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Objective To evaluate the effect of progesterone supplementation during the luteal phase on pregnancy outcome in natural frozen-thawed embyo transfer (FTET) cycles. Methods In this retrospective cohort study, 228 consecutive patients who underwent FTET cycles between January 2009 and September 2012 were included. One hundred forty-five patients received luteal progesterone support (P group) but 83 patients did not receive any progesterone supplementation during luteal phase (control group). Results There were no differences in patients' characteristics between the two groups. The two groups were similar with respect to the characteristics of previous fresh in vitro fertilization cycle in which embryos were cryopreserved including the numbers of oocytes retrieved, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and frozen embryos. Also, significant differences were not observed between the P and control groups in clinical pregnancy rate, embryo implantation rate and multiple pregnancy rate. However, miscarriage rate was significantly lower in the P group and live birth rate was significantly higher in the P group than in the control group (P

Objective To evaluate whether the surgical resection or aspiration with ethanol sclerotherapy (AEST) of endometrioma before in vitro fertilization (IVF) affect controlled ovarian stimulation (COS) and IVF outcome in the infertilie women with endometroma undergoing IVF. Methods In this retrospective cohort study, 101 consecutive IVF/intracytoplasmic sperm injection cycles that were performed in 101 patients with endometrioma(s) between January 2008 and December 2012 were included. Before IVF, 36 patients underwent surgical resection of endometrioma (resection group), 29 patients had transvaginal endometrioma AEST (aspiration group), and 36 patients did not take any surgical intervention (control group). The three groups were compared in terms of COS and IVF outcomes. Results Total antral follicle count was significantly lower in the resection group than in the aspiration or control group. The numbers of follicles with a diameter of 14 to 17 mm on the human chorionic gonadotropin day, retrieved oocytes, mature oocytes, and fertilized oocytes were significantly lower in the resection group than in two other groups. However, three groups were similar in terms of clinical pregnancy rate (CPR) per initiated cycle, CPR per embryo transfer, embryo implantation rate, and miscarriage rate. Conclusion Neither of surgical resection and AEST of endometrioma before IVF treatment can give any beneficial effect on IVF outcomes. Moreover, surgical resection of endometrioma can affect the ovarian reserve and ovarian response during COS.

Objective: To investigate the relationship between embryo population density and embryo development in vitro. Methods: Swiss Webster albino mice were used and blastocysts were flushed from the uterine horns. Various numbers of blastocysts were randomly assigned to separate 35 mm dishes and cultured for 9 days. Results: The effect of duration of culture to the mean success rates was different as the number of embryos in the dish was changed. In early egg cylinder (EEC) stage; the mean success rate was a flat function of the number of embryos. But the mean success rate was a decreasing function in late egg cylinder (LEG) stage and the decreasing rate was faster in early somite (ES) stage. Interestingly, the mean success rate to ES stage was nearly constant when more than 10 embryos were cultured in one dish. Conclusion: The success rate to each developmental stage in vitro decreased as the number of embryos in the dish and the duration of culture increased.

목적: To investigate the influence of endometrial polypectomy performed on the day of oocyte retrieval in patients with large endometrial polyp undergoing IVF/intracytoplasmic sperm injection (ICSI), compared with polypectomy on 1st day of ovarian stimulation. 방법: A total of 74 consecutive IVF/ICSI cycles were included in 62 women with endometrial polyp with a mean diameter of 10 mm or more in whom endometrial polypectomy was performed on either the day of oocyte retrieval (late polypectomy group, 39 cycles) or 1st day of ovarian stimulation (early polypectomy group, 35 cycles). 결과: There were no differences in patients` characteristics between the two groups. There were also no differences in total dose and days of recombinant human FSH (rhFSH) administered, and numbers of retrieved oocytes, mature oocytes, fertilized oocytes, grade 1 or 2 embryos and embryos transferred between the two groups. There were no differences in the clinical pregnancy rate per cycle initiated, embryo implantation rate and miscarriage rate between the two groups. 결론: Early and late endometrial polypectomy groups were comparable with respect to IVF and pregnancy outcomes, and therefore endometrial polypectomy on the day of oocyte retrieval is more patient-friendly option for patients with large endometrial polyp undergoing IVF/ICSI.

