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This study was undertaken to verify a specific effect of intravenous immunoglobulin treatment on the outcome of pregnancy in the patients with a history of unexplained recurrent spontaneous abortion. Five patients with a history of unexplained recurrent spontaneous abortion were treated with intravenous immunoglobulin during their following pregnancy, as soon as pregnancy was confirmed. When pregnancy was confirmed, women were started with 10 gm of immunoglobulin intravenously which was repeated every 2 weeks and four to six times. One of them experienced termination of pregnancy due to blighted ovum syndrome at 9th weeks of gestation and four patients delivered live births at term. Two of them had experienced cesarean section because of breech presentation and placenta previa respectively, rest of them delivered vaginally without problem. There were no adverse reaction in the study patients. These results imply that intravenous immunoglobulin could be effective on the patients with a history of unexplained recurrent spontaneous abortion, and could be applied to them as an alternative method of allogenic leukocyte transfusion.
The present study was designed to investigate if antithyroid antibodies(ATA) could affect the pregnancy outcome in euthyroid women undergoing superovulation with intrauterine insemination(IUI). From January 1995 to September 1996, 18 euthyrouid women with ATA who undersent superovulation with IUI were suudied. Thirty-two euthyroid women without ATA who underwent superovulation with IVI were served as control. Thyroid peroxidase antibody (TPOA) and thyroglobulin antibody(TGA) were assayed using radio ligand assay kits as ATA. All patient included in the study and the control groups had only ovulatory factor in infertility or had suffered from unexplained infertility. The infertile patients with ovulatory factor were resistant to clomiphene citrate(CC) or had previously failed to conceive despite 3 ovulatory cycles using CC. Long protocol of gonadotropin-releasing hormone agonist(GnRH-a) was used for superovulation in all patients. There were no significant differences between the study and the control groups in patient characteristics such as age, infertility duration and hormonal profil. There were also no significant differences between two groups with respect to the clinicalresponse to superovulation. The clinical pregnancy rate per cycle was significantly lower in the study group at 23.5%(8/34) compared with 44.4%(24/54) in the control group.l The biochemical pregnancy rate per cycle was significantly higher in the study group at 17.6%(6/34) compared with 3.7%(2/54) in the control group. The miscarriage rate seemed to be higher in the study group than in the control group(37.5% vs 8.3%), but the difference was not statistically significant. In the study group, both TPOA and TGA titers were higher in the miscarriage group than in the ongoing or delivery group, although statistical significance was not found. This study suggests that ATA in euthyroid women could be associated with the poor pregnancy outcome in superovulation with IUI cycles and ATA may serve as possible marker for reproductive failure.
The purpose of this study was to evaluate the relationship between umbilical coiling index and Doppler velocimetry in umbilical artery. The umbilical coiling index was calculated by dividing the total number of helices by the entire cord length(in centimeter) postnatally between December 1995 and March 1996. Doppler flow velocities were obtained from the umbilical artery bifore delivery(within 3 days). The mean umbilical coiling index was 0.17 +or- 0.09 )n=186). The subjects with umbilical coiling indices below the tenth percentile(0.08), above the 90th percentile(0.3), and between the tenth and 90th percentile were defined as hypocoiled, hypercoiled, and normocoiled. The subjects with hypocoiled and hypercoiled cords did not differ from those with normocoiled cords in perinatal outcomes. The correlations between umbilical coiling index and umnilical artery systolic-diastolic ratio were not significang(r=0.015, p$lt;0.05). The subjects with umbilical artery systolic-diastolic ratio above 90th percentile(3.0) differed from those with below 90th percentile in several ways : fetal heart rate disturbances, birth weight, intrauterine growth retardation and admission to intensive care unit were higher in high S-D ratio group. This study suggest that the umbilical coiling level dose not interfere umbilical aretery flow.
