We examined the lymphocytes of peripheral blood (PB) and peritoneal fluid (PF) of women with or w... more We examined the lymphocytes of peripheral blood (PB) and peritoneal fluid (PF) of women with or without endometriosis to investigate the alteration of cytotoxic activity of natural killer (NK) cells and activation of T cells in the peritoneal cavity of women with endometriosis. A total of 16 control women and 14 patients with stage III-IV endometriosis were selected on the basis of laparoscopic examination in National Taiwan University Hospital. The lymphocyte subpopulations (B cell, NK cell and T cell), including T-cell activation markers (CD69, CD25, HLA-DR), in PB and PF were analysed by dual-colour flow cytometry. The NK cytotoxicity of PB and PF mononuclear cells was evaluated by 51Cr release assay. There was a significant decrease of NK cytotoxicity and CD25+ CD3+ lymphocyte subpopulation in PF of women with endometriosis compared with those without endometriosis. However, there was no difference in the proportion of NK cells in both PB and PF between women with and without endometriosis. Therefore, the decreased NK cytotoxicity in PF of women with endometriosis was due to the functional defect, but not quantitative defect, of NK cells. The concomitant reduction of activated T cells in women with endometriosis might suggest its possible role in the defect of NK cytotoxicity.
The overall incidence of chromosomal abnormalities was 8%. There was no single distinctive featur... more The overall incidence of chromosomal abnormalities was 8%. There was no single distinctive feature of semen parameters predictive of the existence of a chromosomal anomaly. All of the patients with obstructive azoospermia had normal karyotypes and AZF. Three patients out of 13 (23%) with nonobstructive azoospermia without 47,XXY had AZF deletions, as well as two (5%) of 43 with severe oligozoospermia. Ninety-two couples underwent 112 ICSI cycles for which a pregnancy rate of 58% was achieved. Five patients with abnormal karyotypes underwent 6 cycles of ICSI that resulted in 1 successful pregnancy. Two patients with AZF deletions achieved pregnancies. One ICSI-derived male had the same AZF deletion as his father, and 1 female baby had no risk of AZF deletion. The authors recommend karyotyping, excluding those with obstructive causes, prior to ICSI for genetic counseling.
Journal of the Formosan Medical Association = Taiwan yi zhi, 1992
A case of combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization... more A case of combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization (IVF) and transfer of six embryos is presented. The case was diagnosed as intrauterine triplets ultrasonographically at seven weeks of gestation. Unfortunately, the patient suffered from severe lower abdominal pain and hypovolemic shock at 10 weeks of gestation, and an emergent laparotomy was done. During the operation, a ruptured cornual pregnancy with accompanying hemoperitoneum was found. Because fetal heart beats were not detected by intraoperative ultrasonography in the other two intrauterine fetuses, evacuation of the gestational contents through the uterine defect was done, and the rupture site was repaired. The incidence, mechanism and management of heterotopic pregnancies after in vitro fertilization and embryo transfer are discussed.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2001
Treatment of endometriosis-associated infertility has not yet become standardized. Various protoc... more Treatment of endometriosis-associated infertility has not yet become standardized. Various protocols including surgical treatment, medical therapy, and a combination of both have been suggested but their use remains controversial. The objective of the present study was to determine whether postoperative adjuvant therapy for endometriosis is effective in improving reproductive outcome. Medical records of infertile patients with newly diagnosed endometriosis treated in a university teaching hospital during a 50-month period were reviewed. After exclusion of patients with other major infertility factors, a total of 209 patients were included in the retrospective analysis. These patients were divided into those receiving (n = 78) or not receiving (n = 131) peri- or postoperative adjuvant medical therapy. The adjuvant therapies included danazol (n = 62), gonadotropin releasing hormone analogues (n = 11), progestins (n = 3), oral contraceptives (n = 1), and mixed treatment (n = 1). The pr...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1999
