Hwa Seon Koo

Can high serum anti-Müllerian hormone levels predict the phenotypes of polycystic ovary syndrome (PCOS) and metabolic disturbances in PCOS patients?

Objective To evaluate correlations between serum anti-Müllerian hormone (AMH) levels, phenotypes of polycystic ovary syndrome (PCOS), obesity, and metabolic parameters in patients with PCOS. Methods A total of 175 patients with PCOS were diagnosed according to the Rotterdam Consensus were included. Exclusion criteria were age over 40, FSH>25 mIU/mL, and 17a-OHP>1.5 ng/mL. The Phenotypes of PCOS were divided into a severe form (oligo-anovulation, ANOV/hyperandrogenism/polycystic ovary morphology [PCOM]; n=59) and a mild form without HA (ANOV/PCOM, n=105). The serum AMH levels were classified into 3 groups (<5 vs. 5-10 vs. >10 ng/mL). Obesity was defined as body mass index (BMI) ≥25 kg/m2 (n=34). Results The mean age was 25.9±5.7 year and mean AMH level was 10.1±5.4 ng/mL. The BMI (kg/m2) was higher in group 1 (24.2±6.3) than in group 2 (21.9±4.3, p=0.046) or group 3 (21.6±3.3, p=0.019). There was no difference among the three groups in age, menstrual interval, antral follicle counts, androgens, or other metabolic parameters. The obesity group showed significantly lower AMH (7.7±3.9 ng/mL vs. 10.7±5.6 ng/mL), p=0.004) and low-density lipoprotein levels (93.1±21.2 mg/dL vs. 107.5±39.3 mg/dL, p=0.031), and showed higher total T (0.74±0.59 ng/mL vs. 0.47±0.36 ng/mL, p=0.001), free T (2.01±1.9 vs. 1.04±0.8 pg/mL, p=0.0001), and free androgen index (6.2±7.9 vs. 3.5±3.0, p=0.003). After controlling for age factors and BMI, the serum AMH levles did not show any significant correlations with other hormonal or metabolic parmeters. Conclusion For PCOS patients under the age 40, serum AMH is not negatively correlated with age. High serum AMH levels can not predict the phenotype of PCOS and metabolic disturbances in PCOS patients in the non-obese group. Further study might be needed to define the relation more clearly.

Resistance of uterine radial artery blood flow was correlated with peripheral blood NK cell fraction and improved with low molecular weight heparin therapy in women with unexplained recurrent pregnancy loss.

To investigate whether peripheral blood natural killer (pbNK) cell levels are associated with uterine blood flow, and low molecular weight heparin (LMWH) treatment is effective to improve uterine blood flow in women with decreased uterine blood flow and unexplained recurrent pregnancy loss (RPL).

Laparoscopic management of early primary peritoneal pregnancy: a case report

Peritoneal pregnancy is an implantation in the peritoneal cavity exclusive of tubal, ovarian, or intra-ligamentary implantations. This is a rare obstetric complication with high maternal mortality and even higher perinatal mortality, and secondary type was most common. Risk factors for peritoneal pregnancy are previous history of extrauterine pregnancy or tubal surgery pelvic post-inflammatory status or presence of an intra-uterine device. As it is a life-threatening condition, expectant management carries a risk of sudden life-threatening intra-abdominal bleeding and a generally poor fetal prognosis. So, when it is recognized, immediate termination of pregnancy is usually recommended. Early diagnosis of peritoneal pregnancy is difficult, but is important by their life threatening progress course to patients. Recently, we experienced primary peritoneal pregnancy which meets both the original and modified criteria. In this paper, we reported the case of early diagnosed and successfully treated peritoneal pregnancy despite of their diagnosis was incidentally.

Elevated natural killer cell levels and autoimmunity synergistically decrease uterine blood flow during early pregnancy

