[show abstract][hide abstract] ABSTRACT: To investigate the association of individual follicular fluid (FF) leptin and adiponectin levels with the quality of the corresponding oocyte and embryo.
We prospectively enrolled 67 women who underwent controlled ovarian hyperstimulation with 89 FF samples. FF and the corresponding oocyte was obtained from a single dominant preovulatory follicle at the time of oocyte retrieval. Concentrations of leptin and adiponectin were measured by enzyme-linked immunosorbent assay in an individual follicle. The oocyte quality, fertilization rate, and corresponding embryo development were assessed.
The FF level of leptin was significantly associated with body mass index (r=0.334, p<0.01). The FF adiponectin level was significantly higher in the normal fertilization group than the abnormal fertilization group (p=0.009) in the non-obese women. A lower FF leptin level was associated with a trend toward mature oocytes, normal fertilization, and good embryo quality, although these relationships were not statistically significant. The leptin:adiponectin ratio of FF did not differ significantly according to oocyte and embryo quality. The quality of the oocyte and embryo was not associated with the FF leptin level tertile. However, the normal fertilization rate was positively associated with FF adiponectin level tertile. There was a trend towards improved oocytes and normal fertilization rates with the lowest tertile of the FF leptin:adiponectin ratio, but this difference was not statistically significant.
Our results suggest that a high FF adiponectin concentration could be a predictor of normal fertilization. However, the FF leptin concentration and leptin:adiponectin ratio is not significantly related to oocyte maturity and corresponding embryo development.
Clinical and experimental reproductive medicine. 03/2014; 41(1):21-8.
[show abstract][hide abstract] ABSTRACT: Objective
To determine whether intracytoplasmic sperm injection (ICSI) could prevent total fertilization failure (TFF) and enhance the embryo quality in patients with non-male factor infertility.
Two hundred and ninety-six in vitro fertilization (IVF) cycles performed in patients with non-male factor infertility between April 2009 and March 2013 were included in this retrospective study. During the period, ICSI and conventional IVF were performed in 142 and 154 cycles, respectively. The usual indications for ICSI were in the cycles of patients with 1) known low fertilization rate, 2) repetitive implantation failure, 3) advanced maternal age, 4) presence of endometrioma, 5) low oocyte yield (number of oocytes ≤3), or 6) poor quality oocytes. The rate of TFF, normal fertilization, abnormal pronuclei (PN) formation, embryo quality, and pregnancy outcomes between the patients treated with ICSI and conventional IVF cycles were compared.
The patients treated with ICSI (ICSI group, n = 142) presented fewer number of oocytes than patients treated with conventional IVF cycles (n = 154). The TFF rate was not different (4.2% vs. 0.6%, P = 0.059), but the ICSI group presented a significantly higher rate of normal fertilization (83.4% vs. 79.1%, P = 0.04) and lower rate of abnormal PN formation (3.9% vs. 13.3%, P < 0.01). The cleavage stage embryo quality was better in the ICSI group (grade A: 31.1% vs. 21.3%, P = 0.001; grade A + B: 65.1% vs. 47.6%, P < 0.001).
The result of this study does not support the use of ICSI to prevent TFF in patients with non-male factor infertility. However, ICSI improved the fertilization rate and the embryo quality.
European Journal of Obstetrics & Gynecology and Reproductive Biology. 01/2014;
[show abstract][hide abstract] ABSTRACT: Study Objective
The objective of this study was to evaluate laparo-endoscopic single-site myomectomy (LESS-M) for the surgical treatment of fibroids and to compare surgical outcomes and postoperative pain to conventional laparoscopic myomectomy (CLM).
Data was obtained from medical records of patients who underwent LESS-M between August 2011 and June 2012. Considering the surgeon’s learning curve for LESS-M, we collected the data after 100 LESS-M procedures were performed. The cases were compared with a historic cohort of patients who underwent CLM performed by the same surgeon between July 2008 and May 2009. A single experienced surgeon performed both procedures in all patients. A total of 118 patients who underwent LESS-M or CLM were included in the study (59 in the LESS-M group and 59 in the CLM group).