Pernicious anemia has recently been recognized as one of the risk factors for osteoporosis and bone fractures, but the underlying pathophysiologic mechanism is still unknown. To determine whether vitamin B12 has any direct effect on osteoblasts, we studied the effects of vitamin B12 on the proliferation and alkaline phosphatase activity in human bone marrow stromal osteoprogenitor cells (hBMSC) and UMR106 osteoblastic cells. Vitamin B12 at concentrations as low as 10(-12) mol/L significantly stimulated [3H]-thymidine incorporation in both types of cells, but concentrations higher than 10(-12) mol/L did not produce a greater effect. Vitamin B12 in the concentration range from 10(-12) to 10(-8) mol/L concentration-dependently increased alkaline phosphatase activity in both hBMSC and UMR106 cells. Based on these results, we suggest that a suppressed activity of osteoblasts may contribute to osteoporosis and fractures in patients with vitamin B12 deficiency.

Objective To determine if the immunotherapy with corticosteroids would improve pregnancy rate in infertile patients with ovulatory factor and patients with unexplained infertility who undergo superovulation with IUI. Design Prospective, controlled study. Setting Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Ulsan, Seoul, Korea. Patients Ninety-one infertile patients with ovulatory factors and 78 patients with unexplained infertility who underwent superovulation with IUI. Results The prevalence of autoantibodies (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, antidouble-stranded DNA antibody) was elevated significantly in patients with unexplained infertility compared with patients with ovulatory infertility (20.5% versus 3.3%). Forty-five patients with ovulatory factor underwent 72 cycles of superovulation with IUI, receiving corticosteroids. Thirty-eight patients with unexplained infertility underwent 75 cycles of superovulation with IUI, receiving corticosteroids. Forty-six patients with ovulatory factor who underwent 66 cycles of superovulation with IUI and 40 patients with unexplained infertility who underwent 75 cycles of superovulation with IUI served as controls, not receiving corticosteroids. In patients with ovulatory factor, there were no significant differences between the corticosteroid treatment group and control group in clinical pregnancy rate (38.9% versus 33.3%) or in spontaneous abortion rate (14.3% versus 13.6%). In patients with unexplained infertility, there was a significantly higher clinical pregnancy rate per cycle in the corticosteroid treatment group, with 45.3% (34/75) compared with 29.3% (22/75) in the control group but no difference between the corticosteroid treatment and control groups in spontaneous abortion rate (17.6% versus 13.6%). There were no side effects due to the use of corticosteroids. Conclusion These results demonstrate that immunotherapy with corticosteroids could improve pregnancy rate in patients with unexplained infertility who undergo superovulation with IUI.

Endometriosis is defined as the presence of functional endometrial tissue outside the uterus, causing diverse progressive symptoms such as infertility, pelvic pain, and dysmenorrhea. Although endometriosis has been described since the 1800s, the mechanisms responsible for its pathogenesis and progression remain poorly understood. It is well established that endometriosis grows and regresses in an estrogen-dependent fashion and the disease can be effectively cured by definitive surgery. However, prolonged medical therapy may be needed in most of the cases since conservative surgery is usually performed especially in young women. This treatment modality is often associated with only partial relief and/or recurrence of the disease. In the present review, up-to-date findings on the treatment of endometriosis will be briefly summarized. The outcomes of surgery in patients with endometriosis will be reviewed in terms of pelvic pain relief as well as infertility treatment largely based on recent Cochrane reviews and clinical reports. The efficacy of newer drugs including aromatase inhibitor, anti-tumor necrosis factor-alpha, and dienogest will be also reviewed based on recent clinical studies.

OBJECTIVE: To investigate the effect of intravenous immunoglobulin (IVIG) treatment on pregnancy outcome following IVF/ICSI in infertile patients with endometriosis. DESIGN: Prospective, randomized controlled trial. MATERIALS AND METHODS: A total of 120 infertile patients with stage III or IV endometriosis were randomized in a 2:1 ratio to IVIG treatment group or control group. GnRH agonist (GnRH-a) long protocol was used for controlled ovarian stimulation (COS) in all subjects. For the treatment group (n1⁄480), 10 gm of IVIG were administered on the day of oocyte retrieval. One to three embryos were transferred into the uterus on the third day after oocyte retrieval. The primary endpoint was the embryo implantation rate. RESULTS: Patient’s characteristics were comparable in the treatment and control groups. There were also no significant differences with respect to COS and IVF results between the two groups. However, embryo implantation rate was significantly higher in the treatment group of 22.3% (50/ 224) compared with 12.2% (14/115) in control group (P1⁄40.024). Clinical pregnancy rate (CPR) was higher in the treatment group with a borderline significance (P1⁄40.052). In singleton pregnant women following IVF/ICSI, serum b-hCG level on the eleventh day after embryo transfer was significantly higher in the treatment group of 180.2 45.7 mIU/ml compared with 82.8 26.7 mIU/ml in the control group (P

