불임 환자의 치료에서 Mild Ovarian Hyperstimulation을 이용한 Single IUI와 Double IUI의 비교

손영수,이상훈,Son, Young-Soo,Lee, Sang-Hoon 대한생식의학회 2004 Clinical and Experimental Reproductive Medicine Vol.31 No.3

Objective: To compare the clinical efficacy of double intrauterine insemination with single intrauterine insemination in GnRH antagonist combined ovarian hyperstimulation (Mild ovarian hyperstimulation) Materials and Methods: From Jan. 2001 to Jul. 2004, a retrospective clinical analysis was done of a total of 295 cycles in 170 patients who underwent ovarian hyperstimulation for ART (assisted reproductive technique). Subjects were divided into three groups; only clomiphene citrate ovarian hyperstimulation (n=55, 95cycles), GnRH antagonist combined ovarian hyperstimulation (soft ovarian hyperstimulation) (n=66 99cycles), and GnRH agonist combined ovarian hyperstimulation (short protocol) (n=49, 101cycles) Each group were randomly devided into two subgroups. One group underwent single IUI and the other group underwent double IUI. Results: GnRH antagonist group and GnRH agonist group had similar pregnancy rate. In GnRH antagonist Group, pregnancy rate was 36.1% in single IUI subgroup and was 36.6% in double IUI subgroup. These finding were not statistically significant. And Pregnancy rate was 20.8% in single IUI subgroup and was 19.3% in double IUI subgroup in single clomiphene citrate group, and 36.3% in single IUI subgroup and was 33.3% in double IUI subgroup in GnRH agonist group. These finding were not statistically significant, too. Conclusion: Pregnancy rate of GnRH antagonist was high and complication rate such as OHSS and multiple pregnancy was lower. In GnRH antagonist group, to compare with single IUI and double IUI, the result do not statistically differ. So GnRH antagonist single injection with single IUI was relatively comparable ART in infertiliry patient.

불임증 치료를 위한 자궁강내 인공수정에 관한 연구

김석현(SH Kim),지병철(BC Jee),노경록(KR Noh),이재학(JH Lee),이용찬(YC Lee),문신용(SY Moon),이진용(JY Lee) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.7

The objective of this retrospective study was to evaluate the outcomes of intrauterine insemination(IUI) in infertile patients and to investigate the prognostic factors affecting pregnancy results in IUI. From March, 1993 to February, 1996, a total of 123 cycles of IUI in 55 infertile patients were analyzed statistically. Exclusion criteria in this study were the patients ages ≥38 years, high basal serum FSH(≥25mIU/mL), hypothalamic pituitary failure, and previous history of pregnancy by means of IUI. The mean age of study group was 31.7 years, and the mean duration of infertility was 54.5 months. The overall clinical pregnancy rate(PR) was 8.9%(11/123) per cycle and 20.0%(11/55) per patient, and the rates of ectopic pregnancy and multiple pregnancy were the same as 9.1%(1/11). The spontaneous PR with natural intercourse was 5.5%(3/55) per patient. The PR was the highest in patients with ovulatory dysfunction as their infertility factor(25.0% per patient). As the number of IUI trials increased, the cumlative pregnancy rate(CPR) was decreased from 9.1% to 8.1% cycle. In cycles using gonadotropins such as hMG or FSH as their regimen of controlled ovarian hyperstimulation(COH), the PR was higher, compared with those using clomiphene citrate(CC). The PR in cycles with 3 mature follicles(diameter ≥ 16 mm) on hCG administration day was higher than those with 1 or 2 mature follicles, but the largest follicular diameter on hCG administration day was not correlated with the PR. In cycles with premature LH surge, no pregnancy occurred, whereas the PR was 15.0% in cycles without premature LH surge. Between pregnant and nonpregnant groups, there were no significant differences in age of patients, duration of infertility, number of IUI trials, diameter of the largest follicle, number of mature follicles, and length of follicular phase. In conclusion, IUI is a rather simple, safe and cost-effective treatment modality in the management of infertility, and the use of gonadotropins for COH may improve a pregnancy rate significantly in IUI.

자궁내 인공수정 실패 후 조경산가감(調經散加減) 복용을 통해 자연임신에 성공한 난임환자 2례의 임상보고

김현주 ( Hyeon-ju Kim ) 대한한방부인과학회 2017 大韓韓方婦人科學會誌 Vol.30 No.3

Objectives: The purpose of this paper is to report the spontaneous pregnancy of Jokyung-san-gagam treatments on two infertile patients who were failed to in intrauterine insemination (IUI) by three times. Methods: Two patients, in this case, were who failed three times IUI were treated with Jokyung-san-gagam, acupuncture and moxibustion. Results: The two infertile women achieved spontaneous pregnancy after taking Jokyung-san-gagam without assisted reproductive technology. Conclusions: These cases suggest that Jokyung-san-gagam is effective in treating infertile female after failure in IUI and can be an effective option for patients who were failed in IUI. For further study, the clinical approach on infertile patients that is based on Korean medicine treatment including Jokyung-san-gagam would be sustained.