Measurements and Main Results
We analyzed and compared patient basal characteristics and surgical outcomes between the 2 groups. There were no statistically significant differences in basal characteristics (age, body mass index, number and size of myomas, and type of the largest myoma) between the 2 groups. And the surgical outcomes (operative time, estimated blood loss, postoperative hemoglobin drop, postoperative hospital stay, and postoperative pain scores) were not different statistically between 2 groups. Moreover, patients did not experienced major intraoperative complications. Postoperative complications were wound infections that occurred in 3 patients (2 in the LESS-M and 1 in the CLM groups).
LESS-M is feasible for less than 5 myomas and offers comparable surgical outcomes to those of CLM after the surgeon’s initial learning curve.
Journal of Minimally Invasive Gynecology 01/2014; · 1.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: What is the optimal vitrification protocol according to the cryoprotective agent (CPA) for ovarian tissue (OT) cryopreservation?
The two-step protocol with 7.5% ethylene glycol (EG) and 7.5% dimethyl sulfoxide (DMSO) for 10 min then 20% EG, 20% DMSO and 0.5 M sucrose for 5 min showed the best results in mouse OT vitrification.
Establishing the optimal cryopreservation protocol is one of the most important steps to improve OT survival. However, only a few studies have compared vitrification protocols with different CPAs and investigated the effect of in vitro culture (IVC) on vitrified-warmed OT survival. Some recent papers proposed that a combination of CPAs has less toxicity than one type of CPA. However, the efficacy of different types and concentrations of CPA are not yet well documented.
A total of 644 ovaries were collected from 4-week-old BDF1 mice, of which 571 ovaries were randomly assigned to 8 groups and vitrified using different protocols according to CPA composition and the remaining 73 ovaries were used as controls. After warming, each of the eight groups of ovaries was further randomly divided into four subgroups and in vitro cultured for 0, 0.5, 2 and 4 h, respectively. Ovaries of the best two groups among the eight groups were autotransplanted after IVC.
The CPA solutions for the eight groups were composed of EDS, ES, ED, EPS, EF, EFS, E and EP, respectively (E, EG; D, DMSO; P, propanediol; S, sucrose; F, Ficoll). The IVC medium was composed of α-minimal essential medium, 10% fetal bovine serum and 10 mIU/ml follicle-stimulating hormone (FSH). Autotransplantation of vitrified-warmed OTs after IVC (0 to 4 h) using the EDS or ES protocol was performed, and the grafts were recovered after 3 weeks. Ovarian follicles were assessed for morphology, apoptosis, proliferation and FSH level.
The percentages of the morphologically intact (G1) and apoptotic follicles in each group at 0, 0.5, 2 and 4 h of IVC were compared. For G1 follicles at 0 and 4 h of IVC, the EDS group showed the best results at 63.8 and 46.6%, respectively, whereas the EP group showed the worst results at 42.2 and 12.8%, respectively. The apoptotic follicle ratio was lowest in the EDS group at 0 h (8.1%) and 0.5 h (12.7%) of IVC. All of the eight groups showed significant decreases in G1 follicles and increases in apoptotic follicles as IVC duration progressed. After autotransplantation, the EDS 0 h group showed a significantly higher G1 percentage (84.9%) than did the other groups (42.4-58.8%), while only the ES 4 h group showed a significant decrease in the number of proliferative cells (80.6%, 87.6-92.9%). However, no significant differences in apoptotic rates and FSH levels were observed between the groups after autotransplantation.
The limitation of this study was the absence of in vitro fertilization using oocytes obtained from OT grafts, which should be performed to confirm the outcomes of ovarian cryopreservation and transplantation.
