Hamchoon Womens Clinic

Seoul, South Korea

Hamchoon Womens Clinic

Seoul, South Korea
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Moon K.Y.,Seoul National University | Moon K.Y.,Seoul Maria Fertility Hospital | Kim H.,Seoul National University | Lee J.Y.,Hamchoon Womens Clinic | And 7 more authors.
Clinical and Experimental Reproductive Medicine | Year: 2016

Objective: Ovarian reserve tests are commonly used to predict ovarian response in infertile patients undergoing ovarian stimulation. Although serum markers such as basal follicle-stimulating hormone (FSH) or random anti-Müllerian hormone (AMH) level and ultrasonographic markers (antral follicle count, AFC) are good predictors, no single test has proven to be the best predictor. In this study, we developed appropriate equations and novel nomograms to predict the number of oocytes that will be retrieved using patients' age, serum levels of basal FSH and AMH, and AFC. Methods: We analyzed a database containing clinical and laboratory information of 141 stimulated in vitro fertilization (IVF) cycles performed at a university-based hospital between September 2009 and December 2013. We used generalized linear models for prediction of the number of oocytes. Results: Age, basal serum FSH level, serum AMH level, and AFC were significantly related to the number of oocytes retrieved according to the univariate and multivariate analyses. The equations that predicted the number of oocytes retrieved (log scale) were as follows: model (1) 3.21-0.036×(age)+0.089×(AMH), model (2) 3.422-0.03×(age)-0.049×(FSH)+0.08×(AMH), model (3) 2.32-0.017×(age)+0.039×(AMH)+0. 03×(AFC), model (4) 2.584-0.015×(age)-0.035×(FSH)+0.038×(AMH)+0.026×(AFC). model 4 showed the best performance. On the basis of these variables, we developed nomograms to predict the number of oocytes that can be retrieved. Conclusion: Our nomograms helped predict the number of oocytes retrieved in stimulated IVF cycles. © 2016. The Korean Society for reproductive medicine.


PubMed | Catholic University of Korea, Seoul National University, Hamchoon Womens Clinic, Dongguk University and 5 more.
Type: Journal Article | Journal: Obstetrics & gynecology science | Year: 2015

To analyze practice patterns and checklists of second trimester ultrasonography, and to investigate management plans when soft markers are detected among Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) members.An internet-based self-administered questionnaire survey was designed. KSUOG members were invited to the survey. Checklists of the second trimester ultrasonography were also requested. In the questionnaire survey, general practice patterns of the second trimester ultrasonography and management schemes of soft markers were asked. In the checklists analysis, the number of items were counted and also compared with those recommended by other medical societies.A total of 101 members responded. Eighty-seven percent routinely recommended second trimester fetal anatomic surveillance. Most (91.1%) performed it between 20+0 and 23+6 weeks of gestation. Written informed consents were given by 15.8% of respondents. Nearly 60% recommended genetic counseling when multiple soft markers and/or advanced maternal age were found. Similar tendencies were found in the managements of individual soft markers. However, practice patterns were very diverse and sometimes conflicting. Forty-eight checklists were analyzed in context with the number and content of the items. The median item number was 46.5 (range, 17 to 109). Of 49 items of checklists recommended by International Society of Ultrasound in Obstetrics and Gynecology and/or American Congress of Obstetricians and Gynecologists, 14 items (28.6%) were found in less than 50% of the checklists analyzed in this study.Although general practice patterns were similar among KSUOG members, some of which were conflicting, and there is a need for standardization of the practice patterns and checklists of second trimester ultrasonography, which also have very wide range of spectrum.


Lee J.Y.,Hamchoon Womens Clinic | Kim E.N.,A-Life Medical | Kim E.N.,University of Ulsan | Hong J.-S.,Seoul National University | And 7 more authors.
Journal of Clinical Pathology | Year: 2015