보조생식술 실패 후 犀角地黃湯加味 복용치료를 통해 자연임신에 성공한 난임 환자 치험 2례

고지은,유명숙 대한한방부인과학회 2015 大韓韓方婦人科學會誌 Vol.28 No.1

Objectives: Spontaneous pregnancy is a rare event after repeated failure of invitro fertilization (IVF) or Intrauterine insemination (IUI) treatment. So thispaper is to report the natural pregnancy of Gamiseogagjihwang-tang treatmentson two infertile patients who were repeatedly failed in IVF or IUI. Methods: One patient was a 35-year-old patient diagnosed with the adenomyosisand contralateral tubal obstruction, treated with 90 cc Gamiseogagjihwang-tangtwo times per day for 6 weeks after second failure of IVF. The other patient wasa 34-year-old patient undergone induced abortion by three times, treated with 90 ccGamiseogagjihwang-tang two times per day for 4 weeks after second failure of IUI. Results: Through taking Gamiseogagjihwang-tang without assisted reproductiontechniques, two cases got pregnant naturally. Conclusions: These cases suggest that Gamiseogagjihwang-tang is effective intreating infertile female after failure in IVF or IUI and inducing spontaneouspregnancy. Therefore, there needs to be more trial on infertile patients treated withSeogagjihwang-tang.

자궁강내 인공수정을 위한 과배란유도시 Clomiphene Citrate 부하검사를 이용한 난소 반응의 예측에 관한 연구

김석현(SH Kim),최수희(SH Choi),지병철(BC Jee),서창석(CS Suh),최영민(YM Choi),김정구(JK Kim),문신용(SY Moon),이진용(JY Lee) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

Objective: This clinical study was performed to set up a cut-off value of clomiphene citrate challenge test[CCCT] as a predictor of the diminished ovarian reserve and fecundity and to assess the clinical usefulness of CCCT as a predictor of ovarian response in controlled ovarian hyperstimulation[COH]. Materials and Methods: From January, 1994 to September, 1998, CCCT was performed in 105 infertile patients undergoing COH with clomiphene citrate[CC] or exogenous gonadotropins for intrauterine insemination[IUI]. Diagnoses of infertility for inclusion were ovulatory factor, minimal and mild endometriosis, cervical factor, and unexplained infertility. Infertile patients whose basal serum FSH was more than 30 mIU/mL were excluded. Results: To define the abnormal ovarian response, the cut-off value of serum FSH measured on the tenth day of menstrual cycle[FSH10] was determined as 25.3 mIU/mL arbitrarily from 17 patients who conceived naturally after CCCT. Mean values of age, infertility duration, basal LH[LH3] and estradiol[E23], and CC-stimulated LH[LH10] and E2[E210] in normal CCCT group[n=95] were not significantly different from those in abnormal CCCT group[n=10]. Only basal FSH[FSH3] was lower significantly in normal CCCT group[p=0.003]. CC-stimulated FSH[FSH10] was well correlated with FSH3[r=0.656, p<0.001], but not with age, LH3, LH10, E23, and E210. Twenty pregnancies were obtained in COH cycles with natural coitus or IUI. The number of patients with abnormal CCCT was only 1[5.0%] in pregnant group and 9[10.6%] in nonpregnant group. Only mean value of FSH10 was lower significantly in pregnant group [p=0.042]. Conclusion: As serum FSH response to CC stimulation[FSH10] predicts ovarian reserve and fecundity better than age or basal serum FSH level[FSH3], CCCT might be a very useful clinical test as a predictor of ovarian response in COH, especially in infertile patients with no other abnormal findings that predict poor prognosis in COH.

