Byung-Moon Kang

Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection

OBJECTIVEnTo investigate whether levothyroxine (LT4) treatment has beneficial effects on IVF results and pregnancy outcome in infertile patients with subclinical hypothyroidism undergoing IVF/intracytoplasmic sperm injection (ICSI).nnnDESIGNnProspective, randomized trial.nnnSETTINGnUniversity-affiliated infertility clinic.nnnPATIENT(S)nA total of 64 infertile patients with subclinical hypothyroidism, defined as an elevated serum TSH level associated with a normal free T4 level and without frank symptoms of hypothyroidism.nnnINTERVENTION(S)nPatients were randomized into an LT4 treatment group or control group. For the LT4 treatment group, 50 μg LT4 was administered from the first day of controlled ovarian stimulation for IVF/ICSI.nnnMAIN OUTCOME MEASURE(S)nResults of IVF and pregnancy outcome.nnnRESULT(S)nThere were no differences in patient characteristics between the two groups. Total dose and days of recombinant human FSH used for controlled ovarian stimulation were also similar. The number of grade I or II embryos was significantly higher in the LT4 treatment group than in the control group. There was no significant difference in the clinical pregnancy rate per cycle between the two groups. However, the miscarriage rate was significantly lower in the LT4 treatment group than in the control group. Embryo implantation rate and live birth rate were significantly higher in the LT4 treatment group. In the control group, both thyroid peroxidase antibody and thyroglobulin antibody levels were significantly higher in the miscarried subgroup than in the delivered subgroup.nnnCONCLUSION(S)nLT4 treatment can improve embryo quality and pregnancy outcome in subclinical hypothyroid women undergoing IVF/ICSI.

Minimal stimulation using gonadotropin-releasing hormone (GnRH) antagonist and recombinant human follicle-stimulating hormone versus GnRH antagonist multiple-dose protocol in low responders undergoing in vitro fertilization/intracytoplasmic sperm injection

This prospective randomized study was performed to investigate the effectiveness of minimal stimulation using recombinant human FSH (rhFSH) and GnRH antagonist compared with GnRH antagonist multiple-dose protocol (MDP) in low responders undergoing IVF/intracytoplasmic sperm injection. Our study demonstrated that minimal stimulation in natural cycles provides similar pregnancy rates to the GnRH antagonist MDP with fewer dose and days of rhFSH used and thus can be a cost-effective alternative as a last chance before oocyte donation in low responders.

Influence of Antiphospholipid Antibodies on Pregnancy Outcome in Women Undergoing In Vitro Fertilization and Embryo Transfer

Problemu2002 Antiphospholipid antibodies (APA) are thought to be involved in recurrent pregnancy loss. Therefore, we investigated the impact of APA on pregnancy outcome in women undergoing in vitro fertilization and embryo transfer (IVF‐ET).

Increased expression of glutathione by estradiol, tumor necrosis factor-alpha, and interleukin 1-beta in endometrial stromal cells.

Problemu2002 The intracellular antioxidant system, based on glutathione (GSH), plays a key role in endometrial detoxification reactions and has been proposed to be involved in the pathogenesis endometriosis. This study was designed to evaluate whether estradiol (E2) and proinflammatory cytokines have any effects on expression of glutathione in endometrial stromal cells (ESCs).

The effect of luteal phase progesterone supplementation on natural frozen-thawed embryo transfer cycles

Objective To evaluate the effect of progesterone supplementation during the luteal phase on pregnancy outcome in natural frozen-thawed embyo transfer (FTET) cycles. Methods In this retrospective cohort study, 228 consecutive patients who underwent FTET cycles between January 2009 and September 2012 were included. One hundred forty-five patients received luteal progesterone support (P group) but 83 patients did not receive any progesterone supplementation during luteal phase (control group). Results There were no differences in patients characteristics between the two groups. The two groups were similar with respect to the characteristics of previous fresh in vitro fertilization cycle in which embryos were cryopreserved including the numbers of oocytes retrieved, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and frozen embryos. Also, significant differences were not observed between the P and control groups in clinical pregnancy rate, embryo implantation rate and multiple pregnancy rate. However, miscarriage rate was significantly lower in the P group and live birth rate was significantly higher in the P group than in the control group (P<0.05, P<0.05). Conclusion Our results suggest that luteal phase progesterone supplementation decreases miscarriage rate and improves live birth rate in natural FTET cycles.

GnRH antagonist multiple dose protocol with oral contraceptive pill pretreatment in poor responders undergoing IVF/ICSI

Objective To investigate the effectiveness of GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment in poor responders undergoing IVF/ICSI, compared with GnRH antagonist MDP without OCP pretreatment and GnRH agonist low-dose long protocol (LP). Methods A total of 120 poor responders were randomized into three groups according to controlled ovarian stimulation (COS) options; GnRH antagonist MDP after OCP pretreatment (group 1), GnRH antagonist MDP without OCP pretreatment (group 2) or GnRH agonist luteal low-dose LP without OCP pretreatment (group 3). Patients allocated in group 1 were pretreated with OCP for 21days in the cycle preceding COS, and ovarian stimulation using recombinant human FSH (rhFSH) was started 5 days after discontinuation of OCP. Results There were no differences in patients characteristics among three groups. Total dose and days of rhFSH used for COS were significantly higher in group 3 than in group 1 or 2. The numbers of mature oocytes, fertilized oocytes and grade I, II embryos were significantly lower in group 2 than in group 1 or 3. There were no significant differences in the clinical pregnancy rate and implantation rate among three groups. Conclusion GnRH antagonist MDP with OCP pretreatment is at least as effective as GnRH agonist low-dose LP in poor responders and can benefit the poor responders by reducing the amount and duration of FSH required for follicular maturation.

