• The Journal of Korean Obstetrics and Gynecology
• /
• v.31 no.3
• /
• pp.152-163
• /
• 2018

Objectives: In recent studies, increased AMH level has been suggested as objective surrogate marker for diagnosis PCOS, one of the major causes of oligomenorrhea. The purpose of this study is to report the clinical effect of Korean medicine treatment on oligomenorrhea patient with increased Anti-mullerian hormone level, who can be diagnosed who can be ruled out PCOS. Methods: A 27 year old woman with oligomenorrhea was enrolled in this study. We measured serum hormone levels and ruled out PCOS. The patient received Korean medicine treatment for 3 months, we assessed the result of treatment through observation of the menstrual cycle and follow-up measurements of serum hormone levels. Results: 1. The patient had menstrual cycle regularly. 2. Increased serum AMH level of the patient decreased from 12.16 ng/ml to 8.51 ng/ml. 3. The other serum hormone levels such as testosterone, LH/FSH ratio decreased Conclusion: This case shows that Korean medicine treatment could have a beneficial effect on menstrual cycle and decrease the increased serum hormone levels of ruled out PCOS patient.

• The Journal of Korean Obstetrics and Gynecology
• /
• v.26 no.3
• /
• pp.73-84
• /
• 2013

Objectives: This study aims to identify associated factors in female infertility treatment using herbal medicine, acupuncture and moxibustion. Methods: Acupuncture and moxibustion treatments were performed with intake of herbal medicines (Jokyungjongoktanggagam-bang, Sutaehwangagam-bang) for six menstrual cycles in 32 subfertile women. The variables selected for initial analysis were age, duration and type of infertility, frequency of previous In Vitro Fertilization (IVF) and live births, weekly frequency of sexual intercourse, number of treatment cycles, endometrial thickness on MCD15 and hormonal parameter (anti-mullerian hormone, follicle-stimulating hormone, luteinizing hormone, estrone). Results: Six patients became pregnant (18.75%) and seven patients withdrew. Factors influenced pregnancy were age (${\leq}35$ years), a shorter duration of infertility (<6 years), frequency of IVF (${\leq}3$), anti-mullerian hormone level (>1 ng/ml), and number of treatment cycles(${\leq}3$ cycles). Conclusions: Korean medicine is a useful and optimized treatment option for women with younger age, fewer previous IVF cycles, shorter infertile duration and normal anti-mullerian hormone level at first 3 cycles of treatment.

• Journal of Embryo Transfer
• /
• v.28 no.2
• /
• pp.149-155
• /
• 2013

Mullerian inhibiting substance (MIS) is a member of the TGF-${\beta}$ (transforming growth factor-${\beta}$) family whose members play key roles in development, suppression of tumour growth, and feedback control of the pituitary-gonadal hormone axis. MIS is expressed in a highly tissue-specific manner in which it is restricted to male Sertoli cells and female granulose cells. The serum levels of MIS in prenatal and postnatal ICR mice were measured using the enzyme-linked immuno-solvent assay (ELISA) using the MIS/AMH antibody. Mice were grouped by age: the significant periods were at the onset of development. During sex organ differentiation, no remarkable difference between female and male foetus MIS serum levels (both<0.1 ng/ml) was observed. However, MIS serum levels in pregnant mice markedly changed (4.5~12.2 ng/ml). After birth, postnatal female and male mice serum MIS levels changed considerably (male: <0.1~138.5 ng/ml, female: 5.3~103.4 ng/ml), and the changing phase were diametrically opposed (male: decreasing, female: fluctuating). These findings suggest that MIS may have strong associations with not only develop-ment but also puberty. For further studies, establishing the standard MIS serum levels is of importance. Our study provides the basic information for the study of MIS interactions with reproductive organ disability, cancer, and the effect of other hormone or menopause. We hypothesise that if MIS is regularly injected into middle-age women, meno-pause will be delayed. We detected that serum MIS concentration curves change with age. The changing phase is different between males and females, and this difference is significant after birth. Moreover, MIS mRNA is expressed during the developmental period (prenatal) and also in the postnatal period. This finding indicates that MIS may play a significant role in the developmental stage and in growth after birth.

