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신장이식을 받은 여성에서의 성공적인 임신 및 분만에 관한 보고
연혜정(HJ Yeon),박용원(YW Park),김유선(YS Kim),조재성(JS Cho),송찬호(CH Song),박기일(KI Park) 대한산부인과학회 1993 Obstetrics & Gynecology Science Vol.36 No.8
Transplant recipients who are pregnant are often faced with several kinds of medical problems, such as toxemia and infection, which may contribute to produce a high incidence of preterm labor. As yet many questions regarding the likelihood of successful pregnancy and birth in women after renal allograft and unanswered. In this report, we present our experience of 5 cases of successful pregnancy and birth after renal transplant under strict perinatal care protocol with short review of world literature to establish the proper guideline. There were neither serious complications during gestation in mothers nor problems in infants. But still unknown is the feature of these infants and their progency because of their intrauterine exposure to immunosuppressive drugs. In conclusion, renal allograft with chronic immunosuppression is not per sean obstacle for successful pregnancy and birth, if graft function is excellent and stable.
장기홍,연혜정,박경수,이윤호,황동훈,Chang, Ki-Hong,Yeon, Hye-Jeong,Park, Kyoung-Soo,Lee, Yoon-Ho,Hwang, Dong-Hun 대한생식의학회 1993 Clinical and Experimental Reproductive Medicine Vol.20 No.2
Endometriosis involving sites outside the pelvic cavity is a relatively uncommon occurrence and its frequency is cited as being less than one percent of all occurences of endometriosis. Sites previously reported in literature have described involvement of the extraperitoneal portion of the round ligament, the rectosigmoid, the appendix, and the ileum. Other more distal sites reported to have been found to have endometriosis lesions include the inguinal ligaments, the umbilicus, abdominal incisional wounds, thoracic lesions involving the pleura or diaphragm which may result in catamenial pneumothorax, the kidneys, and vulvar episiotomy wounds. Endometriosis have even been reported to occur in males. In this presentation, three cases of endometriosis, two involving the vulvar area and one involving a Pfannenstiel incision wound, is presented with a review of the pertinent literature in order to discuss its etiology, pathology, diagnosis and treatment.
난소기능평가를 위한 Gonadotropin Releasing Hormone Agonist Stimulation Test (GAST)의 효용성에 관한 연구
김미란,송인옥,연혜정,최범채,백은찬,궁미경,손일표,이진우,강인수,Kim, Mee-Ran,Song, In-Ok,Yeon, Hye-Jeong,Choi, Bum-Chae,Paik, Eun-Chan,Koong, Mi-Kyoung,Song, Il-Pyo,Lee, Jin-Woo,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2
Objectives: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. Design: Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. Materials and Methods: After blood sampling for basal FSH and estradiol $(E_2)$ on cycle day two, 0.5ml (0.525mg) GnRH agonist ($Suprefact^{(r)}$, Hoechst) was injected subcutaneously. Serum $E_2$ was measured 24 hours later. Initial $E_2$ difference $({\Delta}E_2)$ was defined as the change in $E_2$ on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by ${\Delta}E_2$; group A (n=30):${\Delta}E_2$<40 pg/ml, group B (n=52): 40 pg/ml${\leq}{\Delta}E_2$<100 pg/ml, group C (n=20): ${\Delta}E_2{\leq}100$ pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-ET was followed. Ratio of $E_2$ on day of hCG injection over the number of ampules of gonadotropins used ($E_2hCGday$/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as $E_2$ hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. Results: Mean age $({\pm}SEM)$ in group A, B and C were $33.7{\pm}0.8^*,\;31.5{\pm}0.6\;and\;30.6{\pm}0.5^*$, respectively ($^*$: p<0.05). Mean basal FSH level of group $A(11.1{\pm}1.1mlU/ml)$ was significantly higher than those of $B(7.4{\pm}0.2mIU/ml)$ and C $(6.8{\pm}0.4mIU/ml)$ (p<0.001). Mean $E_2hCGday$ of group A was significantly lower than those of group B or C, i.e., $1402.1{\pm}187.7pg/ml,\;3153.2{\pm}240.0pg/ml,\;4078.8{\pm}306.4pg/ml$ respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: $38.6{\pm}2.3,\;24.2{\pm}1.1\;and\;18.5{\pm}1.0$ (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: $6.4{\pm}1.1,\;15.5{\pm}1.1\;and\;18.6{\pm}1.6$, respectively (p<0.0001). By stepwise multiple regression, only ${\Delta}E_2$ showed a significant correlation (r=0.68, p<0.0001) with $E_2HCGday$/Amp, while age or basal FSH level were not significant. Likewise, only ${\Delta}E_2$ correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). Conclusions: These data suggest that initial $E_2$ difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial $E_2$ difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.
불임여성에서 생화학적 임신이 향후 성공적 임신을 예측할 수 있는 인자로서의 유용성에 관 한 연구
이재훈(JH Lee),연혜정(HJ Yeon),김의숙(ES Kim),한정렬(JY Han),송인옥(IO Song),궁미경(MK Koong),강인수(IS Kang),전종영(JY Jun) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11
The objective of this study is to test the hypothesis that the occurrence of biochemical pregnancy is a good prognostic indicator in the future pregnancy performance in subfertile women. A total 174 cycles of conservative treatment in 50 patients infertile for more than one year were included in the analysis. Patients with tubal factor, severe male factor, moderate to severe peritoneal adhesions or patients having assisted reproductive technology were excluded. Serum level of hCG on postovulation day 12 or 13 was measured by immunoradiometric assay using duplicates with sensitivity of 3 mIU/ml and serial measurements were done if hCG>3 mIU/ml. Biochemical pregnancy was defined as serum hCG>3 mIU/ml without gestational sac monitored by vaginal ultrasonography. No-Biochem group was defined as patients having at least three cycles of hCG less than 3 mIU/ml and Biochem group as patients having at least one cycle of biochemical pregnancy. In survival analysis, Kaplan-Meier method was used. The occurrence of viable pregnancy, defined as pregnancy maintaining beyond 20 weeks, was regarded as a terminal event. The patients who were lost to follow up or remaining not experiencing viable pregnancy were regarded as censored. Log rank test was done to determine the difference of cumulative pregnancy rates between the two groups. In this setting, the incidence of biochemical pregnant cycle in infertile women was 10%. There was no significant difference between No-Biochem and Bio- chem group in age, duration of infertility and duration of observation. The 40-month cumulative viable pregnancy rate in No-Biochem was similar to that of Biochem group. By survival analysis, there was no significant difference between the two groups in the cumulative viable pregnancy rate. From these data, the occurrence of biochemical pregnancy dose not appear to be a good prognostic indicator for developing a viable pregnancy via conservative treatment in subfertile patients. Biochemical pregnancy may have two different aspects, one is a success of initiating pregnancy, and the other is a failure of maintaing pregnancy. Thus, it is speculated that in subfertile women, the potential merit of biochemical pregnancy may be counter-balanced by the intrinsic factor(s) which may prevent a viable pregnancy. Further studies are needed to delineate these two different aspects using specific subgroup of patients.