Effects of pioglitazone on ovarian stromal blood flow, ovarian stimulation, and in vitro fertilization outcome in patients with polycystic ovary syndrome

OBJECTIVEnTo investigate the effects of pioglitazone on ovarian stimulation, in vitro fertilization (IVF) outcome, and intraovarian stromal blood flow in patients with polycystic ovary syndrome (PCOS).nnnDESIGNnProspective, randomized, controlled trial.nnnSETTINGnUniversity-affiliated infertility clinic.nnnPATIENT(S)nSixty infertile patients with PCOS resistant to clomiphene citrate.nnnINTERVENTION(S)nAn IVF protocol involving use of a gonadotropin-releasing hormone (GnRH) antagonist and oral contraceptive pretreatment. Patients were randomized into two groups: pioglitazone (30 mg daily) in the study group or placebo in the control group, commenced on the day on which oral contraceptive intake began.nnnMAIN OUTCOME MEASURE(S)nOvarian stimulation, IVF outcome, and resistance index of the intraovarian stromal artery.nnnRESULT(S)nThe resistance index value on the day of human chorionic gonadotropin (hCG) injection in the study group was statistically significantly higher in the study group than in controls. The serum estradiol level and number of retrieved oocytes were statistically significantly lower in women treated with pioglitazone. However, the number of mature oocytes and fertilized oocytes, and the clinical pregnancy rate were similar in both groups.nnnCONCLUSION(S)nPioglitazone therapy reduced intraovarian stromal blood flow and might be beneficial in improving both the response to ovarian stimulation and IVF outcome in PCOS patients.

A large advanced seminoma in an older woman with androgen insensitivity syndrome

A 58-year-old woman who presented with inguinal hernia for the first time was diagnosed as seminoma and complete androgen insensitivity syndrome (CAIS). The patient received a late diagnosis, and therefore she could not take a proper management. CAIS is a rare X-linked recessive disease with an XY karyotype that is caused by androgen receptor defects. It usually present with primary amenorrhea or inguinal hernia. The risk of malignant transformation of undescended testis increases with age, thus gonadectomy should be performed after puberty. We present a case of large advanced seminoma in a woman with CAIS who was neglected and diagnosed lately.

Effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase compared with GnRH agonist long protocol in non-obese and obese patients with polycystic ovary syndrome undergoing IVF/ICSI.

Objective To evaluate the effectiveness of GnRH antagonist multiple dose protocol applied during early and late follicular phase (MDP-EL) in comparison with standard GnRH agonist luteal long protocol (LP) in each non-obese and obese polycystic ovary syndrome (PCOS) women undergoing IVF. Methods Two hundred eleven infertile women with PCOS were recruited and randomized to undergo either GnRH antagonist MDP-EL (antagonist group) or standard GnRH agonist luteal LP (agonist group). IVF cycle outcomes were compared between the two groups. Results Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the antagonist group than in the agonist group. Incidence of severe ovarian hyperstimulation syndrome was significantly lower in the antagonist group. However, IVF and pregnancy outcomes were similar in the two groups. When all subjects were divided into non-obese and obese subgroups, in non-obese PCOS subgroup, IVF and pregnancy outcomes were comparable in the antagonist and agonist groups but total dose and days of rhFSH were also significantly fewer in the antagonist group. Similar findings were also observed in obese PCOS subgroup. Conclusion GnRH antagonist MDP-EL is at least as effective as GnRH agonist LP and may be a more patient-friendly alternative in controlled ovarian stimulation for PCOS patients undergoing IVF, independent of body mass index.

Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma

Objective To evaluate whether the surgical resection or aspiration with ethanol sclerotherapy (AEST) of endometrioma before in vitro fertilization (IVF) affect controlled ovarian stimulation (COS) and IVF outcome in the infertilie women with endometroma undergoing IVF. Methods In this retrospective cohort study, 101 consecutive IVF/intracytoplasmic sperm injection cycles that were performed in 101 patients with endometrioma(s) between January 2008 and December 2012 were included. Before IVF, 36 patients underwent surgical resection of endometrioma (resection group), 29 patients had transvaginal endometrioma AEST (aspiration group), and 36 patients did not take any surgical intervention (control group). The three groups were compared in terms of COS and IVF outcomes. Results Total antral follicle count was significantly lower in the resection group than in the aspiration or control group. The numbers of follicles with a diameter of 14 to 17 mm on the human chorionic gonadotropin day, retrieved oocytes, mature oocytes, and fertilized oocytes were significantly lower in the resection group than in two other groups. However, three groups were similar in terms of clinical pregnancy rate (CPR) per initiated cycle, CPR per embryo transfer, embryo implantation rate, and miscarriage rate. Conclusion Neither of surgical resection and AEST of endometrioma before IVF treatment can give any beneficial effect on IVF outcomes. Moreover, surgical resection of endometrioma can affect the ovarian reserve and ovarian response during COS.