in 38 cases (53%). Staging was performed in 19 surgeries, with 16 done by pediatric surgeons. Appendectomywasperformed in17 cases,with pediatric surgery performing 15 of these (88%). Immature teratomaswere present in 6 cases (8.3%) ages 5-20 years. All were laparotomies and in 5 tumor markers were obtained and staging performed. Alpha-fetoprotein, drawn in all 5,was elevated, ranging 25-390 ng/mL. Immature teratomas had an average greatest diameter of 15.4 cm (range 12 to 25.5 cm). Conclusions: Pediatric surgeons weremore likely to perform laparotomy and oophorectomy as compared to general gynecologists and gynecology oncologists. Although there is minimal information regarding incidence of immature teratomas in children and adolescents, our percentage was higher than expected based on previous studies. Movement toward standardized imaging, tumor marker assessment and ovarian sparing surgery when appropriate should be done to benefit children and adolescents' recovery and future fertility.

목적 지방평활근종은 매우 드문 자궁의 양성 신생물로 이에 대한 연구보고는 소규모로 제한적이었다. 본 논문의 임상적 분석은 자궁평활근종의 임상적 경과를 명확하게 하고 또한 수술 전 진단 시 영상학적 검사의 유용성과 한계를 이해하여 치료계획을 수립하는 데 도움을 주고자 시행하였다. 연구방법 본 연구는 1995년부터 2009년까지 서울아산병원에서 수술 후 지방평활근종으로 진단된 51예를 후향적으로 검토하였다. 임상적 소견, 영상학적 소견, 그리고 병리적 소견을 환자 의무기록을 토대로 조사하였다. 결과 환자의 평균나이는 52.1±10.8세였고 종양의 크기의 평균값은 5.6 ± 3.5 cm였다. 수술 소견에서 46명(90%)은 자궁체부, 3명(6%)은 자궁넓은인대에 지방평활근종이 있었다. 1명(2%)은 자궁경부에서 다른 1명(2%)은 뒤쪽 더글라스와의 배막뒤공간에서 진단되었다. 모든 환자는 수술 전에 영상학적 검사를 시행하였는데 수술 전에 지방평활근종을 진단받은 환자는 7명(14%)이었다. 난소 종양으로 진단받은 환자가 8명(16%)이었다. 병리학적 소견상 세포학적 이형성, 괴사 또는 다른 변성은 없었다. 추적 관찰기간 동안에 지방평활근종과 관련된 사망은 없었고 재발도 발견되지 않았다. 결론 지방평활근종은 양성 종양이며 지방성분으로 인한 영상학적 특성은 컴퓨터단층촬영과 자기공명영상으로 지방평활근종을 진단하는 데 유용하다. 지방평활근종이 자궁넓은인대나 배막뒤공간에 위치하는 경우에는 수술이 필요한 난소종양과 감별하기 어렵다. 결국 이러한 경우에는 증상이 없어도 병리학적 진단을 위해 수술적 치료를 시행해야 한다.

Uterus didelphys with unilateral obstructed hemivagina, and ipsilateral renal agenesis is a rare congenital anomaly due to Mullerian duct malformation. The most common clinical manifestation is dysmenorrhea, pelvic pain, vaginal or pelvic mass after menarche. Early diagnosis is important, to preserve fertility, to prevent adhesion due to retrograde menstruation, hematometra, hematosalpinx and endometriosis which lead to distorted pelvic anatomy. These anomalies could be diagnosed with ultrasonography and magnetic resonance imaging. Resection or incision of vaginal septum is adequate treatments to relieve symptoms and reserve fertility. We report a case of uterus didelphys with unilateral obstructed hemivagina and ipsilateral renal agenesis with a brief review of the literature.

