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We report a case of a cystic adenomyoma in a 19-year-old nullipara who presented with severe dysmenorrhea and pelvic pain. Preoperative magnetic resonance imaging showed a 3-cm well-circumscribed mass with a 2.1-cm cystic cavity in the myometrium of the left fundus. The tumor, including the cyst, was excised via laparoscopy with a part of the normal myometrium using a modified myomectomy method. On histologic examination, the cystic cavity was lined by endometrial tissue composed of endometrial epithelium and stroma. After 12 months of postoperative follow-up, the patient had significant improvement of dysmenorrhea.

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.

Objective The aim of this study was to investigate whether anti-Mullerian hormone (AMH) levels could be predict ovarian poor/hyper response and IVF cycle outcome. Methods Between May 2010 and January 2011, serum AMH levels were evaluated with retrospective analysis. Three hundred seventy infertile women undergoing 461 IVF cycles between the ages of 20 and 42 were studied. We defined the poor response as the number of oocytes retrieved was equal or less than 3, and the hyper response as more than 25 oocytes retrieved. Serum AMH was measured by commercial enzyme-linked immunoassay. Results The number of oocytes retrieved was more correlated with the serum AMH level (r=0.781, p3.55 ng/mL), the groups showed no statistical differences in mature oocyte rates (71.6% vs. 76.5% vs. 74.8%) or fertilization rates (76.9% vs. 76.6% vs. 73.8%), but showed significant differences in clinical pregnancy rates (21.7% vs. 24.1% vs. 40.8%, p=0.017). Conclusion The serum AMH level can be used to predict the number of oocytes retrieved in patients, distinguishing poor and high responders.

Uterine artery pseudoaneurysm is a rare disease and it can be diagnosed using conventional doppler ultrasongraphy. Damaged uterine arteries from cesarean section, myomectomy, dilatation & curettage, etc. are known as causes of the disease. Massive bleeding in the rupture can cause fatal result. We observed an increase in β-hCG and uterine artery pseudoaneurysm a year after the performance of dilatation & curettage for hydatidiform mole and treated it with arterial embolization and chemotherapy. We report the case and give a brief review of the literature.

Objective To determine the preferred regimen for women with adenomyosis undergoing in vitro fertilization (IVF), we compared the IVF outcomes of fresh embryo transfer (ET) cycles with or without gonadotropin-releasing hormone (GnRH) agonist pretreatment and of frozen-thawed embryo transfer (FET) cycles following GnRH agonist treatment. Methods This retrospective study included 241 IVF cycles of women with adenomyosis from January 2006 to January 2012. Fresh ET cycles without (147 cycles, group A) or with (105 cycles, group B) GnRH agonist pretreatment, and FET cycles following GnRH agonist treatment (43 cycles, group C) were compared. Adenomyosis was identified by using transvaginal ultrasound at the initial workup and classified into focal and diffuse types. The IVF outcomes were also subanalyzed according to the adenomyotic region. Results GnRH agonist pretreatment increased the stimulation duration (11.5±2.1 days vs. 9.9±2.0 days) and total dose of gonadotropin (3,421±1,141 IU vs. 2,588±1,192 IU), which resulted in a significantly higher number of retrieved oocytes (10.0±8.2 vs. 7.9±6.8, p=0.013) in group B than in group A. Controlled ovarian stimulation for freezing resulted in a significantly higher number of retrieved oocytes (14.3±9.2 vs. 10.0±8.2, p=0.022) with a lower dose of gonadotropin (2,974±1,112 IU vs. 3,421±1,141 IU, p=0.037) in group C than in group B. The clinical pregnancy rate in group C (39.5%) tended to be higher than those in groups B (30.5%) and A (25.2%) but without a significant difference. Conclusion FET following GnRH agonist pretreatment tended to increase the pregnancy rate in patients with adenomyosis. Further large-scale prospective studies are required to confirm this result.

Objective: To evaluate the efficacy of earlier oocyte retrieval in IVF patients with a premature LH surge on hCG day. Methods: One hundred forty IVF patients (164 cycles) with premature LH surge on hCG day were included, retrospectively. We divided them into 2 study groups: LH surge with timed ovum pick-up (OPU) 36 hours after hCG injection (group B, 129 premature cycles), and LH surge with earlier OPU within 36 hours after hCG injection (group C, 35 cycles). Control groups were tubal factor infertility without premature LH surge (group A, 143 cycles). Results: The mean age (year) was statistically higher in group C than in groups A or B (38.2 ± 5.4 vs. 36.2 ± 4.2 vs. 36.8 ± 4.9, respectively; p = 0.012). The serum LH levels (mIU/mL) on hCG day were significantly higher in group B and C than in group A (22.7 ± 14.9 vs. 30.3 ± 15.9 vs. 3.2 ± 2.9, respectively; p > 0.001). Among groups A, B, and C, 4.9%, 31.7%, and 51.4% of the cycles, respectively, had no oocytes, and the overall rates of cycle cancellation (OPU cancellation, no oocyte, or no embryos transferrable) were 15.4%, 65.9%, and 74.3%, respectively. The fertilization rate (%) was significantly higher in group B than in group C (73.2 ± 38.9 vs. 47.8 ± 42.9, p = 0.024). The clinical pregnancy rate was significantly higher in group C than in groups A and B (44.4% vs. 27.3% vs. 9.1%, respectively, p = 0.021). However, the miscarriage rate was also higher in group C than in group B (22% vs. 0%, respectively, p = 0.026). Conclusion: Earlier OPU may not be effective in reducing the risk of cycle cancellation in patients with premature LH surge on hCG day. A larger scale study will be required to reveal the effectiveness of earlier ovum retrieval with premature LH surge.