Objective To investigate whether natural killer (NK) cell and autoimmune antibody acts synergistically, by the action of autoantibodies to increase NK cell number and cytotoxicity, to decrease uterine blood flow during early pregnancy in pregnant women with a history of recurrent spontaneous abortion (RSA). Methods Seventy-five pregnant women (between 5 and 7 weeks gestation) with a history of unexplained RSA were included in the study group. Forty-one pregnant women without a history of RSA were included as controls. All women with a history of RSA were tested for autoantibodies and number of peripheral blood natural killer (pbNK) cell by flow cytometry. Study populations were stratified into four groups by existence of autoantibody and degree of increase of pbNK cells. The uterine radial artery resistance index (RI) was measured by color-pulsed Doppler transvaginal ultrasound. Results The mean RI of the autoimmune antibody-positive (AA+) group (0.63±0.09) was significantly higher than that of the normal control group (0.53±0.10, P=0.001). The mean RI of the AA+/only-NK elevated (eNK) group (0.63±0.09) was significantly higher than those of the only-AA+ group (0.55±0.07, P=0.019) and the only-eNK group (0.57±0.07, P=0.021). Conclusion Concurrent elevation in NK cells and autoimmunity results in decreased uterine blood flow during early pregnancy. However, the majority of cases of RSA remain unexplained and larger scale studies are needed to confirm our conclusion and to develop diagnostic and therapeutic plans for women with a history of RSA.

Early gonadotropin-releasing hormone antagonist start improves follicular synchronization and pregnancy outcome as compared to the conventional antagonist protocol

Objective To assess whether an early GnRH antagonist start leads to better follicular synchronization and an improved clinical pregnancy rate (CPR). Methods A retrospective cohort study. A total of 218 infertile women who underwent IVF between January 2011 and February 2013. The initial cohort (Cohort I) that underwent IVF between January 2011 and March 2012 included a total of 68 attempted IVF cycles. Thirty-four cycles were treated with the conventional GnRH antagonist protocol, and 34 cycles with an early GnRH antagonist start protocol. The second cohort (Cohort II) that underwent IVF between June 2012 and February 2013 included a total of 150 embryo-transfer (ET) cycles. Forty-three cycles were treated with the conventional GnRH antagonist protocol, 34 cycles with the modified early GnRH antagonist start protocol using highly purified human menopause gonadotropin and an addition of GnRH agonist to the luteal phase support, and 73 cycles with the GnRH agonist long protocol. Results The analysis of Cohort I showed that the number of mature oocytes retrieved was significantly higher in the early GnRH antagonist start cycles than in the conventional antagonist cycles (11.9 vs. 8.2, p=0.04). The analysis of Cohort II revealed higher but non-significant CPR/ET in the modified early GnRH antagonist start cycles (41.2%) than in the conventional antagonist cycles (30.2%), which was comparable to that of the GnRH agonist long protocol cycles (39.7%). Conclusion The modified early antagonist start protocol may improve the mature oocyte yield, possibly via enhanced follicular synchronization, while resulting in superior CPR as compared to the conventional antagonist protocol, which needs to be studied further in prospective randomized controlled trials.

EFFICACY OF SURGICAL TREATMENT FOR SUCCESSFUL PREGNANCY IN INFERTILE PATIENTS WITH HYDROSALPINX

목적 저자들은 불임 환자에서의 난관수종의 수술적인 치료가 임신의 성공에 미치는 영향에 대해 연구해 보고자 하였다. 연구방법 2006년부터 2009년까지 본원에서 자궁난관조영술검사로 난관수종을 진단받은 불임 환자 106명 중 추적 관찰이 가능한 65명을 대상으로 의무기록을 후향적으로 분석하였다. 난관수종의 수술적인 치료를 받지 않은 군(n=27)과 수술적인 치료를 받은 군(n=38)으로 나누었고, 후자를 수술의 방법 즉, 난관신개구술을 받은 그룹(n=29)과 난관절제술을 받은 그룹(n=9)으로 분류하여 임신과 관련된 여러 요인을 비교 분석하였다. 결과 나이, 불임기간, 임신력, 동반불임요인 분석에서 각 군 간의 통계학적인 차이는 없었다. 특별한 수술적 치료를 시행하지 않은 군에서 체외 수정시술을 통해 임신성공한 경우는 34.8% (8/23)인 반면 난관절제술 후 체외수정시술을 통해 임신에 성공한 경우는 77.8% (7/9)의 결과를 보여 난관절제술을 시행한 군에서 통계적으로 의미 있게 높은 임신율을 보였다(P = 0.035). 체외수정시술을 주기당 분석한 결과에서도 수술적 치료를 받은 군이 받지 않은 군에 비해 높은 체외수정시술 성공률을 보였다(P = 0.028). 결론 난관 수종의 수술적 치료는 체외수정시술을 통한 임신의 성공에 도움이 될 것으로 생각된다.