Aims: Primary histopathology of miscarriage remains undetermined in the majority of cases. This study was conducted to determine histological characteristics pertinent to miscarriage. Methods: The study groups were composed of elective abortions (n=29) and miscarriages (n=45) comprised of chromosomally normal (n=15) and abnormal cases (n=30). Immunohistochemistry was done against CD3, CD8, TIA-1 and CD56. Results: Two histological features - diffuse decidual leucocytoclastic necrosis (DDLN) and decidual natural killer cell aggregates (NKCA) - were relatively common in miscarriages. The frequencies of DDLN and NKCA were different between the groups (p<0.05 and p<0.05, respectively). DDLN was found in 13.8% (4/29) of elective abortions, while it was observed in 60.0% (9/15) and 23.3% (7/30) of chromosomally normal and abnormal miscarriages, respectively. DDLN was more frequent in chromosomally normal miscarriages than in elective abortions (p=0.004). NKCA was present in 13.8% (4/29) of elective abortions, while being found in 33.3% (5/15) and 43.3% (13/30) of chromosomally normal and abnormal miscarriages, respectively. NKCA was more frequent in chromosomally abnormal miscarriages than in elective abortions (p=0.020). Conclusions: The findings strongly suggest that defective placentation and abnormal maternal immune response are associated with miscarriage. DDLN and NKCA seem to have diagnostic values in the pathological evaluation of miscarriage. © 2015, BMJ Publishing Group. All rights reserved.


Kim E.N.,University of Ulsan | Kim E.N.,Asan Medical Center | Yoon B.H.,Seoul National University | Jeon E.J.,Asan Medical Center | And 8 more authors.
Placenta | Year: 2015

This study examined the occurrence of placental C-reactive protein (CRP) in normal pregnancy with term delivery, spontaneous preterm delivery (sPTD), preeclampsia, and miscarriage. CRP immunoreactivity was detected in the syncytiotrophoblast. The immunopositive rate was significantly higher in sPTD than preeclampsia. The CRP immunopositive rate was also higher in acute chorioamnionitis than those without and showed a good correlation with the maternal serum CRP concentration. CRP mRNA expression was not detected in human and mouse placentas or choriocarcinoma cells. CRP may play a role in the pathological and physiological states of pregnancy. © 2015 Elsevier Ltd.


PubMed | University of Ulsan, Hamchoon Womens Clinic and Seoul National University
Type: Journal Article | Journal: Journal of clinical pathology | Year: 2015

Primary histopathology of miscarriage remains undetermined in the majority of cases. This study was conducted to determine histological characteristics pertinent to miscarriage.The study groups were composed of elective abortions (n=29) and miscarriages (n=45) comprised of chromosomally normal (n=15) and abnormal cases (n=30). Immunohistochemistry was done against CD3, CD8, TIA-1 and CD56.Two histological features--diffuse decidual leucocytoclastic necrosis (DDLN) and decidual natural killer cell aggregates (NKCA)--were relatively common in miscarriages. The frequencies of DDLN and NKCA were different between the groups (p<0.05 and p<0.05, respectively). DDLN was found in 13.8% (4/29) of elective abortions, while it was observed in 60.0% (9/15) and 23.3% (7/30) of chromosomally normal and abnormal miscarriages, respectively. DDLN was more frequent in chromosomally normal miscarriages than in elective abortions (p=0.004). NKCA was present in 13.8% (4/29) of elective abortions, while being found in 33.3% (5/15) and 43.3% (13/30) of chromosomally normal and abnormal miscarriages, respectively. NKCA was more frequent in chromosomally abnormal miscarriages than in elective abortions (p=0.020).The findings strongly suggest that defective placentation and abnormal maternal immune response are associated with miscarriage. DDLN and NKCA seem to have diagnostic values in the pathological evaluation of miscarriage.


PubMed | Hamchoon Womens Clinic, Sungkyunkwan University, University of Ulsan, Asan Medical Center and Seoul National University
Type: Journal Article | Journal: Placenta | Year: 2015

This study examined the occurrence of placental C-reactive protein (CRP) in normal pregnancy with term delivery, spontaneous preterm delivery (sPTD), preeclampsia, and miscarriage. CRP immunoreactivity was detected in the syncytiotrophoblast. The immunopositive rate was significantly higher in sPTD than preeclampsia. The CRP immunopositive rate was also higher in acute chorioamnionitis than those without and showed a good correlation with the maternal serum CRP concentration. CRP mRNA expression was not detected in human and mouse placentas or choriocarcinoma cells. CRP may play a role in the pathological and physiological states of pregnancy.