We compared eight vitrification protocols according to CPA composition and found the EDS protocol to be the optimal method among them. The data presented herein will help improve OT cryopreservation protocols for humans or other animals.
This study was supported by a grant (No. A120080) from the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea.
[show abstract][hide abstract] ABSTRACT: To evaluate the safety and feasibility of single-port laparoscopic adnexal surgery during pregnancy.
A retrospective study (Canadian Task Force Classification III).
A university hospital.
A total of 14 women with intrauterine pregnancy who underwent single-port laparoscopic surgery (SPLS).
We retrospectively reviewed the medical records of 14 women with intrauterine pregnancy who underwent SPLS between November 2009 and September 2012 for the treatment of an adnexal mass.
Factors investigated included the duration of surgery, differences between preoperative and postoperative hemoglobin, the size of the mass as measured by ultrasonography, major intraoperative or postoperative complications, conversion to multiport laparoscopy, and pregnancy outcomes. Single-port laparoscopic adnexal surgery was successfully performed in all 14 pregnant patients with an adnexal mass. The median gestational age at operation was 9 weeks (range, 4 weeks-17 weeks 4 days). Procedures included ovarian cystectomy with or without detorsion (n = 9), cyst aspiration with detorsion (n = 2), salpingectomy (n = 2), and salpingostomy (n = 1). The median duration of surgery was 59 minutes (range, 36-84 minutes). No major intraoperative or postoperative complications were encountered, and there was no need for conversion to multiport laparoscopic surgery. Five women had spontaneous vaginal delivery, and 5 women underwent cesarean delivery at term. One woman had preterm delivery at a gestational age of 24 weeks 5 days. In 1 case, abortion occurred 2 weeks after the operation.
Based on these initial findings, SPLS appears to be a safe and technically feasible treatment for an adnexal mass during pregnancy.
Journal of Minimally Invasive Gynecology 07/2013; · 1.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigate outcomes of stimulated IVF cycles in which GnRH antagonist was omitted on the ovulation triggering day.
A total of 86 women who underwent controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonist flexible multiple-dose protocols were recruited and prospectively randomized into the conventional group (group A) or cessation group (group B). The GnRH antagonist, 0.25 mg/day of cetrorelix, was started when the leading follicle reached 14 mm in diameter and was continuously administered until the hCG triggering day (group A, 43 cycles) or until the day before hCG administration (group B, 43 cycles). The maturity of oocytes, fertilization rate, embryo quality, and implantation and clinical pregnancy rates were evaluated.
The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in group B than group A (2.5±0.9 vs. 3.2±0.8 ampoules, p<0.05). There was no premature luteinization in any of the subjects. The proportion of mature oocytes and fertilization rate were not significantly different in group B than group A (70.7% vs. 66.7%; 71.1% vs. 66.4%, respectively). There were no significant differences in the implantation or clinical pregnancy rates.
Our prospective randomized study suggested that cessation of GnRH antagonist on the hCG administration day during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising its effects on pregnancy rates.
Clinical and experimental reproductive medicine. 06/2013; 40(2):83-9.
[show abstract][hide abstract] ABSTRACT: The aim of the present study was to identify variables associated with treatment failure in women with menorrhagia who were treated with thermal balloon ablation (TBA) or levonorgestrel releasing intrauterine system (LNG-IUS), and to determine if there are subgroups where one treatment type is more effective than the other.
The study included 106 women with menorrhagia who were treated with TBA or LNG-IUS at the study institute between January 2003 and December 2007, with a follow-up period greater than 12 months. Data were collected by retrospective review of medical records. Treatment failure was defined as persistent or recurrent menorrhagia within one year after treatment or hysterectomy at any time during follow-up. The relationships between variables and treatment outcome were analyzed using the chi-square or Fisher's exact test. The treatment outcome of TBA was compared with LNG-IUS.