정자표면의 항정자항체에 의한 불임환자들에 있어서 과배란유도주기에서의 자궁강내 인공수정과 체외수정시술의 비교

김정훈(JH Kim),김낙연(NY Kim),전용필(YP Jeon),강병문(BM Kang),장윤석(YS Chang),목정은(JE Mok) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.2

This prospective study was performed to evaluate the effectiveness of controlled ovarian hyperstimulation(COH) with intrauterine insemination(IUI) versus in vitro fertilization and embryo transfer(IVF-ET) in the treatment of male infertility caused by sperm surface antibodies. From March 1995 to August 1996, 29 couples with male immunologic infertility entered the trial. Only men with ≥40% motile spermatozoa with bound antibodies of immunoglobulin (Ig)G, IgA or a combination of both in direct immunobead test(IBT) were included in this study. There was no evidence of other factors in infertility in any infertile couples. The couples were randomized to undergo either COH with IUI(IUI group), or IVF-ET(IVF group). IUI group and IVF group were similar with respect to female and male age, duration of infertility, and IBT results. There were no significant differences between two groups with regard to the amount of gonadotropins required, days of gonadotropins administration, serum estradiol concen- tration on the day of human chorionic gonadotropin(hCG) administration, the number of mature (≥14mm) follicles, or endometrial thickness. A total of 10 clinical pregnancies were obtained in IUI group, and 12 in IVF group. In 2 of 30 IVF cycles, intracytoplasmic sperm injection(ICSI) was performed because of fertilization failure. One patient became pregnant after ICSI. There were no significant differences between two groups in the clinical pregnancy rate per cycle (31.3% vs 40.0%), miscarriage rate(20.0% vs 8.3%), and multiple pregnancy rate(20.0% vs 16.7%). There were also no significant differences in pregnancy outcome between two groups according to the Ig isotype of sperm surface antisperm antibody(ASA)(GA group, IgG ASA ≥ 40%, IgA ASA≥40%; G group, IgG ASA ≥40%, IgA<40%; A group, IgG ASA <40%, IgA ASA ≥40%). This study suggests that it could be reasonable to offer COH with IUI to the patients with infertility caused by sperm surface ASA, prior to their referral for more expensive and invasive procedure, IVF-ET.

Dual trigger with gonadotropin-releasing hormone agonist and recombinant human chorionic gonadotropin improves the outcome of intrauterine insemination

Binarwan Halim,Hilma Putri Lubis 대한산부인과학회 2022 Obstetrics & Gynecology Science Vol.65 No.2

ObjectiveThe objective of this study was to evaluate the effectiveness of dual trigger, which is a combination of gonadotropinreleasingagonist (GnRH-a) and recombinant human chorionic gonadotropin (hCG) in the final oocyte maturation, inthe outcome of intrauterine insemination (IUI). MethodsThis retrospective observational study was conducted from January 2016 to October 2018 and involved 639 IUI cyclesat the Halim Fertility Center, Indonesia. Controlled ovarian stimulation was performed during IUI cycles. The ovulationtriggers were divided into two groups: group I received a combination of GnRH-a and recombinant hCG as a dualtrigger, and group II received only recombinant hCG as a single trigger. The baseline characteristics, cycle parameters,and IUI outcomes of both groups were compared. ResultsOur study included a total of 639 IUI cycles, 334 were in the dual trigger group and 305 in the single trigger group. The clinical pregnancy rates were significantly higher in the dual trigger group than in the single trigger group(P<0.001). Based on the multivariate analysis, the dual trigger increased the clinical pregnancy rate by 2.524 timesthan that by the single trigger. ConclusionOur data showed that the dual trigger combination of GnRH-a and recombinant hCG significantly improves theoutcome of intrauterine insemination.

자궁강내 인공수정에 의한 임신율

홍정의,이지삼,Hong, Jeong-Eui,Lee, Ji-Sam 대한생식의학회 1998 Clinical and Experimental Reproductive Medicine Vol.25 No.2

The effectiveness of intrauterine insemination (IUI) combined with controlled ovanan hyperstimulation (COH) in the treatment of infertility with various etiologies was compared in a total of 152 cycles. Patients received a maximum of three IUI cycles for the treatment. Severe male ($<2\times10^6$ motile sperm) or age factor (> 39 y) patients were excluded in this study. Pregnancy was classified as clinical if a gestational sac was seen on ultrasound. The overall clinical pregnancy rate was 7.9% per cycle (12/152) and 9.7% per patient (12/124). The pregnancy rates were 0% in unstimulated natural (0/18), 7.5% in CC (3/40), 8.2% in CC+hMG (4/49), 5.9% in GnRH-a ultrashort (1/17), 5.9% in GnRH-a long (1/17) and 27.3% in dual suppression cycles (3/11), respectively. The pregnancy rate was higher in dual suppression cycle than other stimulated cycles, but this was not significant. The multiple pregnancy rates were 25.0% (2 twins and 1 triplet). No patient developed ovarian hyperstimulation. Abortion rates were 66.7% in CC (2/3) and 100% in ultrashort cycles (1/1). The livebirth rate was 5.9% per cycle (9/152) and 7.3% per patient (9/124). There were no differences in age, duration of infertility, follicle size, total ampules of gonadotropins and days of stimulation between pregnant and non-pregnant groups. However, significant(P<0.05) differences were observed in the level of estradiol $(E_2)$ on the day of hCG injection ($3,266.6{\pm}214.2$ vs $2,202.7{\pm}139.4$ pg/ml) and total motile sperm count ($212.1{\pm}63.4$ vs $105.1{\pm}9.9\times10^6$) between pregnant group and non-pregnant group. These results suggest that IUI combined with successful ovarian stimulation tends to improve the chance of pregnancy as compared to IUI without COH and a total motile sperm count may be considered predictive of the success for pregnancy.

