폐경후 여성에서 호르몬 치료에 따른 골 생화학 표지자들의 양상에 관한 연구

추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),강병문(Byung Moon Kang),장영우(Young Woo Chang),강은희(Eun Hee Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objectives: To investigate the patterns of biochemical bone markers, such as urinary deoxypyridinoline (DPD), N-telopeptide of type I collagen (NTX), and serum osteocalcin (OC), bone-specific alkaline pbosphatase (BSAP) in postmenopansal women with hormone replacement therapy (HRT). Materials and Method: From July 1997 to January 1998, total 239 postmenopausal women were emolled in the present study, and 198 healthy premenopausal women with regular menstruation were served as control. The postmenopausal women were pouped into the HRT group and the non-HRT group. The women in the HRT poup have received estrogen with continuous or cyclic progestin therapy far more tban 6 months. The biochemical bone markers of all women were assayed. Results were analysed with Students t-test. Results: The urinary DPD of the non-HRT group was sigaificantly higher than both the HRT poup and the premenopausal group(5.51 +- 2.47 vs. 3.36 +- 1.02 and 4.01 +- 3.86 nM/mM, p < 0.05, repectively). The urinary NTX of the non-HRT group was also higher in comparison to the HRT group and the premenopausal group(48.71 +- 11.54 vs. 33.70 +- 17.43 and 33.70 +- 17.43 nM BCE/mmol, p < 0.05, repectively). However, there were no significant differences in the concentrations of serum BSAP and OC among the three poups. Conclusion: The urinary DPD and NTX were more sensitive indicators of bone metabolism tban serum BSAP and OC in postmenopausal women undergoing HRT.

Immunohistochemical study for expression of p53, bc1-2 and bax in uterine sarcoma

추형식 ( Hyung Sik Chu ),( Jong Hyeok Kim ),( So Duk Lim ),( Joo Ryung Huh ),( Jun Hee Na ),( Chang Won Koh ),( Yong Man Kim ),( Young Tak Kim ),( Joo Hyun Nam ),( Jung Eun Mok ) 대한산부인과학회 1997 대한산부인과학회 학술대회 Vol.80 No.-

다낭성난소증후군 환자들에게서 배란유도시 성장억제호르몬 유사체가 난소반응에 미치는 영향

추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),강병문(Byung Moon Kang),장윤석(Yoon Seok Chang),강은희(Eun Hee Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

N/A Objective: To determine whether the somatostatin analogue, octreotide, given concunently with human menopausal gonadotropin (HMG) affects ovarian response, ovulation induction outcome, and serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) in infertile patients with polycystic ovarian syndrome (PCOS) resistant to clomiphene citrate (CC). Methods: From August 1996 to June 1998, 42 infertile patients with PCOS urresponsive to CC were enrolled in the present study. Women who had other infertility factors were excluded from this study. Patients were randomly allocated either to combined HMG and octreotide treatment (treatment group) (n 21) or HMG alone (control group) (n=21). In the treatment group, 100 micrograms of octreotide were administered daily concomitantly with HMG from the 3rd day of menstrual cycle to the preceding day of human chorionic gonadotropin (HCG) injection. Results: Patient's characteristics were comparable in both groups. One cycle in the control group was abandoned because of excessive follicular development. However, none of the cycles in the treatment group was abandoned. There were no differences in the number of HMG ampules required and the duration of HMG administration between the two groups. The number of follicles > 14mm diameter on the day of HCG injection was significantly less in the treatment group than that in the control group (p<0.01). The serum estradiol level on the day of HCG injection was also significantly lower in the treatment group, with 1391.0 +- 695.5 pg/ml compared with 2217.5 +- 811.6pg/ml in the control group (p<0.001). The incidence of severe ovarian hyperstimulation syndrome seemed to be lower in the treatment group, but the difference did not achieve significance (4.9% vs 23.8%). There were no differences in the clinical pregnancy rate, miscarriage rate and multiple pregnancy rate between the two groups. Although serum GH levels were comparable between the two groups, serum IGF-1 level on the day of HCG injection was significantly higher in the treatment gmup than that in the control group (p<0.001). Conclusion: This study suggests that the combined octreotide and HMG treatment could improve hormonal milieu and folliculogenesis compared to HMG alone, and therefore may be effective in ovulation induction for patients with PCOS resistant to CC.