Sixty-seven women were treated with TBA and 39 women were managed with LNG-IUS. Fifty-two women had a myoma ≥2.5 cm. Treatment failure was observed in 24 women (2 recurrent or persistent menorrhagia and 22 hysterectomies) and myoma size (≥2.5 cm vs. <2.5 cm) was associated with treatment outcome. TBA and LNG-IUS showed similar treatment outcomes.
A large myoma is a risk factor for treatment failure in women with menorrhagia treated with TBA or LNG-IUS.
[show abstract][hide abstract] ABSTRACT: In 2009 anti-Müllerian hormone (AMH) assay was approved for clinical use in Korea. This study was performed to determine the reference values of AMH for predicting ovarian response to controlled ovarian hyperstimulation (COH) using the clinical assay data.
One hundred sixty-two women who underwent COH cycles were included in this study. We collected data on age, basal AMH and FSH levels, total dose of gonadotropins, stimulation duration, and numbers of oocytes retrieved and fertilized. Blood samples were obtained on cycle day 3 before gonadotropin administration started. Serum AMH levels were measured at a centralized clinical laboratory center. The correlation between the AMH level and COH outcomes and cut-off values for poor and high response after COH was analyzed.
Concentration of AMH was significantly correlated with the number of oocytes retrieved (OPU; r=0.700, p<0.001). The mean±SE serum AMH levels for poor (OPU≤3), normal (4≤OPU≤19), and high (OPU≥20) response were 0.94±0.15 ng/mL, 2.79±0.21 ng/mL, and 6.94±0.90 ng/mL, respectively. The cut-off level, sensitivity and specificity for poor and high response were 1.08 ng/mL, 85.8%, and 78.6%; and 3.57 ng/mL, 94.4%, and 83.3%, respectively.
Our data present clinical reference values of the serum AMH level for ovarian response in Korean women. The serum AMH level could be a clinically useful predictor of ovarian response to COH.
Clinical and experimental reproductive medicine. 12/2012; 39(4):176-81.
[show abstract][hide abstract] ABSTRACT: To determine age-specific reference values for anti-Müllerian hormone (AMH) and to set up an optimal model for AMH changes by age for infertility investigations.
Several infertility clinics and two university hospitals.
A total of 21 226 AMH samples were obtained.
Data on patients' age, race/ethnicity, and AMH levels were available from the laboratory center data registry between November 2008 and January 2011.
The distribution of AMH levels by age. From 16 972 women aged between 25 and 45 years, we established and validated five AMH-age regression models.
The overall mean AMH level was 4.09 ± 3.71 ng/mL (median: 3.13 ng/mL). There was an inverse relation between AMH level and age. Among multiple regression models, the quadratic model was most appropriate to describe AMH-age relation (log AMH = 0.205 × age - 0.005 × age(2) - 0.047).
AMH levels show a progressive decline with increasing age. Age-specific AMH values may provide more specific information useful for patients and clinicians. AMH-age models could play a role as a basic step to approach more accurate ovarian reserve estimation.
[show abstract][hide abstract] ABSTRACT: This study was performed to assess the prognostic value of serum hCG, progesterone, and inhibin A levels measured at 11 days post-ET for predicting pregnancy outcome in women participating in IVF.
Between May 2005 and April 2008, sera were obtained from 70 infertile women who underwent IVF-ET at 11 days post-ET and stored. HCG, progesterone, and inhibin A levels were measured by commercial enzyme-linked immunosorbent assay kits. The predictive accuracy of hCG, progesterone, and inhibin A levels for establishment of intrauterine pregnancy and ongoing pregnancy was calculated by receiver-operating characteristic curve analysis.
For the prediction of intrauterine and ongoing pregnancy, serum hCG was better than progesterone and inhibin A. The predictive performance of progesterone and inhibin A was similar. The serum progesterone and inhibin A levels were significantly correlated each other (r=0.915, p=0.010).
A single measurement of the serum hCG level is sufficient to predict pregnancy outcome in IVF-ET patients.
