난관불임술후 발생된 임신에 관한 임상적 고찰

서병희,이재현,Suh, Byung-Hee,Lee, Jae-Hyun 대한생식의학회 1983 Clinical and Experimental Reproductive Medicine Vol.10 No.2

In recent days, family planning is not only a problem limitted to our country but an important problem for the while world to solve. Up to present, various methods of sterilization have been developed for population control. When a patient with a previous tubal sterilization by operative method develops any symptoms and signs of pregnancy, we strongly consider it ectopic pregnancy and intrauterine pregnancy. As the cause of sterilization failure, we think that the tubal loop sloughs away and tubal ends either unite and recanalization results or heal and failure of union results in fistula. This present study considered of the 34 cases of ectopic pregnancies and 2 cases of intrauterine pregnancies after tubal sterilization by laparoscopy and Pomeroy's method, at the Dept. of Gynecol. in Kyung Hee University Hospital, during 6 years from Jan. 1977 to Dec. 1982. Authors take result in this study retrospectively. 1. Mean age was 33.7 years for the laparoscopic tubal sterilization group, 31.5 years for the Pomeroy tubal sterilization group. 2. The number of mean gravida and parity at the sterilization was 4.9, 2.8 for the laparoscopic tubal sterilization group, 4.2, 2.2 for the Pomeroy tubal sterilization group, :respectively. 3. The number of mean artificial abortion at the sterilization was all 2.2 for the laparoscopic and Pomeroy tubal sterilization groups. 4. Mean intervals from the tubal surgery to the incidental pregnancy was 3.2 years for the laparoscopic tubal sterilization group, and 3.8 years for the Pomeroy tubal sterilization group. 5. 63.3% of the laparoscopic tubal sterilization group had problem of inadequate tubal ligation, in comparison to having no inadequate problem in the Pomeroy tubal sterilization group. 6. The previous tubal sterilized scar was found to be 6 cases (17.6%) of inner portion, 15 cases (44.4%) of midportion, 13 cases (38.2%) of outer portion at the time of operation. The tubal site of ectopic pregnancy was found to be 23 cases (67.6%) of ampullary portion,S cases ( 4.7%) of isthmic and fimbrial portion, respectively. 7. The causes of table sterilization failure were, in order of frequency, technical error (19 cases), fistula formation (6 cases) and recanalization (5 cases) for the laparoscopic tubal sterilization group and fistula formation (2 cases), technical error (l case), recanalization (l case) fo the Pomeroy tubal sterilization group. 8. As the new applicated contraceptive method in incidental pregnant patient, Authors used 2 gravigard insertion for the two intrauterine pregnancy and 34 Pomeroys' tubal ligation, 2 total abdominal hysterectomy (due to associated pelvic inflammatory disease) for the 36 tubal pregnancy.

종설 : 새로운 불임치료법과 나팔관 임신 아기 프로그램 ( Review : Gamete Intrafallopian Transfer Program : Gift )

서병희(Byung Hee Suh),이재현(Jae Hyun Lee) 경희대학교 경희의료원 1987 慶熙醫學 Vol.3 No.2

종설 : Estrogen 보충요법 ( Review : Estrogen Replacement Therapy )

서병희(Byung Hee Suh),이재현(Jae Hyun Lee) 경희대학교 경희의료원 1988 慶熙醫學 Vol.4 No.3

배란유도방법에 의한 과배란주기에서 혈중및 요중 황체화호르몬 Surge에 관한 연구

박원종,서병희,이재현,Park, Won-Jong,Suh, Byung-Hee,Lee, Jae-Hyun 대한생식의학회 1988 Clinical and Experimental Reproductive Medicine Vol.15 No.2