Objective To compare the effectiveness and convenience of a pen device for the self-administration of follitropin β with a conventional syringe delivering follitropin β solution in patients undergoing IVF-ET. Methods GnRH agonist long protocol was used for controlled ovarian stimulation (COS) in all subjects. A total of 100 patients were randomized into the pen device group or the conventional syringe group on the first day of COS. Local tolerance reactions were assessed within 5 minutes, at 1 hour and at 3 hours after each injection. On the day of hCG injection, patients were asked to rate their overall pain and convenience experienced with self-injection on a visual anlaogue scale (VAS). Results There were no differences in patients' characteristics between the two groups. The duration of COS was significantly shorter in the pen device group than in the conventional syringe group. Patients included in the pen device group needed a significantly smaller amount of follitropin β. However, no differences between the two groups were found in IVF results and pregnancy outcome. The incidence of local pain within 5 minutes, at 1 hour and at 3 hours after the injection was significantly lower in the pen device group. VAS scores indicated that injections using the pen device were significantly less painful and more convenient. Conclusion The pen device for self-administration of follitropin β is less painful, safer and more convenient for the patients, and can be more effective because of the shorter duration and smaller dose of follitropin β when compared with the conventional syringe.

자궁경부암은 발생 빈도가 높은 여성암 중 하나이다. 초기 자궁경부암 환자에서 생식력보존이 필요한 경우 근치적 자궁경부절제술은 흔히 사용되는 치료법이 되었다. 하지만 근치적 자궁경부절제술 시행 후 임신을 시도할 경우 협부협착으로 인한 불임 그리고 자궁경부 절제로 인한 조기 진통 및 조기 양막파수 등의 합병증이 문제 되고 있다. 본원에서 자궁경부암 Ib1을 진단받고 복강경식 근치적 자궁경부절제술 및 양측 골반내 임파선절제술 시행 후 자궁 협부협착이 발생한 환자에서 협부확장술 시행 후 자궁강내 인공수정으로 임신하고 제왕절개술 분만에 성공한 1예를 경험하였기에 간단한 문헌 고찰과 함께 보고하는 바이다.

�Objective: To investigate the effects of pioglitazone on controlled ovarian stimulation (COS), IVF outcomes, and follicular fluid (FF) cytokine concentrations in patients with polycystic ovary syndrome (PCOS). Methods: Eighty-six infertile patients with PCOS resistant to clomiphene citrate were randomized to receive pioglitazone (30 mg/day) or placebo on the starting day of oral contraceptive (OC) pretreatment, followed by an IVF protocol using a GnRH antagonist. Pioglitazone or placebo was administered once daily from the starting day of OC to the day of hCG injection. Results: Total dose and days of recombinant follicle-stimulating hormone administered, and the numbers of retrieved and mature oocytes, were significantly lower in the pioglitazone group than in the control group. FF tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) concen trations at oocyte retrieval were also significantly lower in the pioglitazone group. The clinical pregnancy rate was higher and the incidence of severe ovarian hyperstimulation syndrome was lower in the pioglitazone group, but the differences were not statistically significant. Conclusion: Pioglitazone reduces FF TNF-α and IL-6 levels, and may improve ovarian response to COS in patients with PCOS.

�Objective: To investigate the effectiveness of GnRH antagonist multiple-dose protocol (MDP) with oral contraceptive pill (OCP) pretreatment in poor responders undergoing IVF/ICSI, compared with GnRH antagonist MDP without OCP pretreatment and GnRH agonist low-dose long protocol (LP). Methods: A total of 120 poor responders were randomized into three groups according to controlled ovarian stimulation (COS) options; GnRH antagonist MDP after OCP pretreatment (group 1), GnRH antagonist MDP without OCP pretreatment (group 2) or GnRH agonist luteal low-dose LP without OCP pretreatment (group 3). Patients allocated in group 1 were pretreated with OCP for 21days in the cycle preceding COS, and ovarian stimulation using recombinant human FSH (rhFSH) was started 5 days after discontinuation of OCP. Results: There were no differences in patients’ characteristics among three groups. Total dose and days of rhFSH used for COS were significantly higher in group 3 than in group 1 or 2. The numbers of mature oocytes, fertilized oocytes and grade I, II embryos were significantly lower in group 2 than in group 1 or 3. There were no significant differences in the clinical pregnancy rate and implantation rate among three groups. Conclusion: GnRH antagonist MDP with OCP pretreatment is at least as effective as GnRH agonist low-dose LP in poor responders and can benefit the poor responders by reducing the amount and duration of FSH required for follicular maturation.