폐경 전후 여성에서 생화학적 골대사지표들의 폐경기간에 따른 변화 양상에 관한 연구

추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),강병문(Byung Moon Kang),조준식(Jun Sik Jo),강은희(Eun Hee Kang) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.12

N/A Changes of bone turnover with aging are responsible for bone loss and play a major role in osteoporosis. Among the early postmenopausal women, as are known by previous study, there are about 35% fast bone losers and bone turnover is more uncoupled in osteoporotic group than in normal control. So, early detection of such fast losers and women who have high turnover rate is important to prevent postmenopausal osteoporosis and spontaneous fracture. Dual-energy X-Ray absorptiometry (DEXA), however, cannot reflect current bone loss because changes in bone mineral density (BMD) are only seen after 1 or more years of bone densities declining. In this study, we have measured a battery of new sensitive and specific markers of bone turnover which reflect current bone loss. To investigate the changing pattern of those markers, 674 healthy women including 451 postmenopausal women were classified, according to their menopausal period (less than 5 years, 5-10 years, more than 10 years). Bone formation was assessed by serum osteocalcin (OC), bone-specific alkaline phosphatase (BSAP) and bone resorption by the urinary excretion of deoxypyridinoline (DPD), cross-linked N-telopeptide of type I collagen (NTX). All Biochemical markers, except OC, significantly increased after menopause (p < 0.05). NTX and BSAP remained elevated after 10 years of menopause. These data indicated that the overall rates of both bone formation and bone tesorption increased after menopause and remained high in elderly women.

체외수정시술후 발생한 횡경막탈장증 1 례

추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),장윤석(Yoon Seok Chang),이종표(Jong Pyo Lee),강은희(Eun Hee Kang),강병문(Byung Moon Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.3

Congenital diaphragmatic hernia (CDH) is caused by a failure of fusion of the muscular diaphragm and results in herniation of abdominal viscera into the thorax, It occurs in appoximately 1 in 2,200 to 5,000 live births, and most cases are probably multifactorial, but they can be also associated with chromosomal abenation. Due to the improvement of sonography, it can be diagnosed more accurately. However, the mortality associated with CDH is extremely high. It is well known that the incidence of congenital anomaly in infants after in vitro fertilization and embryo transfer (IVF-ET) is not increased copared with that of general population, and CDH that occurred following IVF-ET has not been reported. A case of CDH that occurred following IVF-ET is presented with brief review of literatures.

체외수정시술시 예후 인자로서 정자 첨체반응 유발검사의 유용성

김정훈,채희동,강은희,추형식,전용필,강병문,장윤석,목정은,Kim, Chung-Hoon,Chae, Hee-Dong,Kang, Eun-Hee,Chu, Hyung-Sik,Cheon, Yong-Pil,Kang, Byung-Moon,Chang, Yoon-Seok,Mok, Jung-Eun 대한생식의학회 1998 Clinical and Experimental Reproductive Medicine Vol.25 No.3

It is well known that the clinical test for responsibility of accurate fertilization capacity in male partners is very important to diagnose and treat the infertility. However, it has been reported that the traditional semen analysis cannot accurately predict fertilization and pregnancy potential. The present study was performed to evaluate the acrosomal reaction to ionophore challenge (ARIC) test as a prognostic indicator for fertilization of sperm and oocyte in an in vitro fertilization and embryo transfer (IVF-ET) program. From March 1996 to Februry 1997, 30 couples undergoing IVF program were allocated to this study group. All female partners in the study group were 35 years old or less and their serum level of basal follicle stimulating hormone (FSH) and estradiol $(E_2)$ were normal. All the male partners have normal parameters of semen analysis. The ARIC tests were performed on the day of ovum pick up and in vitro insemination in all the male partners. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone (GnRH) agonist was used in all couples for IVF-ET. The acrosomal reaction with $10{\mu}l$ of 10% DMSO was induced spontaneously in $10.1{\pm}9.8%$, and acrosomal reaction with calcium ionophore A 23187 was induced in $27.4{\pm}18.1%$, and the ARIC value was $17.4{\pm}16.2%$. There were no significant correlation between the ARIC value and the fertilization rate ($r^2$=0.044, p=0.268). There were also no significant correlation between the ARIC value and the percentage of the grade I, II embryos ($r^2$=0.046, p=0.261). On the basis of above results, it was suggested that ARIC test might not be a useful prognostic indicator for fertilization in IVF-ET in male partners with normal parameters of conventional semen analysis. We guessed that IVF-ET could be performed to the patients primarily without universal appilcation of ARIC test to all male partenrs, and if fertilization failure occurs, the micro assisted fertilization (MAF) such as intracytoplsmic sperm injection (ICSI) might be used as an alternative mode of treatment with acceptable success rate.