• Annals of Pediatric Endocrinology and Metabolism
• /
• v.23 no.4
• /
• pp.210-214
• /
• 2018

Purpose: Premature adrenarche (PA) often leads to polycystic ovary syndrome (PCOS). Higher anti-mullerian hormone (AMH) levels are reported in PCOS. We studied the androgen profile and AMH profiles in Hispanic girls with PA (aged 5-8 years) and age and body mass index (BMI) matched controls. Methods: Retrospective review of electronic medical records of girls who met the inclusion criteria for premature adrenarche were done. Results: PA girls (n=76) were matched to control girls (n=12) for age (mean${\pm}$standard deviation) ($6.7{\pm}1years$ vs. $6.2{\pm}1.3years$) and BMI ($20{\pm}10kg/m^2$ vs. $17.8{\pm}2.7kg/m^2$). Dehydroepiandrostenedione sulfate ($63.3{\pm}51.3{\mu}g/dL$ vs. $29.8{\pm}17.3{\mu}g/dL$, P<0.001) and testosterone levels ($11.4{\pm}4.8ng/dL$ vs. $8.2{\pm}2.9ng/dL$, P=0.001) were significantly higher in the PA group than controls. AMH values (<14 years: reference range, 0.49-3.15 ng/mL) were $3.2{\pm}2.2ng/mL$ vs. $4.6{\pm}3.2ng/mL$ respectively in the PA and control groups and were not different (P=0.4). AMH did not show a correlation with bone age (P=0.1), and testosterone (P=0.9) in the PA group. 17-hydroxyprogesterone levels (17-OHP ng/dL) were $39.5{\pm}30.5ng/dL$ vs. $36.8{\pm}19.8ng/dL$ in PA versus control girls. The concentration of 17-OHP was not statistically different between the control and PA groups. Conclusion: Higher AMH was not observed in PA girls and no correlation with BA and androgen levels was observed.

• The Journal of Korean Obstetrics and Gynecology
• /
• v.28 no.2
• /
• pp.174-182
• /
• 2015

Objectives : AMH (Anti-Müllerian Hormone) is considered a sensitive marker of ovarian reserve, and it tends to be included among basic fertility tests. This paper is to report four pregnancies which were achieved by subfertile women with low AMH level after Korean medical treatments. Methods : Four cases of pregnancy by subfertile women, aged 34 to 37, with low AMH level (0.04 to 0.76 ng/mL), after Korean medical treatments between July 2012 and May 2015, were analysed. The patients were diagnosed as Kidney deficiency (腎虛), Blood extravasation (瘀血) and/or Liver Qi stagnation (肝氣 鬱結). Herbal medicine, acupuncture, pharmacopuncture and moxibustion treatments were applied. Results : The four subfertile women with low AMH level achieved pregnancy after Korean medical treatments. Conclusions : The case report suggests that Korean medical treatment can be an effective option for subfertile women with low AMH level before Assisted Reproductive Technology.

• Clinical and Experimental Reproductive Medicine
• /
• v.49 no.2
• /
• pp.76-86
• /
• 2022

Ovarian cystectomy is the preferred technique for the surgical management of ovarian endometrioma. However, other techniques such as ablation or sclerotherapy are also commonly used. The aim of this review is to summarize information regarding the efficacy of ablation and sclerotherapy compared to cystectomy in terms of ovarian reserve, the recurrence rate, and the pregnancy rate. Several studies comparing ablation versus cystectomy or sclerotherapy versus cystectomy in terms of the serum anti-Müllerian hormone (AMH) decrement, endometrioma recurrence, or the pregnancy rate were identified and summarized. Both ablation and cystectomy have a negative impact on ovarian reserve, but ablation results in a smaller serum AMH decrement than cystectomy. Nonetheless, the recurrence rate is higher after ablation than after cystectomy. More studies are needed to demonstrate whether the pregnancy rate is different according to whether patients undergo ablation or cystectomy. The evidence remains inconclusive regarding whether sclerotherapy is better than cystectomy in terms of ovarian reserve. The recurrence rates appear to be similar between sclerotherapy and cystectomy. There is not yet concrete evidence that sclerotherapy helps to improve the pregnancy rate via in vitro fertilization in comparison to cystectomy or no sclerotherapy.

• Clinical and Experimental Reproductive Medicine
• /
• v.49 no.3
• /
• pp.202-209
• /
• 2022

Objective: The aim of this study was to assess the correlation of oocyte number with serum anti-Müllerian hormone (AMH) levels measured by two automated methods (Access or Elecsys) in fresh stimulated in vitro fertilization (IVF) cycles. Methods: In this retrospective study at a university hospital, data were collected from 243 fresh stimulated IVF cycles performed from August 2016 to December 2020. The serum AMH level was measured by Access in 120 cycles and by Elecsys in 123 cycles. The cut-off of serum AMH for prediction of poor responders (three or fewer oocytes) or high responders (15 or more oocytes) was calculated by the receiver operating characteristic curve analysis. Results: For the two automated methods, the following equations were derived: total oocyte number=2.378+1.418×(Access-AMH) (r=0.645, p<0.001) and total oocyte number=2.417+2.163×(Elecsys-AMH) (r=0.686, p<0.001). The following combined equation could be derived: (Access-AMH)=0.028+1.525×(Elecsys-AMH). To predict poor responders, the cut-off of Access-AMH was 1.215 ng/mL (area under the curve [AUC], 0.807; 95% confidence interval [CI], 0.730-0.884; p<0.001), and the cut-off of Elecsys-AMH was 1.095 ng/mL (AUC, 0.848; 95% CI, 0.773-0.923; p<0.001). To predict high responders, the cut-off of Access-AMH was 3.450 ng/mL (AUC, 0.922; 95% CI, 0.862-0.981; p<0.001), and the cut-off of Elecsys-AMH was 2.500 ng/mL (AUC, 0.884; 95% CI, 0.778-0.991; p<0.001). Conclusion: Both automated methods for serum AMH measurement showed a good correlation with oocyte number and good performance for predicting poor and high responders in fresh stimulated IVF cycles. The Access method usually yielded higher measured serum AMH levels than the Elecsys method.