Clinical and experimental reproductive medicine. 03/2012; 39(1):28-32.
[show abstract][hide abstract] ABSTRACT: c1 All correspondence to: Chang Suk Suh. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 300 Gumi-dong Bundang-gu Seongnam, 463–707, Korea. Tel: +82 31 787 7251. Fax: +82 31 787 4054. e-mail: email@example.com
[show abstract][hide abstract] ABSTRACT: To investigate the effect of antifreeze protein (AFP) supplementation during mouse oocyte vitrification on the survival, fertilization and embryonic development.
In vivo-matured metaphase II oocytes were vitrified with the use of CryoTop by two-step exposure to equilibrium and vitrification solution supplemented or not with 500 ng/mL AFP III.
Postwarming survival, fertilization, embryonic development up to blastocyst in vitro, morphology of spindle and chromosome, membrane integrity, adenosine triphosphate (ATP) contents, and several gene expressions.
In the AFP-treated group, blastocyst formation rate was significantly higher and blastomere count with positive caspase was significantly lower compared with the nontreated group. Rate of intact spindle/chromosome, stable membrane, and ATP contents were significantly higher in AFP group. AFP group showed higher Mad2 and lower Eg5 gene expression. Both vitrification groups showed increased Hsf1, Zar1, and Zp1/Zp2 expression and decreased Hook1 and Zp3 expression compared with fresh control samples.
Supplementation of AFP in vitrification medium has a protective effect on mouse oocytes for chilling injury; it can preserve spindle/membrane integrity and intracellular ATP contents. More stable spindle integrity in the AFP group may be associated with higher Mad2 and lower Eg5 gene expression.
Fertility and sterility 09/2011; 96(5):1239-45. · 3.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: In order to find the optimal exposure time of cryoprotectant, we performed a comparison of vitrification versus slow freezing according to the degree of normal morphology and apoptosis of human ovarian follicles.
Eleven patients aged 20-41 years who underwent operative laparoscopy for benign ovarian cysts or cesarean section were enrolled in this study. We carried out a prospective parallel comparison of survival and morphology of follicles after freezing (slow freezing and vitrification) and thawing. The ovarian strips were vitrified with two-step exposure to equilibration and vitrification solutions at room temperature. After various exposure times of cryoprotectant solution (5 min, 10 min, and 20 min, respectively), cryoprotectant-filled cryovials with pretreated cortical tissues were immediately plunged into liquid nitrogen.
In total, 336 follicles were analyzed by light microscopy to assess the morphology. The distribution of follicles was as follows: primordial, primary, and secondary follicles were 55.7% (187/336), 36.9% (124/336), and 7.4% (25/336), respectively. Vitrification in the 10-min exposure group preserved the follicles most effectively (ratio of grade 1 follicle: 3.6%, 34.7%, 13.8%, and 20.0% in the 5-min, 10-min, 20-min, and slow-freezing groups, respectively). Fewer terminal-deoxynucleotidyl-transferase-dUTP-nick-end-labeling-positive cells were found in vitrification in the 10-min equilibrium group compared with the other cryopreserved-thawed groups (52.1%, 31.5%, 53.1%, and 46.7% in the 5-min, 10-min, 20-min, and slow-freezing groups, respectively). The stromal cells were also better preserved in the 10-min group than the others (P < 0.05).
The 10-min exposure group for vitrification showed better results compared with other conditions and the slow-freezing group.
Journal of Obstetrics and Gynaecology Research 04/2011; 37(8):1092-101. · 0.84 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was performed to compare antimüllerian hormone (AMH) levels measured by two commercially available AMH measuring kits currently available, and to evaluate the AMH levels as predictor of controlled ovarian hyperstimulation (COH) outcome using the two different kits. The two assays for AMH measurement provide similar results, and serum AMH levels measured by the two kits both could be used as COH outcome predictors with similar reference values.