The likelihood of achieving pregnancy through timed coitus in young infertile women with decreased ovarian reserve

Objective To evaluate the pregnancy rate and time to pregnancy after timed coitus with or without superovulation in infertile young women younger than 35 years old with low serum anti-Müllerian hormone (AMH) levels (<25th percentile). Methods A total of 202 patients younger than 35 years old were recruited retrospectively between 2010 and 2012. Ninety-eight women had normal serum AMH levels (25–75th percentile), 75 women had low serum AMH levels (5th≤&<25th percentile) and 29 women had very low serum AMH levels (<5th percentile), according to reference values for their age group. Results The clinical pregnancy rate was positively associated with AMH levels, but this trend did not reach statistical significance (43.9% vs. 41.3% vs. 27.6% in the normal, low, and very low AMH groups, respectively). The time to pregnancy was longer in the very low AMH group than in the normal AMH group (13.1±10.9 months vs. 6.9±6.1 months, p=0.030). The cumulative live birth rate over 18 months was lower in the very low AMH group than in the normal AMH group, with marginal significance (20.0% vs. 55.9%, p=0.051). The duration of infertility was negatively correlated with achieving pregnancy (odds ratio, 0.953; 95% confidence interval, 0.914–0.994; p=0.026). Conclusion Conservative management, such as timed coitus with or without superovulation, should be considered in young patients who have low ovarian reserve without any infertility factors. However, for women with a long duration of infertility or very low serum AMH levels, active infertility treatment should be considered.

The value of circulating progesterone levels on hCG day and pregnancy outcomes in controlled ovarian stimulation cycles for in vitro fertilization using flexible antagonist protocol

THE VALUE OF CIRCULATING PROGESTERONE LEVELS ON HCG DAY AND PREGNANCY OUTCOMES IN CONTROLLED OVARIAN STIMULATION CYCLES FOR IN VITRO FERTILIZATION USING FLEXIBLE ANTAGONIST PROTOCOL. H. S. Koo, M. H. Choi, I. O. Song, I. S. Kang, M. K. Koong, C. W. Park. Division of Reproductive Endocrinology and Infertility, Department OB/GYN, Cheil General Hospital, Kwandong University College ofMedicine, Seoul, Republic of Korea.

Resistance of uterine radial artery blood flow is positively correlated with peripheral blood NK cell fraction in patients with unexplained recurrent spontaneous abortion

Methods This study designed prospectively 33 pregnant women between 5 to 7 gestational weeks with a history of unexplained RSA included in this study. 47 normal pregnant women between 5 to 7 gestational weeks without history of infertility and/or RSA included as a control. Peripheral blood natural killer (pbNK) (CD3/56) fractions among peripheral blood monocyte (PBMC) were checked by flow cytometry. Uterine color-pulsed Doppler trans-vaginal ultrasound for evaluation of uterine radial artery RI was checked. Uterine radial artery resistance index (RI) compared between study and control group. After then, uterine radial artery RI was compared between high pbNK cell fraction above 12.1% among PBMC and normal pbNK cells fraction below 12.1%. Correlation between pbNK cell fraction to uterine radial artery RI was also evaluated.

In vitro suppression of natural killer cell cytolytic activities by prednisolone in patients with history of unexplained recurrent spontaneous abortion and elevated peripheral blood NK cell fraction

We aimed to evaluate the effect of prednisolone (PDS) on natural killer cell (NK cell) cytolytic activity in vitro. Methods Blood samples from 74 patients with history of unexplained recurrent spontaneous abortion who elevated peripheral blood NK cell fraction were collected prospectively. Peripheral blood monocytes which containing NK cells were isolated and separated to three different tubes which containing target (K562) cells by the 50:1 effector to target (E:T) ratio. PDS or intravenous immunoglobulin (IVIG) was additionally added to 2 tubes for evaluate their suppressive effect. The percentage killing of target cells was recorded numerically by using flow cytometer and the values between groups were statistically analyzed. Results The mean target cell killing percentage was 40.5% in co-culture tube which was not added PDS or IVIG. In culture experiments which was added IVIG, the killing percentage is reduced to 37.7% which showed no significant differences compared to that of co-cultured tube which was not added PDS or IVIG. But, in experiments with added PDS, the killing percent was reduced to 19.5% and the difference was statistically significant ( P<0.001) compared to that of co-cultured tube which was not added PDS or IVIG. On comparing the reduction in killing percentage of target cells by PDS and IVIG, statistically significant reduction in the PDS coculture was noted ( P<0.005). Conclusion NK cell cytolytic activity is effectively down-regulated by using PDS in vitro. Moreover, the effect of PDS in down-regulation of NK cell cytolytic activity is seems to superior than that of IVIG. But, large scaled in vivo study is needed.