A 58-year-old woman who presented with inguinal hernia for the first time was diagnosed as seminoma and complete androgen insensitivity syndrome (CAIS). The patient received a late diagnosis, and therefore she could not take a proper management. CAIS is a rare X-linked recessive disease with an XY karyotype that is caused by androgen receptor defects. It usually present with primary amenorrhea or inguinal hernia. The risk of malignant transformation of undescended testis increases with age, thus gonadectomy should be performed after puberty. We present a case of large advanced seminoma in a woman with CAIS who was neglected and diagnosed lately.

Transvaginal radiofrequncy myolysis is minimally invasive treatment by creating thermal energy in myoma and causing the necrosis of uterine fi broid cells. Unlike myomectomy which is considered to be the most common treatment of uterine myoma in infertile women, transvaginal radiofrequncy myolysis can be performed as outpatient procedure using only sedation for pain relief without additional need for medication. Due to its less invasive approach, the hospitalization is not required. There are many published studies reporting the pregnancy complications and outcomes after myomectomy, but there are very limited data on pregnancy after myolysis. Therefore, we present a case of successful pregnancy and childbirth after transvaginal radiofrequency myolysis of uterine myoma in an infertile women with a brief review of the literature.

Results The number of patients with primary amenorrhea was 89 (12.0%) and secondary amenorrhea was 652 (88.0%). The number of patients with primary amenorrhea was 62 (22.6%) and secondary amenorrhea was 212 (77.4%) in age 10-20 group. In age 2130 group, the number of primary amenorrhea was 27 (6.5%) and secondary amenorrhea was 389 (93.5%). In age 31-40 group, the number of secondary amenorrhea was 51 (100%). The causes of primary amenorrhea in group I were as follows; MayerRokitansky-Kuster-Hauser (MRKH) syndrome (17.7%, 11/62), Turner syndrome (11.3%, 7/62), constitutional delay (9.7%, 6/62). In group II; MRKH syndrome (18.5%, 5/27), Turner syndrome (18.5%, 5/27), and Idopathic hypogonadotropic hypogonadism (14.8%, 4/27). The causes of secondary amenorrhea in group I were as follows; Polycystic ovarian syndrome (PCOS; 60.8%, 129/212), weight related hypogonadotropic hypogonadism (12.3%, 26/212), premature ovarian failure (POF; 9.9%, 21/212). In group II; PCOS (62.5%, 243/389), weight related hypogonadotropic hypogonadism (9.8%, 38/389), POF (9.3%, 36/389). In group III; POF (43.1%, 22/51), PCOS (17.6%, 9/51).

Objective: To compare the angiogenic activities of endothelial cells in the eutopic endometrium of women with and without endometriosis. Design: Vessels with active angiogenesis were identified using the monoclonal antibody to endoglin. Setting: University department of obstetrics and gynecology. Patient(s): Twenty women with histologically confirmed endometriosis after laparotomy or laparoscopy. Women with carcinoma in situ of uterine cervix, but no evidence of endometriosis (n = 20), served as control subjects. Intervention(s): Formalin-fixed, paraffin-embedded archival tissues were sectioned and stained. Main Outcome Measure(s): Number of vessels stained with monoclonal antibody to endoglin. Result(s): For all menstrual phases, the mean number of vessels with endoglin expression was significantly greater in patients with endometriosis compared with control subjects. In each menstrual phase, a significant difference was observed only during the late secretory phase. Within the group with endometriosis, the mean numbers of vessels with endoglin expression in stages I and II were not different from the numbers in stages III and IV. Conclusion(s): This study shows the expression of endoglin in the eutopic endometrium of women with endometriosis is significantly increased and the increase is observed only in the late secretory phase. It is suggested from these findings that activation of angiogenesis in the eutopic endometrium might be a key factor in the pathogenesis of endometriosis.