Fertility and sterility 02/2011; 95(8):2602-4. · 3.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: We performed this study to investigate the effect of histone deacetylase inhibition during extended culture of in vitro matured mouse oocytes. In vitro matured mouse (BDF1) oocytes were cultured in vitro for 6, 12, and 24 h, respectively, and then inseminated. During in vitro culture for 6 and 12 h, two doses of trichostatin A (TSA), a histone deacetylase inhibitor, were added (100 nM and 500 nM) to the culture medium and the oocytes were then inseminated. During the 24-h in vitro culture, two doses of TSA were added (100 nM and 500 nM) to the medium and the oocytes were activated with 10 mM SrCl2. After the 6-h culture, the fertilization rate was similar to that of the control group, but the blastocyst formation rate was significantly decreased. After the 12-h culture, both the fertilization and blastocyst formation rates were significantly decreased. After the 24-h culture, total fertilization failure occurred. In the oocytes cultured for 6 and 12 h, the fertilization and blastocyst formation rates did not differ between the TSA-supplemented and control groups. Although extended culture of the mouse oocytes significantly affected their fertilization and embryo development, TSA supplementation did not overcome their decreased developmental potential.
[show abstract][hide abstract] ABSTRACT: It is still controversial that GnRH agonist (GnRHa) protects ovarian function from chemotherapy-induced gonadotoxicity. Indeed, the results of many studies related to this issue are neither consistent nor convincing because of the weak study design and the inadequate sample size. We identified 11 prospective controlled studies (8 nonrandomized and 3 randomized) for the systemic review and meta-analysis. The meta-analysis showed that GnRHa cotreatment during chemotherapy can protect ovarian function. However, it is worthy to note that the result of this meta-analysis is influenced by nonrandomized studies. The protective effect of GnRHa will remain elusive until the currently ongoing large, prospective, randomized studies are completed. In addition, tamoxifen, a selective estrogen receptor modulator, may have the protective effect against loss of follicles and ovarian function, which was caused by chemotherapy.
Clinical obstetrics and gynecology 12/2010; 53(4):740-52. · 2.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: To investigates the effect of sphingosine-1-phosphate (S1P) supplementation on follicular integrity and apoptosis in vitrified-warmed mouse ovarian grafts.
Ovaries from 4-week-aged ICR mice were vitrified using a vitrification solution with or without 2 μM S1P. After warming, follicular normality was assessed by histological analysis and TUNEL assay. A part of ovaries vitrified with or without 2 μM S1P was transplanted, and 2 weeks later, gross and microscopic follicular morphology was assessed.
During vitrification and warming, inclusion of 2 μM S1P into the vitrification solution significantly raised the rate of morphologically intact follicles compared to controls (36.6% vs. 30.8%, p=0.047). This protective effect was profound especially in primordial follicles (45.5% vs. 34.6%, p=0.034). After transplantation of vitrified-warmed ovaries, the morphological integrity of primordial follicles was superior in the S1P-treated group (55.0% vs. 39.4%, p=0.035). The rates of non-apoptotic follicles (TUNEL-negative) were similar in the two groups in either non-transplanted or transplanted ovaries.
Inclusion of S1P in the vitrification solution during transplantation of vitrified-warmed ovary had a beneficial effect on preservation of the primordial follicular pool.
European journal of obstetrics, gynecology, and reproductive biology 10/2010; 152(2):176-80. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Anti-Müllerian hormone (AMH) has been suggested as a marker of ovarian reserve and predictor of ovarian response to controlled ovarian hyperstimulation (COH). Several studies have demonstrated AMH changes during follicular and luteal phases during COH, but not after human chorionic gonadotrophin (hCG) administration. The objectives of this study were to investigate changes in AMH levels during the entire COH cycle and to clarify the regulatory mechanism of AMH secretion. In addition, we analyzed the COH outcome parameters to determine the optimal timing for AMH measurement to predict outcome.