Ovulation induction was done with 3 different regimens as clomid combined with HMG, HMG only, and FSH combined with HMG in 28 menstrual cycles for IVF-ET and GIFT program. The appearance of endogenous LH surge, estradiol plateau, atypical LH surge, and time from initiation to peak of LH surge in serum and urine were observed and compared in 3 groups. 1. The estradiol concentration of serum LH surge day was similar in three groups but 1st group (Clomiphene Citrate+Sequential HMG) was slightly higher at $1924.0{\pm}865.1\;pg/ml$. In regards to the existence of serum estradiol plateau, 3rd group (FSH+Sequential HMG) was highest at 60%, and 1st group and 2nd group (HMG only) were similar at 33% and 44% respectively. 2. The number of ovarian of ovarian follicle which was more than 18mm in diameter was $4.1{\pm}2.0$, $4.2{\pm}2.1$ respectibely for 2nd group and 3rd group. Although the numbers were slightly higher thean 1st group for each ovarian follicle, serum estradiol value per follicle was higher for 1st group at $583.0{\pm}261.2pg/ml$. 3. When measuring the urine LH surge according to Hi-Gonavi and according to the standard set by three different types of surge, simultameous satisfaction for 1st group, 2nd group, 3rd group was two cases, five cases, four cases respectively at 40%, and the remained cases were composed of numorous type combination which satisfied the two definition, simultaneously in this study, the LH surge starting time was determined only in the cases tow combination were satisfied simultaneously at first, but there are something to study more. In one case of the 3rd group. 4. The concentration of LH surge start in urine and serum of 2nd group was highest at306. $0{\pm}287.2IU/l$ and $34.0{\pm}9.9mIU/ml$ and 1st group was low at $116.6{\pm}66.1IU/l$ and 7.4mIU/ml. The urine and serum value of LH was highest at $1644.4{\pm}988.8IU/l$, $65.9{\pm}15.0mIU/ml$ for 2nd group, 1st group was low at urine, and 3rd group was low of serum. With pregnancy established, the LH concentration of urine was relatively high but on the contrary the LH concentration of serum was low compared to urine concentration. 5. Time from LH surge start to the maximun of urine and serum value was highest at 15. $7{\pm}9.1$ hrs and $10.8{\pm}4.9$ hrs for 1st group and 3rd group. With pregnancy established, time was shortened for urine but on the contrary serum showed an increase in time. 6. The concentration of LH which increases with time on urine was highest at 2nd group ($194.6{\pm}76.8\;IU/hour$). The lowest increase for serum was at 3rd group (2.1mIU/hour). With pregnancy established, urine showed more increase than control group ($266.5{\pm}47.4\;IU/hour$) and for serum there was similar increase ($3.4{\pm}0.8\;mIU/hour$). 7. There were two examples of non-typical surge from 1st group and 3rd group each. Among these three cases showed a reestablishment of LH surge after 10-24 hours. 8. Endogenous spontaneous Lh surge occurs once for each 2nd group and 3rd group.

증례 : 초음파로 산전 진단된 선천성 부난소낭종 일례 ( Case Report : A Case of Congenital Parovarian Cyst )

정희숙(Hee Sook Jung),최형금(Hyung Keum Choi),서병희(Byung Hee Suh),이재현(Jae Hyun Lee) 경희대학교 경희의료원 1988 慶熙醫學 Vol.4 No.2

햄스터 난자의 동결보존과 그의 임상적 이용에 관한 연구

김재명,서병희,이재현,유승환,정길생,Kim, Jae-Myeoung,Suh, Byung-Hee,Lee, Jae-Hyun,Yu, Seung-Hwan,Chung, Kil-Sheng 대한생식의학회 1991 Clinical and Experimental Reproductive Medicine Vol.18 No.1

There studies were carried for evaluation of the efficiency of freezing of hamster oocytes for use in a human sperm penetration assay. The hamster oocytes fully equilibrated in various cryoprotectant agents and inseminated with human sperm. After insemination with hamster oocytes, there was no difference in penetrated rates. Cumulus free oocytes equilibrated in 1.5M various cryoprotective agents and slowely cooled to temperature $-30^{\circ}C$ before rapid cooling and storage in nitrozen tank. After rapid thawing, survival rates of frozen oocytes according to cryo-protective agents were examined and the human sperm penetration assay with zona free hamster oocytes was conducted. 1. Survival rates of oocytes after cryoprotectants exposure have no significant difference (range 88-91%) and peneration rate was 51.1%. 2. Recovery and survival rate of frozen-thawed oocytes were 85.1 and 66.8%. There was no significant difference on cryoprotective agents. 3. Penetration rates of the frozen-thawed and intact oocytes were 69.0 and 77.0%, respectively. 4. Hamster oocytes cryopreservation provides a convenient way of supplying and trans-porting hamster oocytes for the assessment of the fertilizing potential of human spermatozoa.

배란유도주기에서 배란예측지표로서 자궁경관점액의 관강화(Canalization) 현상의 의의

심현남,서병희,이재현,Shim, Hyun-Nam,Suh, Byung-Hee,Lee, Jae-Hyun 대한생식의학회 1987 Clinical and Experimental Reproductive Medicine Vol.14 No.1

35 patients of normal reproductive age group (22-37 yrs) were selected for ovulation induction using $Clomid^{(R)}$ and HMG. Correlation between canalization of cervical mucus and estradiol level in plasma. morphological ovarian follicular change by ultrasonogram, Ferning and Spinnbarkeit were studied in the induced ovulatory menstrual cycles. By retrospective analysis, the results were following; 1. Canalization appeared on the eighth day of the menstrual cycle in $Clomid^{(R)}$ group, and seventh day of HMG group. And the number of the channels increased gradually until the ovulation time. 2. The mean number of channels increased from 12${\pm}$12 in $Clomid^{(R)}$ group, 19${\pm}$14 in HMG group (Day-6) to a maximum of 46${\pm}$22 in $Clomid^{(R)}$ group (Day-1). 3. The maximum plasma estradiol(E2) level was 812${\pm}$722pg/ml in $Clomid^{(R)}$ group (Day-1), 1792${\pm}$504 pg/ml in HMG group (Day-1), and there was a good statistical correlation between the number of channels and the plasma E2 level. 4. The maximal follicular diameter was 19.4${\pm}$6.7 mm in $Clomid^{(R)}$ Group (Day-1) 19.3${\pm}$4.6mm in HMG group (Day-1) and after than decreased. There was a good statistical correlation between the number of channels and the follicular diameter. 5. When grade of ferning was I, the number of channels were 19.4${\pm}$6.7 in $Clomid^{(R)}$ group, 38${\pm}$26 in HMG group. When grade of ferning was III, the number of channels were 54${\pm}$30 in $Clomid^{(R)}$ group, 71${\pm}$36 in HMG group. 6. The maximum score of Spinnbarkeit was 2.6${\pm}$0.5 in Clomid group (Day-0), 2.6${\pm}$0.5 in HMG group (Day-2). In conclusion, the phenomenon of cervical mucus canalization showed the value of the clinical use as an ovulatin marker.