• Clinical and Experimental Reproductive Medicine
• /
• v.50 no.4
• /
• pp.285-291
• /
• 2023

Objective: Infertility can result from a diminished ovarian reserve, but a potential remedy exists in the form of platelet-rich plasma (PRP) administration. This treatment involves both biological factors and tissue trauma mechanisms, which stimulate folliculogenesis, making it a promising and effective strategy. We assessed the impact of direct PRP injections into the ovaries on the fertility outcomes of women classified as poor responders. Methods: A quasi-experimental study was conducted from April 2021 to December 2022, focusing on patients classified as POSEIDON grade 3 or 4. PRP injections were administered into both ovaries. After 3 months, data were collected on anti-Mullerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and the numbers of oocytes, mature oocytes, and good-quality embryos following ovarian stimulation. We then compared the data from before and after PRP injection. Results: This study included 50 women, with a mean of 39 years (interquartile range [IQR], 35 to 43) and 4 years (IQR, 2 to 6) for age and infertility duration, respectively. FSH levels decreased after treatment, while AMH levels and the numbers of oocytes, metaphase II oocytes, and high-quality embryos increased. However, only the increase in high-quality embryos was significant. The pregnancy and spontaneous pregnancy rates were 20% and 14%, respectively. Notably, women with secondary infertility exhibited a significantly higher pregnancy rate than those with primary infertility. Conclusion: Ample evidence suggests that PRP can enhance ovarian function. However, further studies are needed to identify the appropriate candidates for this procedure, establish the optimal PRP preparation method, and standardize the procedure for its adjuvant use in assisted reproductive technology cycles.

• Clinical and Experimental Reproductive Medicine
• /
• v.45 no.1
• /
• pp.31-37
• /
• 2018

Objective: To evaluate the pregnancy rate and time to pregnancy after timed coitus with or without superovulation in infertile young women younger than 35 years old with low serum $anti-M{\ddot{u}}llerian$ hormone (AMH) levels ( < 25th percentile). Methods: A total of 202 patients younger than 35 years old were recruited retrospectively between 2010 and 2012. Ninety-eight women had normal serum AMH levels (25-75th percentile), 75 women had low serum AMH levels (5th ${\leq}$ & < 25th percentile) and 29 women had very low serum AMH levels ( < 5th percentile), according to reference values for their age group. Results: The clinical pregnancy rate was positively associated with AMH levels, but this trend did not reach statistical significance (43.9% vs. 41.3% vs. 27.6% in the normal, low, and very low AMH groups, respectively). The time to pregnancy was longer in the very low AMH group than in the normal AMH group ($13.1{\pm}10.9months$ vs. $6.9{\pm}6.1months$, p= 0.030). The cumulative live birth rate over 18 months was lower in the very low AMH group than in the normal AMH group, with marginal significance (20.0% vs. 55.9%, p= 0.051). The duration of infertility was negatively correlated with achieving pregnancy (odds ratio, 0.953; 95% confidence interval, 0.914-0.994; p= 0.026). Conclusion: Conservative management, such as timed coitus with or without superovulation, should be considered in young patients who have low ovarian reserve without any infertility factors. However, for women with a long duration of infertility or very low serum AMH levels, active infertility treatment should be considered.

• The Journal of Korean Obstetrics and Gynecology
• /
• v.31 no.4
• /
• pp.39-53
• /
• 2018

Objectives: The purpose of this review was to overview and evaluate the efficacy of electroacupunture for women with polycystic ovarian syndrome (PCOS) Methods: Relevant randomized controlled studies (RCTs) were identified by database searches in PubMED, EMBASE, OASIS, and Google scholar, up to May 2018. Data were extracted regarding hyperandrogenism, obesity and hyperinsulinemia indices. The risk of bias was assessed. Results: Five RCTs were included for analysis. In one RCT, electroacupuncture group had significantly lower free testosterone and testosterone, compared to no treatment group. However, The other RCTs showed no significant difference between two groups. For LH/FSH, Ferriman Gallway score, anti-mullerian hormone, body mass index, weight and waist, and insulin, electroacupuncture group showed no significant difference, compared to physical exercise, no treatment, and sham acupuncture group. Conclusions: Only a limited number of RCTs have been reported. At present, there is insufficient evidence to support the use of electroacupuncture for treatment of PCOS.