호르몬의 사용

김선행,장기훈,구병삼,Kim, Sun-Haeng,Chang, Ki-Hoon,Ku, Pyoung-Sahm 대한생식의학회 1994 Clinical and Experimental Reproductive Medicine Vol.21 No.3

Despite increasing success rate of IVF, poor response to ovarian stimulation remains a problem. So, attempts to improve ovarian responses, for example, by using combined gonadotropin-releasing hormone analogue(GnRH-a) and human menopausal gonadotropin(hMG) have shown limited success. It is reported that response of granulosa cells in vitro to FSH is stimulated by co-incubation with IGF-l, and IGF-l production can be increased by growth hormone. This suggest that combination regimen of G.H. and hMG may augment follicle recruitment. In fifteen patients who had previous history of poor ovarian response to gonadotropin stimulation after pituitary suppression with mid -luteal GnRH-a, the effectiveness of cotreatment with G.H. in IVF program was evaluated using a combination regimen of G.R. and hMG at Korea University Hospital IVF Clinic. Ovarian responses to gonadotropin stimulation in control and GH-treated cycles assessed by total dose and duration of hMG treatment, follicular development and peak $E_2$ level, number of eggs retrieved, and fertilization rates were also assessed. In each group, serum and follicular fluid IGF-1 concentrations on day of egg collection were measured by RIA after acidification and extraction by reveresed phase chromatography. Patients receiving G.H. required fewer days and ampules of gonadotropins, developed more oocytes, and more embryos transferred. But, the differences were not statistically significant, except the duration of hMG treatment. Our data showed a significantly higher concentration of IGF-l in the serum, not in the follicular fluid, of patients treated with G.H. compared with control group. These data suggest that growth hormone treatment does not improve the ovarian response in women with limited ovarian reserve to gonadotropin stimulation for IVF.

Standardized Glass-wool Column을 이용한 운동성 정자의 선택적 분리 및 이의 체외수정에의 이용

김선행,구병삼,Kim, Sun-Haeng,Ku, Pyung-Sham 대한생식의학회 1988 Clinical and Experimental Reproductive Medicine Vol.15 No.2

To increase fertilization rate in vitro, separation of viable spermatozoa from the seminal plasma and its other components may be a useful procedure. Ejaculates from healthy men, whose semen analysis findings were normal in 19, and abnormal in 10, were filtered using the glass-wool filtration technique to yield a concentrated, viable sperm samples for IVF, and the usefulness and safety of this method were evaluated. The recovery rate of motile sperm in abnormal groups was 46.2% and 54.5% in normal group. The % motility was increased significantly compared with original sample after filtration, and the grade motility was improved, too. The sperm population with normal morphology was also increased significantly in both group. Using transmission electron microscopy, the ultrastructural integrity of acrosomal segment was examined in order to evaluate the potentially hazardous effect of glass-wool filtration to sperm head, however, sperm population with normal ultrastructure was increased compared with that of original ejaculate after separation. The filtered sperm was then processed for IVF, as the fertilizing capacity is the ultimate parameter of the sperm function. In abnormal group, the fertilization rate(41.5 %) and the ET rate per stimulated cycle were much lower than that of mormal group(69.6%). However, the cleavage rate and the number of embryos transfered per ET cycle were comparable with those of nomal group. The results suggest that the glass-wool filtration of sperm, particularly in oligo-asthenozoospsrmia, may be useful and safe method in the preparation of sperm for IVF.

체외수정시술 주기에서 자궁내막발달과 착상에 관한 연구

김선행,Kim, Sun-Haeng 대한생식의학회 1993 Clinical and Experimental Reproductive Medicine Vol.20 No.2

The condition of the endometrium is an important factor which may influence the success or failure in IVF-ET. This study was undertaken for evaluation of the value of endometrial growth as an early predictor for the success of IVF. Ultrasonographic endometrial measurement were performed in 43 IVF cycles that conceived, 101 cycles that did not with an IVF-ET There was no significant difference in the endometrial thickness and the serum concentration of estradiol in the pregnant versus nonpregnant group(10.4 vs. 9.9 mm: 2348 vs. 2017 pg/ml no hCG administration day). No correlation was found between the ultrasound image and serum estradiol levels around the time of hCG administration(r=0.54, p=0.13 no Day 2; r=0.45, p=0.14 no Day 1). The duration of gonadotropin treatment, number of follicles, number of oocytes retrieved, and fertilization rate were not statistically different in the two groups, however, there was a significant difference in the number of embryos in the pregnant versus nonpregnant group)p< 0.05). A higher pregnancy rate and ongoing pregnancy rate occured with an endometrial thickness over 11 mm compared with below 7mm(p< 0.05, p< 0.005). however, no significant differences were noted in the implantation rate and abortion rate among the groups that classified according to their endmetrial thickness. The endometrial growth(${\Delta}$) from hCG administration day(DO) to D6 was greater in the women who achieved pregnancy than in the nonpregnant group(p< 0.01). There were no significant differences in serum estradiol levels, implantation rate, pregnancy rate, and abortion rate among the groups that classified according to the pattern of echogenesity of endometrium, however, significantly higher ongoing pregnancy rate was noted in group A, B compared with group C.(p< 0.0001, p< 0.001) These results suggest that there were no ultrasonographically detectable differences in the patterns of endometrial growth and development around the time of hCG administration in patients who conceive versus those that do not in IVF-ET.

Reg. Guide 1.52(Rev.3)를 적용한 원전 ESF 공기정화계통 성능시험법 개선 연구

이숙경,김광신,손순환,송규민,이계우,박정서,조병호,유병재,홍순준,강선행,Lee, Sook-Kyung,Kim, Kwang-Sin,Sohn, Soon-Hwan,Song, Kyu-Min,Lee, Kae-Woo,Park, Jeong-Seo,Cho, Byoung-Ho,Yoo, Byeang-Jea,Hong, Soon-Joon,Kang, Sun-Haeng 한국방사성폐기물학회 2010 방사성폐기물학회지 Vol.8 No.4

U. S. NRC Regulation Guide 1.52 regulating ESF ACS in nuclear power plants has been revised to revision 3. To apply reduction of operability test time, allowance of alternative challenge agents for in-place leak test of HEPA filters, and upgrade of Methyl Iodide penetration acceptance criterion in activated carbon performance test suggested in Reg. Guide 1.52(Rev.3) on Yonggwang units 5 and 6 ESF ACSes, technical feasibility study was carried out with on-site experiments as well as experiments with a lab-scale model. It was confirmed that the moisture in the system returned to the level before the test in 1 or 4 days even though the moisture was removed during the operability test lasting more than 10 hours. Therefore, it is appropriate to perform monthly operability test in 15 minutes just long enough to check the operability of equipment. To change challenge material for in-place HEPA filter leak test, size of aerosol, production rate, and leak detection capability were compared for DOP and PAO. It was concluded that PAO can be substituted for DOP in nuclear power plants. The upgrade of Methyl Iodide penetration acceptance criterion from 0.175 % to 0.5 % in active carbon filter bed deeper than 4 inches was to conform to the change of activated carbon performance test method to ASTM D3803(1989). It was confirmed that Methyl Iodide penetration acceptance criterion of 0.5 % under $30^{\circ}C$, relative humidity 95 % condition was conservatively good enough for testing performance of active carbon insitu. The licence change of Yonggwang units 5 and 6 has been completed based on this study.