인간의 체외수정과 투명대제거 햄스터난자의 침투능에 관한 연구

김재명,서병희,이재현,정길생,Kim, Jae-Myeoung,Suh, Byung-Hee,Lee, Jae-Hyun,Chung, Kil-Sheng 대한생식의학회 1991 Clinical and Experimental Reproductive Medicine Vol.18 No.1

We compared fertilizing potential measurements by the zona-free hamster egg penetration assay with the in vitro fertilization and embryo transfer program was evaevulated for their ability to fertilize zona free hamster egg. Spermatozoa from 12 presumeably fertile donors and from the male partners of 56 infertile couples were evaluated for their ability to fertilizing potentials. Penertration rates of fertile donors were $36.2{\pm}27.7%$ ; Fertilization rates of infertile couples between with normal semen parameters and with abnormal semen parameters were $28.7{\pm}19.1$, $5.7{\pm}8.9%$, respectively. Sperm motility of couples with penetration rates between on 15-30% and on 30> were $54.1{\pm}4.6$, $55.5{\pm}8.3%$ respectively. Hamster penetration rates of couples participating in an in vitro fertilization and embryo transfer program was $38.9{\pm}29.9%$. But in one case, a positive fertility assessment was obtained in the absence of fertilization of the wife's eggs attributable to egg immaturity. This method may have potential value as a diagnostic tool in evaluation human sperm fertilization capacity which avoids the ethical and logistical problems associated with fertilizing of human eggs in vitro.

미숙 흰쥐의 과도배란에 따른 난소의 조직학적 형태와 난모세포의 배란 및 수정에 estrogen의 전처치가 미치는 영향

김문회,서병희,이재현,Kim, Moon-Hwoe,Suh, Byung-Hee,Lee, Jae-Hyun 대한생식의학회 1985 Clinical and Experimental Reproductive Medicine Vol.12 No.2

Systemic extrogen therapy promotes multiple preantral follicular development in immature mice. Estrogen pretreated ovaries might therefore be a useful source of cells for in vitro studies of oocytes maturation. Silastic capsules (5.0 mm length; 3.18 mm outer diameter, 1.57 mm inner diameter) filled with diethylstilbesterol were implanted subcutaneously in experimental mice (ICR) for up to 6 days. Ovarian weight and histology in diethylstilbesterol pretreated and control animal were assessed before and after pregnant mare serum gonadotrophin treatment and after human chorionic gonadotrophin. The following results were obtained; 1. Ovarian weight was significantly increased by 6 days of diethylstilbesterol pretreatment. Subsequent ovarian weight gain in response to pregnant mare serum gonadotrophin and human chorionic gonadotrophin was increased. 2. Diethylstilnbesterol pretreatment stimulated the developed healthy preantral follicles. 3. Forty eight hours after pregnant mare serum gonadotrophin treatment, a larger number of the antral follicles which developed in diethylstilbesterol pretreated animals showed signs of atresia, whereas in the control ovaries there was a higher incidence of premature luteinization. 4. Forty eight hours after human chorionic gonadotrophin, numerous corpora lutea and occasional luteinized unruptured follicles were present in both control and diethylstilbesterol ovaries. 5. Ovulation rate, fertilization rate and subsequent preimplantation development in vitro were not adversely affected by diethylstilbesterol pretreatment. However, there was considerable variation in the ovulation rate the number of animals with more than 60 ovulations was greater in the diethylstilbesterol gorup (52.4%) as compared to the control (33.3%).

Clomiphene Citrate로 유도된 배란유도주기에서 발생된 병합임신 1례

박상인,김용만,서병희,이재현,Park, Sang-In,Kim, Yong-Man,Suh, Byung-Hee,Lee, Jae-Hyun 대한생식의학회 1988 Clinical and Experimental Reproductive Medicine Vol.15 No.2

Combined (intra and extrauterine) pregnancy refers to impregnations of two different ova at intrauterine and extrauterine sites simultaneously or within a short time interval each other. It is a rare clinical entity and freqently missed in early diagnosis in most instances. Its incidence rate is about 1 in 30,000 pregnancies and the incidence was rised in cases of using ovulation induced agents. The diagnostic rate is less than 10% at early process of the disease. We experienced a case of intrauterine and left tubal pregnancy as combined pregnaney in ovulation cycle which had been induced by clomiphene citrate and now present it with brief review of related leteratures.