체외수정시술시 미수정 난자에 대한 난자 회수 1일째 난자 세포질내 정자 주입술의 임상적 유용성

김정훈(Chung Hoon Kim),추형식(Hyung Sik Chu),강은희(Eun Hee Kang),채희동(Hee Dong Chae),강병문(Byung Moon Kang),장윤석(Yoon Seok Chang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.11

목적: 체외수정시술시 고식적 수정 방법(conventional insemination)으로 수정에 실패한 미수정 난자들을 대상으로 난자 회수 1일째 난자 세포질내 정자 주입술(intracytoplasmic sperm injection, ICSI)을 통한 재수정 시도의 임상적 유용성에 대하여 알아보고자 하였다. 연구 방법: 1996년 3월부터 1998년 4월까지 울산대학교 의과대학 서울중앙병원 산부인과 불임크리닉에서 체외수정시술을 시행받은 환자들중, 시술전 ICSI의 적응증이 되는 명백한 남성 불임으로 진단되지 아니하였음에도 불구하고 고식적 수정 방법에 의하여 전혀 수정이 이루어지지 않아 수정에 실패한 15명(15주기)의 불임 부부를 대상으로 하였다. 고식적 수정 방법에 의하여 수정을 시도하였으나 14-16 시간 후 선명한 2개의 전핵(pronucleus)이 관찰되지 않은 미수정 난자에 ICSI를 이용하여 수정을 시도하고 익일 수정 유무를 관찰하였으며, 양호한 발달을 보이는 수정란을 자궁내로 이식하여 체외수정시술의 결과 및 임신의 성공 유무를 조사 분석하였다. 결과: 대상 환자들에게서 채취된 난자의 수는 총 120개로 평균 8.0 ± 4.7개이었고 이중 ICSI를 시행할 수 있었던 102개의 미수정 난자들을 대상으로 ICSI를 시행하였다. 이 결과 총 74개가 수정되어 시술 주기당 4.9 ± 3.7개가 수정되어 수정률은 71.1 ± 24.0%로 나타났으며, 정상적인 발달을 보여 자궁내 이식을 시도할 수 있었던 수정란의 수는 평균 3.6 ± 1.7개 이었다. 대상 환자 총 15명중 2예(13.3%)에서 생화학적 임신을 보였고, 1예(6.7%)는 임상적 임신으로 판명되어 현재 추적 관찰 중에 있다. 결론: 체외수정시술을 시행함에 있어 고식적 수정 방법에 의하여 수정이 성립되지 않은 미수정 난자를 난자 채취 다음날에 ICSI를 사용함으로써 재수정을 시도하고 수정된 난자를 배아 이식하는 것은 전혀 임신이 불가능했던 환자에게 임신의 가능성을 제시할 수 있는 유용한 방법이라 사료된다. Objective: To analyze the efficacy of intracytoplasmic sperm injection (ICSI) for totally unfertilized oocytes by the conventional insemination during in vitro fertilization and embryo transfer (IVF-ET) Methods: From March 1996 to April 1998, 15 couples who experienced total fertilization failure after conventional IVF without severe male factor infertility in semen analysis were evaluated. Fertilization were assessed by the presence of 2 pronucleus (PN) after 14-16 hours of conventional insemination. All unfertilized oocytes were reinseminated by ICSI and checked for signs of fertilization between 6-10 hours after ICSI. The embryos with fertilization and development were transferred to the uterine cavity and the outcome was analyzed. Results: Total numbers of unfertilized oocytes were 120, and total numbers of oocytes injected on day 1 using ICSI were 102. Total numbers of oocytes with normal fertilization after ICSI were 74 and mean fertilization rate of 71.1 ± 24.0% was obtained. The numbers of embryos transferred was 3.6 ± 1.7. The biochemical pregnancy rate was 13.3% (2/15) and the clinical pregnancy rate was 6.7% (1/15) per cycle. Conclusion: ICSI to totally unfertilized oocytes by conventional insemination technique during IVF-ET on the next day of oocyte retrieval seems to be a relatively successful mean and afford a chance of pregnancy to the infertile couples whom the ET could not perfomed to because of total fertilization failure.