Results %NK cells among peripheral blood lymphocyte in RSA patients before pregnancy was significantly higher than that of nonpregnant normal control. NK cell cytolytic activity in non-pregnant RSA patients was significantly higher than that of non-pregnant fertile group. After success to get pregnancy, NK cell cytolytic activity in RSA patients were decreased but were not significantly different compared to that of NK cell cytolytic activity checked at non-pregnant status. NK cell cytolytic activity in pregnant RSA patients was significantly higher than that of pregnant normal control.

목적: 원인불명의 습관성 유산 환자에서 말초혈액 중 비정상적 비율로 증가된 자연살해세포가 자궁으로의 혈류를 감소시키는지에 대해 알아보고자 하였다. 연구방법: 본 연구는 전향적 연구로, 습관성 유산의 기왕력을 갖는 임신 5-7주 사이의 환자 33명을 대상으로 하였으며 습관성 유산의 기왕력이 없는 정상 임신 5-7주 47명을 대조군으로 하였고, 습관성 유산군은 말초혈액 자연살해세포 비율 12.1%를 기준으로 정상(normal) natural killer (NK) group과 증가(elevated) NK group으로 나누어 연구를 진행하였다. 임신 5-7주 사이에 측정한 말초혈액에서 유세포분석기를 이용하여 말초혈액 자연살해세포 분획 및 세포용해 활성도를 측정 후 그 결과를 비교 분석하였고 질식초음파의 Doppler를 이용하여 자궁방 사동맥의 저항을 측정 후 각 군에서 비교하였다. 또한 말초혈액 자연살해세포분획과 자궁방사동맥 저항지수 간의 연관성을 알아보았다. 결과: 자궁방사동맥의 평균 저항지수는 대조군에 비교하여 습관성 유산 환자군에서 통계학적으로 의미 있게 높았고(0.60 ± 0.14 vs. 0.54 ± 0.12, P = 0.039), 말초혈액 자연살해세포의 분획이 12.1% 이상 증가(elevated NK)군에서도 정상대조군에 비해 통계학적으로 유의하게 높게 나타났다(0.62 ± 0.13 vs. 0.54 ± 0.12, P = 0.029). 또한 전체 습관성 유산 환자에서 말초혈액 자연살해세포의 비율과 자궁방사동맥 저항지수 사이에는 양의 상관관계가 나타났고(P = 0.013, r = 0.429), 특히 습관성 유산 환자중 증가(elevated) NK군에서는 더욱 강한양의 상관관계를 보였다(P = 0.001, r=0.667). 결론 증가된 말초혈액의 자연살해세포는 자궁방사동맥과 같은 미세 혈관에 향염증 반응을 일으켜 자궁으로의 혈류를 감소시켜 습관성 유산을 야기한다고 설명할 수 있겠다. 하지만 본 연구의 결론을 확인하기 위해서는 더 큰 규모의 연구뿐 아니라 분자생물학적 기전에 대한 연구도 필요할 것으로 생각된다.

Objective We compared the assisted reproductive technology (ART) outcomes among infertile women with polycystic ovary syndrome (PCOS) treated with IVM, conventional IVF, GnRH agonist, and GnRH antagonist cycles. Methods The prospective study included a total of 67 cycles in 61 infertile women with PCOS. The women with PCOS were randomized into three IVF protocols: IVM/IVF with FSH and hCG priming with immature oocyte retrieval 38 hours later (group A, 14 cycles), GnRH agonist long protocol (group B, 14 cycles), and GnRH antagonist multi-dose flexible protocol (group C, 39 cycles). IVF outcomes, such as clinical pregnancy rate (CPR), implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR), were compared among the three groups. Results Age, BMI, and basal FSH and LH levels did not differ among the three groups. The number of retrieved oocytes and 2 pronucleus embryos was significantly lower in group A compared with groups B and C. The CPR, IR, MR, and LBR per embryo transfer showed no differences among the three groups. There was no incidence of ovarian hyperstimulation syndrome in group A. Conclusion The IR, MR, and LBR in the IVM cycles were comparable to those of the GnRH agonist and GnRH antagonist cycles. The IVM protocol, FSH and hCG priming with oocyte retrieval 38 hours later, is an effective ART option that is comparable with conventional IVF for infertile women with PCOS.