The purpose of this study was to investigate the effects of baseline ovarian systs after luteal phase gonadotropin-releasing hormone agonist(GnRH-a) administration on the clinical response to controlled ovarian hyperstimulation(COH) for intrauterine insemination(IUI). From May 1994 to December 1995, 71 COH cycles using luteal long protocol of GnRH0a for IUI were assessed for the formation of baseline ovarian cysts defined as a mean diameter$gt;=15 mm. Outcome data were compared between cycles with and without baseline ovarian cysts. Of 71 COH cycles, baseline cyst$gt;=15 mm were noted in 23 cycles(32.4%). Of 23 cyst cycles, baseline cysts$gt;=20 mm were noted in 15 cycles and aspirated under transvaginal ultrasonogram guidance. There was no significant difference in baseline serum FSH values between cyst cycles and non-cyst cycles. There were also no significant differences in ovarian response as indicated by the number of ampules of gonadotropin used and duration of honadotropin administration in ovarian stimulation, and serum E2 level and number of follicles($gt;=14 mm) on the day of hCG administration between cyst cycles and non-cyst cycles. There was also no significant difference in endometrial thickness measured on the day of hCG administration between cyst cycles and non-cyst cycles. Clinical pregnancy rate was somewhat lower in cyst cycles compared with non-cyst cycles(13.0% versus 31.3%), but was not significantly different. This study suggests that baseline ovarian cysts after luteal phase GnRH-a administration has a potentially harmful effect on the clinical outcome in COH with IUI program.
Retinoic acid(RA), formed in vivo by oxidation of retinol, is known as morphogenic signal. RA plays an active role in normal embryonic development at physiological concentration, but excess RA can be a powerful teratogen in human and animals. The present study was designed to examine the direct effect of RA on murine embryogenesis(gastrulation) and to define the specific development processes perturbed by RA. Five to fifteen blastocysts were randomly assigned to separate culture dishes of the experimental group. Various concentrations of RA(10^-9 M, 10^-7 M, and 10^-5 M) were used in culturing blastocysts. In the effect of RA on the normal grouwth of embryo, the rates of development to the stages of attachment, early egg cylinder(EEC), late egg cylinder(LEC), and early somite(ES)were significantly(p$lt;0.01) decreased as the RA concentration increased. Stil in the yolk sac formation rate, there was a significant, dose-dependent difference(p$lt;0.01) according to the RA concentration. In the degeneration of embryos by RA, the effect was more apparent as the concentration of Ra increased. The production rates of embryos devoid of egg cylinder region and embryos with abnormal egg cylinder region were increased (p$lt;0.01)in a dose-dependent manner according to RA concentration. In conclusion, RA probably act as teratogen at gastrula stage embryos in high concentration and effect of teratogenesis is dose-dependent.
This prospective study was performed to evaluate the effectiveness of controlled ovarian hyperstimulation(COH) with intrauterine insemination(IUI) versus in vitro fertilization and embryo transfer(IVF-ET) in the treatment of male infertility caused by sperm surface antibodies. From March 1995 to August 1996, 29 couples with male immunologic infertility entered the trial. Only men with ≥40% motile spermatozoa with bound antibodies of immunoglobulin (Ig)G, IgA or a combination of both in direct immunobead test(IBT) were included in this study. There was no evidence of other factors in infertility in any infertile couples. The couples were randomized to undergo either COH with IUI(IUI group), or IVF-ET(IVF group). IUI group and IVF group were similar with respect to female and male age, duration of infertility, and IBT results. There were no significant differences between two groups with regard to the amount of gonadotropins required, days of gonadotropins administration, serum estradiol concen- tration on the day of human chorionic gonadotropin(hCG) administration, the number of mature (≥14mm) follicles, or endometrial thickness. A total of 10 clinical pregnancies were obtained in IUI group, and 12 in IVF group. In 2 of 30 IVF cycles, intracytoplasmic sperm injection(ICSI) was performed because of fertilization failure. One patient became pregnant after ICSI. There were no significant differences between two groups in the clinical pregnancy rate per cycle (31.3% vs 40.0%), miscarriage rate(20.0% vs 8.3%), and multiple pregnancy rate(20.0% vs 16.7%). There were also no significant differences in pregnancy outcome between two groups according to the Ig isotype of sperm surface antisperm antibody(ASA)(GA group, IgG ASA ≥ 40%, IgA ASA≥40%; G group, IgG ASA ≥40%, IgA<40%; A group, IgG ASA <40%, IgA ASA ≥40%). This study suggests that it could be reasonable to offer COH with IUI to the patients with infertility caused by sperm surface ASA, prior to their referral for more expensive and invasive procedure, IVF-ET.
