Hyuk Jung

Detection of endometrial and subendometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles

OBJECTIVES Successful implantation depends on interaction between a blastocyst and a receptive endometrium. Endometrial vasculature is important in the early endometrial response to blastocyst implantation, and vascular changes can affect uterine receptivity. This study aims to investigate whether vascular parameters measured using three-dimensional power Doppler ultrasound (3D PD-US) could predict pregnancy following fresh in vitro fertilization and embryo transfer (IVF-ET) using a gonadotropin releasing hormone (GnRH) agonist long protocol. MATERIALS AND METHODS This prospective observational study enrolled 236 nulliparous women who underwent a first IVF-ET using a GnRH long protocol with stimulation by recombinant FSH (rFSH) from May 2009 to April 2012. After excluding two cases of tubal pregnancy, 234 women were in either a pregnant group (n = 113) or a nonpregnant group (n = 121). Color Doppler ultrasound and 3D PD-US examinations were performed on the day of embryo transfer. Main outcomes were pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) of the uterine artery, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) of the endometrium and subendometrial region. Measurements were analyzed relative to IVF-ET outcome (pregnant vs. nonpregnant). RESULTS No significant differences were observed in patient age, infertility duration, body mass index (BMI), basal FSH levels, number of retrieved oocytes or good quality embryos, or endometrial thickness or volume between the two groups. The pregnant group had higher endometrial VI, FI, and VFI scores than the nonpregnant group (p = 0.001, p = 0.000, p = 0.021, respectively). By contrast, neither subendometrial region VI, FI, and VFI scores (p = 0.770, p = 0.252, p = 0.451), nor uterine artery PI, RI, or S/D scores (p = 0.256, p = 0.527, p = 0.365) differed between groups. Cut-off values of endometrial VI, FI, and VFI scores were 0.95, 12.94, and 0.15 for pregnancy achievement. CONCLUSION Three dimensional PD-US was a useful and effective method for assessing endometrial blood flow in IVF cycles. Good endometrial blood flow on the day of embryo transfer might be associated with high pregnancy success with a GnRH long protocol, because this is indicative of endometrial receptivity in fresh IVF cycles.

A myxoid liposarcoma arising in a leiomyoma of the uterus: a case report

BackgroundA liposarcoma is the most frequent soft tissue sarcoma found in adults, however, a liposarcoma arising in uterus is extremely rare. Indeed, a liposarcoma coexistent with a leiomyoma is even rarer and there is only one case has been reported in the English literature to date.CaseWe describe a case of the uterine liposarcoma arising in a leiomyoma in 48-year-old woman who presented with dysmenorrhea, brownish vaginal discharge, and a rapidly enlarging lower abdominal mass. The tumor emerged from the lower segment of the endometrium and filled the endometrial cavity as a polypoid lesion. The authors of this study documented the adipocyte origin of the tumor with immunohistochemical and electron microscopical studies, the available literature was reviewed and the possible histogenesis was discussed.ConclusionWe herein report a case of very rare primary liposarcoma arising in a submucosal uterine leiomyoma.

The Effects of E2 Supplementation from the Early Proliferative Phase to the Late Secretory Phase of the Endometrium in hMG-Stimulated IVF-ET

AbstractPurpose: Our purpose was to determine if pregnancy rates(PRs) for hMG (human menopausalgonadotropin)-stimulated IVF-ET (in vitro ferilization-embryo transfer) can beincreased by estradiol (E2) supplementation from the earlyproliferative phase to the late secretory phase of theendometrium. Method: Eighty-one infertile women with pure tubal factorwere randomized into two groups. One group received noE2 supplementation (control group) and the other receivedoral E2 supplementation (2 mg two times daily) from theearly proliferative phase starting on the third day of themenstrual cycle to the late secretory phase of theendometrium, with hMG stimulation for ovulation induction startingon the sixth day of the menstrual cycle. Results: In 85 cycles, at least one embryo was transferred.Compared with the control group (n = 27 cycles), the E2supplementation group (n = 58 cycles) had a significantlyhigher PR (control, 25.9%, versus E2 supplementation,48.3%) and IR per ET (control, 10%, versus E2supplementation, 26%), but FRs per retrieved oocytes were notstatistically different between the two groups (control, 74%, versusE2 supplementation group, 73%). Four spontaneousabortions occurred in the E2 supplementation group, and onecase in the control group. Ectopic pregnancy occurred inone case in the control group. Conclusions: Clinical PRs and IRs in the E2supplementation group were significantly higher than in the controlgroup, while FRs in the control group did not differstatistically from the E2 supplementation group. This suggests thatE2 supplementation from the early proliferative phase to thelate secretory phase of the endometrium in hMG-stimulatedIVF-ET increases the receptivity of the endometrium fortransferred embryos and clinical PRs.