자궁내막증과 동반된 불임환자의 보조생식술을 이용한 치료

문신용,이경순,노재숙,서창석,김석현,최영민,신창재,김정구,이진용,장윤석,Moon, Shin-Yong,Lee, Kyung-Soon,Roh, Jae-Sook,Suh, Chang-Suk,Kim, Seok-Hyun,Choi, Young-Min,Shin, Chang-Jae,Kim, Jung-Gu,Lee, Jin-Young,Chang, Yoon-Seok 대한생식의학회 1995 Clinical and Experimental Reproductive Medicine Vol.22 No.2

Though the endometriosis is not always related with infertility, endometriosis causes infertility in some patients. There are many treatment modalities of infertile patients who have endometriosis. In recent years, Assisted Reproductive Technology(ART) have been widely accepted as being a useful tool for the treatment of infertile endometriotic patients. The objective of this study was to evaluate the outcome of ART in infertile endometriotic patients who have been carried out IVF-ET from Jan, 1992 to Dec, 1994 and to compare the results between COH/IUI and IVF-ET in the patients with endometriosis stage I. Tubal disease only patients were grouped(308 patient, 956 cycles) as a control. Endometriosis group was subdivided into 4 groups according to American Fertility Society classification; endometriosis stage I (45 patients, 61 cycles), stage II (26 patients, 39 cycles), stage III (26 pateitns, 37 cycles), stage IV (33 patients, 50 cycles). The outcomes of IVF-ET in endometriosis patients were as follows; The oocyte recovery rates were significantly lower in stage III, IV endometriosis. In case of stage III endometriosis, the fertilization rate was significantly lower than other stages of endometriosis. Clinical pregnancy rates per cycle were not different between the tubal group(22%) and the endometriosis group(25%). According to endometriosis stage, the implantation rate and clinical pregnancy rate were significantly lower in stage IV (5.6%, 16%) compared with other stages (I; 10.0%, 26%, II;9.8%, 31%, III;12.6%, 32%). It suggests that some factor like autoantibodies may inhibit implantation of embryos in stage IV endometriosis. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles and CC cycles between 1992 and 1994 in the women with endometriosis stage 1. In case of stage I endometriosis, though the COH/IUI group showed lower FSH level and lesser age profile than IVF-ET group, IUI group has resulted in lower pregnancy rates(19.2%) compared with the IVF-ET group(26.2%). In conclusion, endometriotic infertile patients can get comparable pregnancy rates with the tubal factor infertility patients during IVF-ET program. Moreover even in stage I endometriosis, IVF-ET may be an more effective treatment modality than COH/IUI.

자궁강내 인공수정시 사용되는 카테타에 따른 임상 결과의 비교

채희동(Hee Dong Chae),강은희(Eun Hee Kang),김정훈(Chung Hoon Kim),강병문(Byung Moon Kang),장윤석(Yoon Seok Chang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.2

Objective: To compare the clinical outcomes of intrauterine insemination (IUI) according to the catheter used. Materials and Method: From March 1998 to September 1998, total 95 infertile patients were included in this study. Patients were randomly allocated to TomCat group (n = 39) and Mackler group (n = 56) according to the catheter for insemination. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone agonist (GnRH-a) was used in all patients. Statistical analysis was performed using Student's t-test, Fisher's exact test, and χ2 test as appropriate. Statistical significance was defined as p < 0.05. Results: The total dose and duration of exogeneous gonadotropin required were similar between the two groups. There were also no significant differences in serum estradiol (E2) level, endometrial thickness and texture on the day of hCG administration between the two groups. However, the percentage of uterine souding due to failure of initial approach was significantly higher in TomCat group compared to Mackler group (23.1% vs. 0%, p < 0.01). The percentage of bleeding after IUI in TomCat group seemed to be higher than that in Mackler group (15.4% vs. 3.6%, p = 0.06), although there was no statistically significant difference between the two groups. There was also no significant difference in the clinical pregnancy rate per patient between the two groups. Conclusion: These results suggested that using Mackler catheter might be effective for IUI, especially for the patients with cervical factor infertility.