흰쥐 자궁 상피와 내막에서 기원한 세포주의 체외배양

강병문,이석원,채희동,강은희,추형식,김정훈,장윤석,남주현,Kang, Byung-Moon,Lee, Suk-Won,Chae, Hee-Dong,Kang, Eun-Hee,Chu, Hyung-Sik,Kim, Chung-Hoon,Chang, Yoon-Seok,Nam, Joo-Hyun 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.1

Since the blastocyst is broken and spreads out on a flat plastic culture dish (two dimensional culture) during in vitro development, it has been difficult to study the implantation process. It also has been difficult to analyse the interactions between endometrial epithelial and stromal cells because of the lack of a long-term in vitro model which can stimulate in vivo characteristics, as these cells eventually fail to proliferate or cease to express differentiated functions. Recently nontransformed cell lines, CUE-P and CUS-V2, derived from rat endometrial epithelium and stroma were reported. In this study, morphology of CUE-P and CUS-V2 was examined and oxytocin gene expression by CUE-P cells was demonstrated by RT-PCR. The CUE-P cells have a cuboidal morphology and CUS-V2 cells resemble fibroblast and exhibit a spindle-like morphology. In RT-PCR, same size of PCR products of oxytocin gene at hypothalamus, uterus and CUE-P cells were demonstrated. These results showed three dimensional culture system could be made by using the new cell lines.

난자 세포질내 정자 주입술 시행시 기저 난포자극호르몬의 예후 인자로서의 유용성

강은희(Eun Hee Kang),추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),강병문(Byung Moon Kang),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),안태영(Tai Young Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2

N/A Objective: To determine if basal serom follicle stimulating harmone (FSH) level could be a prognostic factor of the clinical outcome in in vitro fertilization and embryo transfer (IVF-ET) with intracytoplasmic sperm injection (ICSI) in the couples with male factor infertility. Materials and Method: From December 1995 to March 1998, total 118 patients with male factor infertility were included in this study. Patients were allocated to the low basal FSH group (>8.5 mIU/ml) and the high basal FSH group (>8.5 mlU/ml). The basal levels of FSH were measured in the 3rd day of menstrual cycle preceding ovarian stimulation cycle in total IVF cycles by immunoradiometric assay (IRMA). Statistical analysis was performed using Student's t-test, Fishers exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. Results: The total dose of exogeneous gonadotropin required in the patients of the high basal FSH group was significantly higher than that of the patients with the low basal FSH poup (p < 0.05). The numbers of retrieved oocytes, oocytes with grade I, II, fertilized oocytes, cleaved oocytes, embryos with grade I, II, and transferred embryos were significantly higher in the low basal FSH group (p < 0.05), The clinical pregnancy rate per cycle in the low basal FSH gmup (15.7%) seemed to be higher than that in the high basal FSH poup (3.4%) (p 0.08), however, there was no statistically significant difference between the two groups. Conclusion : These results suggested that the basal FSH levels could be predictive of pregnancy outcome and the results of ovarian stimulation in IVF-ET using ICSL.

무운동성 정자를 가진 환자에서 수음으로 채취된 정자와 고환 조직 정자를 이용한 난자 세포질내 정자 직접주입술의 비교 연구

강은희(Eun Hee Kang),추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),강병문(Byung Moon Kang),안태영(Tai Young Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1

N/A With the advent of intracytoplasmic sperm injection (ICSI), the fertiliution and pregnancy have been reported even in complete asthenozoospermia. However, the results of ICSI in men with totally immotile sperm was still disappointing. The reasons for the total lack of sperm movement are not yet determined. The immotility of ejaculated spermatozoa is probably caused by sperm degeneration during epididymal transport, therefore higher viable spermatozoa can be obtained by testicular sperm recovery in some cases with low viability and total lack of movement of ejaculated spermatozoa. Recourse to testicular spermatozoa for ICSI is thus an alternative treatment possibility in this kind of pathology. This clinical study was performed to investigate the efficacy of ICSI employing testicular and ejaculated spermatozoa. From December 1995 to March 1998, 35 couples with totally immotile spermatozoa were included in the study. In 14 patients, the ejaculated spermatozoa were used whereas in 21 patients the spermatozoa were recovered from the testis. There were no significant differences in the fertilization and cleavage rates between the testicular sperm group with 62.6%, 52.7% and the ejaculated sperm group with 56.1%, 74.3%. Two pregnancies were achieved, one in the testicular spnm poup and the other in the ejaculated group. A healthy child was delivered at term in the ejaculated sperm group, but a clinical abortion occurred in a pregnancy in the testicular sperm group. In conclusion, it was suggested that ICSI using ejaculated sperm might be a primary treatment in cases with totally immotile spermatozoa and, if failed, testicular sperm could be used as an alternative mode of heatment.