Study of dienogest for dysmenorrhea and pelvic pain associated with endometriosis

Objective To evaluate the effect of orally administered dienogest (DNG) for dysmenorrhea and pelvic pain associated with endometriosis. Methods For this study we recruited 89 patients with dysmenorrhea and pelvic pain associated with endometriosis diagnosed by laparoscopy. All patients complained of persistent dysmenorrhea and pelvic pain despite surgical treatment 6 months previously. After 6 months of DNG treatment, we used a 0 to 3 point verbal rating scale to measure the severity of disability in daily life due to dysmenorrhea and pelvic pain, and the use of analgesics. Weight gain, serum lipid and liver enzyme tests were performed before treatment and after 6 months of DNG treatment. Results Total dysmenorrhea scores assessed by the verbal rating scale significantly decreased by the end of treatment (P<0.001). The mean (±standard deviation) pain score for dysmenorrhea before and after treatment were 1.42±1.1 and 0.1±0.3, respectively. The mean non-menstrual pelvic pain scores before and after treatment were 0.52±0.6 and 0.18±0.3, respectively, showing a significant difference (P<0.001). The use of analgesics significantly decreased by the end of the treatment (P<0.001). The associated adverse effects were weight gains (in 56 of 89 patients, 63%) and uterine bleeding (in 28 of 89 patients, 31.5%). The weight gain (before treatment, 57.9±9.7; after treatment, 61.1±12.6) was statistically significant (P<0.040). Conclusion This study demonstrated that orally administered DNG could be used to effectively treat dysmenorrhea and pelvic pain associated with endometriosis although the side effects of weight gain and uterine bleeding should be considered.

Raloxifene Administration in Women Treated with Long Term Gonadotropin-releasing Hormone Agonist for Severe Endometriosis: Effects on Bone Mineral Density.

Objectives To evaluate the efficacy of raloxifene in preventing bone loss associated with long term gonadotropin-releasing hormone agonist (GnRH-a) administration. Methods Twenty-two premenopausal women with severe endometriosis were treated with leuprolide acetate depot at a dosage of 3.75 mg/4 weeks, for 48 weeks. Bone mineral density (BMD) was evaluated at admission, and after 12 treatment cycles. Results At cycle 12 of GnRH-a plus raloxifene treatment, lumbar spine, trochanter femoral neck, and Wards BMD differed from before the treatment. A year after treatment, the lumbar spine and trochanter decreased slightly, but were not significantly different. Conclusions Our study shows that the administration of GnRH-a plus raloxifene in pre-menopausal women with severe endometriosis, is an effective long-term treatment to prevent bone loss.

Prevention of cognitive impairment in the midlife women.

Forgetfulness is common symptom with age. Especially for midlife women, hormonal cessation by menopausal change is one of the causes in cognitive disorders. And neuropathological changes in brain can lead to mild cognitive impairment (MCI) and eventually dementia. Prevention of MCI is important for decreasing progression to dementia. This article presents therapeutic approaches based on pathophysiologic changes in brain for preventing cognitive decline.