Kim E.N.,University of Ulsan | Kim E.N.,Asan Medical Center | Yoon B.H.,Seoul National University | Lee J.Y.,Hamchoon Women's Clinic | And 7 more authors.
Virchows Archiv | Year: 2015

Placental C4d deposition is frequent in preeclampsia, and shallow placentation is a characteristic of both preeclampsia and miscarriage. This study was conducted to determine the relationship among placental C4d, maternal human leukocyte antigen (HLA) antibodies, and placental pathology in preeclampsia and miscarriage cases. The patient population (N = 104) included those with (1) preterm preeclampsia with fetal growth restriction (PE-FGR; n = 21), (2) preterm preeclampsia (PE; n = 20), (3) spontaneous preterm delivery (sPTD; n = 39), and (4) miscarriage (n = 24). C4d immunohistochemistry was performed, and the presence of maternal plasma HLA antibodies was examined. C4d staining of the syncytiotrophoblast was more frequent in PE-FGR patients (76.2 %) than in PE (10.0 %; p < 0.001) and sPTD (2.6 %; p < 0.001) patients. Maternal HLA antibody-positive rate was not different among the study groups. There was a significant correlation between C4d immunoreactivity and placental pathology consistent with maternal vascular underperfusion (p < 0.001) but not with maternal HLA antibody status. In miscarriages, the positive rates of C4d, HLA class I, and HLA class II antibodies were 58.3, 25.0, and 12.5 %, respectively. There was no correlation between the presence of maternal HLA class I or II antibodies and placental C4d immunoreactivity. This study confirms frequent placental C4d deposition in preeclampsia with fetal growth restriction and miscarriage. The association between placental C4d deposition and pathological findings of maternal vascular underperfusion suggests that C4d staining of the syncytiotrophoblast is a consequence of defective placentation rather than of a specific maternal immune response against fetal HLA. The study also demonstrates the usefulness of C4d as a biomarker of placentas at risk. © Springer Science+Business Media Dordrecht 2015.


Lee J.Y.,Hamchoon Womens Clinic | Jee B.C.,Seoul National University | Lee J.R.,Seoul National University | Kim C.H.,Hamchoon Womens Clinic | And 6 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2012

Objective. To determine age-specific reference values for anti-Müllerian hormone (AMH) and to set up an optimal model for AMH changes by age for infertility investigations. Design. Prospective study. Setting. Several infertility clinics and two university hospitals. Sample. A total of 21 226 AMH samples were obtained. Methods. Data on patients' age, race/ethnicity, and AMH levels were available from the laboratory center data registry between November 2008 and January 2011. Main outcome measures. The distribution of AMH levels by age. From 16 972 women aged between 25 and 45 years, we established and validated five AMH-age regression models. Results. The overall mean AMH level was 4.09 ± 3.71 ng/mL (median: 3.13 ng/mL). There was an inverse relation between AMH level and age. Among multiple regression models, the quadratic model was most appropriate to describe AMH-age relation (log AMH = 0.205 × age - 0.005 × age 2- 0.047). Conclusions. AMH levels show a progressive decline with increasing age. Age-specific AMH values may provide more specific information useful for patients and clinicians. AMH-age models could play a role as a basic step to approach more accurate ovarian reserve estimation. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.


Kim K.,Hamchoon Womens Clinic
Journal of the Korean Medical Association | Year: 2015

Although conventional prenatal screening tests for Down syndrome have been developed over the past 20 years, the positive predictive value of these tests is around 5%. Through these tests, many pregnant women have taken invasive tests including chorionic villi sampling and amniocentesis for confirming Down syndrome. Invasive test carries the risk of fetal loss at a low but significant rate. There is a large amount of evidence that non-invasive prenatal test (NIPT) using cell free DNA in maternal serum is more sensitive and specific than conventional maternal serum and/or ultrasound screening. Therefore implementing NIPT will increase aneuploidy detection rate and concurrently decrease fetal loss rate accompanying invasive test. More than 1,000,000 NIPT were performed globally since 2011. The uptake rate of NIPT is expected to increase more rapidly in the future. Moreover, as a molecular genetic technique advances, NIPT can be used for not only common aneuploidy screening but single gene disorder, microdeletion, and whole fetal genome sequencing. In this review, I will focus on the NIPT for common aneuploidies such as trisomy 13, 18, and 21. © Korean Medical Association.

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