The study included 74 women who underwent in vitro fertilization (IVF) cycles with a GnRH agonist or antagonist protocol. Serum AMH and inhibin B levels were measured at baseline, Day 5 of stimulation (d5), day of hCG administration (dhCG), day of oocyte retrieval (dOPU) and 14 days after oocyte retrieval (dPO14). Follicular fluid (FF) from dominant follicles upon oocyte retrieval were also analyzed for AMH and inhibin B concentrations. AMH levels were analyzed for changes during the cycle and for correlations with COH outcome parameters.
Serum AMH levels decreased progressively during COH until dhCG, then increased on dOPU and further increased on dPO14. Serum and FF AMH levels and dynamic changes were not different between the GnRH agonist and antagonist cycles. Serum AMH levels on every sample day and the FF AMH levels were significantly correlated with outcomes of COH, such as dose of gonadotrophins used, estradiol level on dhCG and number of retrieved oocytes; the strength of the relationship was highest for baseline AMH.
The results of the present study suggest that changes in the hormonal milieu during stimulation and after the LH surge may affect AMH secretion. Serum AMH levels during COH are good markers to predict ovarian response, but the baseline serum level seems to be the most predictive marker.
Human Reproduction 10/2010; 25(10):2597-604. · 4.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the ovarian reserve changes after laparoscopic cystectomy, we prospectively evaluated pre- and postoperative serum anti-Müllerian hormone (AMH) level, and ovarian volumes.
Prospective longitudinal study.
Twenty women with benign ovarian masses participated; endometrioma , mature teratoma , and mucinous cystadenoma . Seven patients had bilateral ovarian masses.
All patients had undergone laparoscopic ovarian cystectomy. Serum AMH levels were serially measured: preoperative, 1 week, 1 month, and 3 months after operation. Volumes of total ovary and ovarian mass were measured by 3D ultrasonography before operation.
Postoperative serum AMH level and ovarian volume.
Median AMH level was 2.23 ng/mL (95% confidence interval [CI] 1.35-3.41 ng/mL) before operation, but reduced to 0.67 ng/mL (95% CI 0.44-1.70 ng/mL) at the first week postoperatively and then increased to 1.14 ng/mL (95% CI 0.79-2.36 ng/mL) in the first month and 1.50 ng/mL (95% CI 0.58-3.26 ng/mL) in the third month. The serum AMH level after 3 months postoperatively was recovered to about 65% of the preoperative level. The serum AMH level at postoperative 1 week was more decreased in endometrioma compared with nonendometrioma (33.9% vs. 69.2% of preoperative level), and in bilateral group compared with unilateral group (16.9% vs. 62.9%).
This study suggests that ovarian reserve could be reduced after laparoscopic cystectomy; however, it could be restored thereafter up to 3 months postoperative in reproductive women.
Fertility and sterility 05/2009; 94(1):343-9. · 3.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was performed to analyze retrospectively outcomes of stimulated in vitro fertilization (IVF) cycles where the gonadotropin-releasing hormone (GnRH) antagonist was omitted on ovulation triggering day. A total of 92 consecutive IVF cycles were included in 65 women who are undergoing ovarian stimulation with recombinant FSH. A GnRH antagonist, cetrorelix 0.25 mg/day, was started when leading follicle reached 14 mm in diameter until the day of hCG administration (Group A, 66 cycles) or until the day before hCG administration (Group B, 26 cycles). The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and the number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in Group B compared to Group A (2.7+/-0.8 vs. 3.2+/-0.9 ampoules). There was no premature luteinization in the subjects. The proportion of mature oocytes (71.4% vs. 61.7%) and fertilization rate of mature (86.3+/-19.7% vs. 71.8+/-31.7%) was significantly higher in Group B. There were no significant differences in embryo quality and clinical pregnancy rates. Our results suggest that cessation of the GnRH antagonist on the day of hCG administration during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising IVF results.
Journal of Korean medical science 05/2009; 24(2):262-8. · 0.84 Impact Factor