Comparison of Laparoscopic Radiofrequency Myolysis (LRFM) and Ultrasonographic Radiofrequency Myolysis (URFM) in Treatment of Midline Dysmenorrhea

Objectives To access the effectiveness of radiofrequency myolysis (RFM) in women with midline dysmenorrhea. Methods We designed RFM in two ways laparoscopic RFM (LRFM), vaginal ultrasound-guided RFM (URFM). One hundred and thirty-two patients were in the LRFM group and, 140 patients were in the URFM group. Results Upon receipt of surgery, both the LRFM and the URFM groups demonstrated a significant decrease (P < 0.001) in the mean pain score when compared to those before and after surgery. Conclusion The RF uterine myolysis procedure provides an alternative for those patients who suffer from intractable midline dysmenorrhea. LRFM is an alternative choice because it is relatively safe and, simple to perform and moreover, it is satisfactory. LRFM appears to increasingly succeed in the treatment of midline dysmenorrhea.

Comparative Study on Hysteroscopic and Histologic Examinations of the Endometrium in Postmenopausal Women Taking Tamoxifen

Objectives To evaluate the histologic effects of tamoxifen on the endometrium using hysteroscopy in postmenopausal women with breast cancer. Methods The study included 46 postmenopausal patients who were referred from another clinic due to thickening or bleeding of the endometrium after taking tamoxifen for breast cancer. All patients underwent transvaginal sonography (TVS) and hysteroscopic endometrial biopsy with a 5-mm, continuous-flow, operating hysteroscope. Results The incidence of malignancy was high (20%) in cases of abnormal uterine bleeding (AUB) after taking tamoxifen. However, in the non-AUB group with thick endometrium after taking tamoxifen, the incidence of adenocarcinoma was 3.2%. Conclusions Our findings confirm the estrogen-like effect of tamoxifen on the endometrium. Endometrial evaluation with TVS suggests further diagnostic procedures; moreover, histologic examination is necessary under hysteroscopy, especially in cases of endometrial bleeding after taking tamoxifen.

Combination Therapy of Raloxifene and Alendronate for Treatment of Osteoporosis in Elderly Women

Objectives To evaluate and compare the efficacy and safety of the combination of raloxifene and alendronate with those of monotherapies in elderly women with osteoporosis. Methods Sixty-two postmenopausal women (mean age 63.5 ± 0.5 years) attending gynecologic osteoporosis clinics with established osteoporosis were randomly allocated to one of four treatment groups and monitored for 3 years. All patients enrolled in this study, including those in the control group (n = 14), received 1.0 g elemental calcium and 400 units of vitamin D per day. The raloxifene group (n = 16) received raloxifene 60 mg (Evista®) per day; alendronate group (n = 17) received low-dose (5 mg) alendronate with calcitriol 0.5 µg (Maxmarvil®) per day; and the combination therapy group (n = 15) received both raloxifene 60 mg and low-dose (5 mg) alendronate with calcitriol 0.5 µg. Bone mineral density (BMD) was measured in the lumbar spine and hip before and after 3 years of treatment. Results In patients who received the combined therapy, BMD increased in the lumbar spine and the hip by 7.2% (P<0.001) and 4.8% (P<0.001) at 3 years. For patients in the alendronate group, the increases were 6.7% (P<0.001) and 3.1% (P<0.01) respectively, for the raloxifene group, the increases were 4.36% (P<0.001) and 1.9% (P<0.05) in the vertebrae and femora, respectively; however, the BMD of patients in the control group decreased by 1.81% (P<0.05) and 1.6% (P<0.05), respectively, after 3 years. Patients who received the combination therapy had significantly higher BMD in both the vertebrae femora (P<0.01) in comparison to that in those treated with raloxifene or alendronate individually. Conclusions This 3-year randomized study showed the improved effects of alendronate and raloxifene combination on spine and hip BMD in elderly postmenopausal women with established osteoporosis.

A CASE OF ADENOID BASAL CELL CARCINOMA IN UTERINE CERVIX

자궁 경부의 선양기저세포암은 폐경기 여성 주로 발생하는 드문 질환으로 대부분이 특정한 형태의 병변을 보이지 않아 발견이 어렵다. 선양기저세포암은 전이나 재발이 적어 광범위 자궁절제술만으로 치료가 되는 경우가 대부분으로 조직학적 검사가 유사하나 예후가 좋지 않은 선양낭포암과 감별이 필요하다. 저자들은 농자궁증의 진단하에 자궁절제술을 시행한 환자의 수술 후 조직학적 검사상, 선양기저세포암 1예를 경험하여 이를 보고하는 바이다.