Oligomenorrhea is defined as the menses occurring at intervals of 37 days to 180 days, and it is one of a common menstrual disorders. In this study, the clinical characteristics and hormonal profiles were analyzed in 82 infertile patients with oligomenorrhea. One hundred fourty-six infertile patients with normal menstrual cycles served as a control. There were no differences in an age and a rate of primary infertility between oligomenorrheic and control group. A basal luteinizing hormone(LH) level was signigicantly higher in an oligom- enorrheic gorup, with 11.3±11.3mIU/ml compared with 5.8±6.1mIU/ml in a control group. A basal follicle stimulating hormone(FSH) level was also significantly higher in an oligom- enorrheic group, with 15.0±29.8mIU/ml compared with 10.1±10.7mIU/ml in a control group. The incidence of hyperprolactinemia(HPRL) and polycystic ovarian syndrome(PCOS) were significantly higher in an oligomenorrheic group than in a control group. However, there were no differences in the incidences of hypothyroidism, hyperthyroidism, and ovarian failure between two groups. There were no differences in the incidences of myoma uteri, congenital uterine anomalies, intrauterine adhesion, luteal phase defect and endometritis between two groups. This study suggests that infertile patients with oligomenorrhea comprise a special group in which ovulatory defects associated with endocrine abnormalities such as HPRL and PCOS can be observed frequently.
In Korea, Cancer of the Uterine Cervix is the most common gynecologic malignacy and leading cause of death in women. Cytologic screening for cancer of the cervix, specifically precancerous lesions, is generally accepted as being effective in reducing both incidence and mortality for cervical cancer. Due to the absence of a nation-wide mass screening program and national cancer registry program, the prevalance rate of cervical cancer and cervical intraepit- helial neoplasia in the normal population has not been exactly evaluated in our country. The purpose of this tudy is to investigate the efficacy of the cervical cytology as a screening tools for the cervical cancer and to roughly estimate the prevalence of cervical cancer and precancerous lesion in the genenral population by evaluating the cytologic result in the goup of women visited our health care center. Review of the cytologic smears from January 1, 1991 to December 31, 1993 revealed 14.505 cases with 484 abnormal cytology. The results were as follows; 1. Of the women screened 2.9% were the age of 20 years, 29.2% $lt;40 years, 33% $lt; 50 years, 25.1% $lt; 60, 9.0% $lt; 70, 0.8% $gt;_ 70 respectively. 2. abnormal cytology rate was 3.34% including 2.50% of class II, 0.56% of Class III, 0.24% of class IV and 0.24% of class V. 3. Abnormal cytology rate increased with age. The proportion of women with abnormal cytology was highest in those age of 60 years(5.1%). Class III was highest between ages 30 and 49 and class IV, V in those age of 60 years(1.0%). 4. At the histopathologic evaluation of the Biopsy specimens from the women with class III(49/81),34(65.3%) had findings cocsistent with CIN(Cervical intraplthelial neoplasia) I or worse. Among the Histopathologically evaluated women with class IV, V(29/41),28(97%) had lesions worse than mile dysplasia : 5 of these were found to have invasive cancer. 5. The prevalence rate of carcinoma in situ and invasive cancer for the past 3 years were 0.23%(33/14,505) and 0.03%(5/14,505).
Meconium peritonitis is a sterile and chemical peritonitis resulting from prenatal bowel perforation mainly associated with bowel obstruction. It occurs in 1 of 35,000 live births. The underlying bowel disease includes small bowel atresia, volvulus, internal bowel hernia, intussusception, congenital bands, vascular insufficiency, and unkown causes. In recent years, meconium peritonitis has been frequently diagnosed in utero by means of prenatal sonography. Prenatal sonographic findings of meconium peritonitis include polyhydramnios, ascites, abdominal calcification, echogenic messes, pseudocyst and scrotal calcification. Recently, Two cases of meconium peritonitis which are diagnosed in utero by means of ultrasonography are resolved in utero during serial follow-up examination. We present these two cases with a brief review of literatures.