OBJECTIVE: To evaluate the pregnancy and prenatal outcome after ovulation induction with aromatase inhibitor letrozole or clomiphene citrate (CC). DESIGN: A retrospective study. MATERIALS AND METHODS: 1297 subjects were selected from patients referred to our clinic, and they were divided in two groups (letrozole and CC). 5 mg of letrozole per day was given on days 3-7 of menstrual cycles (n1⁄4693). 100 mg of CC per day was given on days 3-7 as well (n1⁄4604). HMG or FSH was prescribed daily from day 8 along with letrozole or CC. Ovulation was triggered with urinary hCG. We compared oocyte maturation rate, fertilization rate, embryonic growth, pregnancy rate, abortion rate and neonatal condition between letrozole and CC groups. RESULTS: There were no differences in clinical results or prenatal outcomes between the two groups. Furthermore, there was no case recognized with major birth defects.

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 515% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.

목적: 뮐러관 기형 환자의 임상양상과 생식력에 대하여 알아보고자 하였다. 연구 방법: 1990년부터 2009년까지 20년간 서울아산병원에서 뮐러관 기형으로 진단받은 186명의 환자들의 임상적 특징과 생식력을 분석하였다. 결과: 뮐러관 기형은 1,326환자당 1명 (0.075%)의 빈도로 대부분 성인기에 발견되었고, 청소년기와 소아기에 발견된 경우는 15.1%에 불과하였다. 약 40% 이상의 환자들은 증상이 없이 우연히 발견되었지만, 그 외 상당수의 환자들은 무월경, 생리통, 이상 생리 등의 증상을 호소하였다. 본 연구에서 자궁 기형 중 가장 흔한 유형은 쌍자궁 (30.6%)이었고, 다음으로 두뿔 자궁(19.4%), Mayer-Rokitansky-Kuster-Hauser 증후군, 중격 자궁, 단각 자궁의 순이었다. 이들 환자들에서 확인된 251예의 임신의 예후는 자연 유산과 조산이 55.8%로 매우 흔하였고, 총 생존아 출산율은 48.6%였다. 각 자궁 기형별로 분석하였을 때 궁상자궁과 쌍자궁의 생존아 출산률이 각각 60.0%, 58.0%였고, 단각 자궁과 두뿔 자궁은 각각 42.1%, 46.7%로 비슷하게 나타난 반면, 중격 자궁은 32.4%로 상대적으로 낮은 생존아 출산율을 보였다. 결론: 대부분의 뮐러관 기형은 성인기에 발견되지만 많은 수의 환자들은 청소년기 이후부터 생리 이상, 생리통 등의 증상을 보일 수 있다. 본 연구에서 중격 자궁 환자들의 생식력에 대한 예후는 궁상 자궁과 쌍자궁 환자들에 비해 나쁜 것으로 나타났다.

OBJECTIVE: To compare the efficacy and convenience of a pen device for the self-administration of follitropin beta with a conventional syringe delivering follitropin alpha solution in patients undergoing controlled ovarian hyperstimulation (COH) for IVF-ET. DESIGN: A prospective, randomized study. MATERIALS AND METHODS: A total of 100 patients who were scheduled for IVF-ET, with or without intracytoplasmic sperm injection (ICSI) were enrolled in this study. All subjects were randomized to the pen device group or the conventional syringe group by a computer-generated randomization list using random numbers on a first day of COH. Local tolerance reactions were assessed and filled in a local tolerance book within 5 min, at 1 and 3 hr after each injection. On the day of hCG injection, patients were asked to rate the pain and convenience experienced by means of a visual analogue scale (VAS). Oocyte pickup was scheduled 35-36 hours after hCG administration, and embryos were transferred 3 days after oocyte pickup. RESULTS: There were no differences in age, body mass index (BMI), infertility duration, endocrine profile and indications for IVF-ET/ICSI between the two groups. The duration of COH with recombinant FSH (rFSH) was significantly shorter in the pen device group than in the conventional syringe group (8.7 1.1 vs 9.3 1.3 days)(P 0.05). Patients included in the pen device group needed significantly less rFSH with 2091.0 318.8 IU compared with 2248.0 405.0 IU in the conventional syringe group (P 0.05). However, no differences between the two groups were found in numbers of oocytes retrieved, mature oocytes, fertilized oocytes and grade I/II embryos, clinical pregnancy rate and miscarriage rate. The prevalence of pain after the daily injection was significantly lower in the pen device group (P 0.05). VAS scores were significantly less painful and more convenient for the pen device (P 0.05, P 0.00l, respectively). CONCLUSION: The pen device for self-administration of follitropin beta is effective, safe, less painful and more convenient for the patients, and can be more beneficial because of the short-term and small dose application of rFSH. Supported by: Organon grant 2003-0219