Both microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI)... more Both microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) are great advances in assisted reproductive techniques. By using the ICSI technique, frozen sperm from the epididymis can result in successful fertilization. The epididymal sperm retrieved via MESA can be cryopreserved for an in-vitro fertilization (IVF) procedure, thus, making repeat surgical retrieval of sperm unnecessary. We report a retrospective analysis of 24 ICSI cycles in 16 patients with obstructive or nonreconstructable azoospermia. Fresh epididymal sperm was used in 13 ICSI cycles and frozen-thawed epididymal sperm was used in the other 11. We compared the fertilization capability of ICSI using frozen-thawed epididymal sperm with fresh epididymal sperm. Eleven patients became pregnant and five of these pregnancies resulted from frozen epididymal sperm. The fertilization rate per oocyte was 58% with fresh sperm, and 66% with frozen-thawed sperm. The rate of clinical pregnancy ...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
Fertilization failure is a serious problem in human in vitro fertilization (IVF) programs and des... more Fertilization failure is a serious problem in human in vitro fertilization (IVF) programs and deserves further investigation and management. Two hundred and ninety-four IVF cycles performed at the National Taiwan University Hospital from July 1989 to June 1991 were retrospectively analyzed. Thirty-seven (13%) of the 294 cycles were observed to have fertilization failure. The incidence of fertilization failure in male factor patients was significantly higher (p < 0.05) than in others. Patients with oligoasthenospermia tended to have a higher rate of fertilization failure than patients with oligospermia or asthenospermia alone. In non-male factor patients, a smaller number of oocytes and mature oocytes was found in patients with fertilization failure than in patients achieving fertilization. Sperm penetration assay (SPA) using zona-free hamster eggs was performed for 15 patients with fertilization failure; no correlation was found between SPA and the fertilizing ability of the sper...
Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association, 1989
One hundred and ten cases of hypertensive disorders in pregnancy were analyzed retrospectively. T... more One hundred and ten cases of hypertensive disorders in pregnancy were analyzed retrospectively. There were 16 cases of gestational hypertension, 36 cases of mild preeclampsia, 43 cases of severe preeclampsia, 6 cases of eclampsia, and 9 cases of chronic hypertension with superimposed severe preeclampsia. The principle of management was conservative in order to prolong pregnancy for patients remote from term. Corticosteroids were used to accelerate fetal lung maturity for patients with gestations of less than 36 weeks and magnesium sulfate was administered to prevent seizures. Fetal heart rate monitoring was done routinely and doppler blood flow velocity time wave form study of uterine and umbilical arteries was also performed in the latter part of the study. The cesarean section rate in gestational hypertension and mild preeclampsia was comparable to the general obstetric population in our institute (26.9% vs. 21.2%), but the rate of severe forms of the disease including severe pree...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1991
In this study, we determined whether there was a correlation between sperm penetration assay (SPA... more In this study, we determined whether there was a correlation between sperm penetration assay (SPA) and acrosome reaction (AR) in sperm after being treated with human follicular fluid (hFF). Sperm specimens were obtained from 13 men participating in our in vitro fertilization program. After washing and preincubation, aliquots of sperm samples were treated with either hFF or Ham's F-10 medium (control). Approximately 1.0 x 10(6) motile sperm from the control and hFF-treated samples were coincubated individually with zona-free hamster eggs for SPA. Sperm remaining in the suspension after coincubation with eggs were taken to determine the incidence of AR by a triple-stain technique. The data revealed that an increased SPA score in hFF-treated samples was related to a higher incidence of acrosome-reacted sperm.
Asia-Oceania Journal of Obstetrics and Gynaecology, 2010
Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyt... more Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyte retrievals were carried out under ultrasound guidance transvaginally and embryos were transferred 48 hours later by laparoscopy into fallopian tubes. Totally 52 cycles were stimulated and 45 retrievals were performed with an average of 8.1 oocytes per retrieval. The average fertilization rate was 54.8%. The implantation rate was 23.8% and the pregnancy rate was 53.5% per transfer. The pregnancy rate per transfer was comparable whether 3 or 4 embryos were transferred. Nine (39.1%) of the 23 pregnancies had multiple pregnancies. Six cases (26.1%) aborted in the first trimester and the remaining 17 were ongoing or term delivery.
By using harmonic generation microscopy, we are able to noninvasive evaluate the health of pre-im... more By using harmonic generation microscopy, we are able to noninvasive evaluate the health of pre-implantation mammalian embryos after in vitro fertilization (IVF) and before transferring to a mother with a high 3D resolution.
To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (... more To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (AAI) was measured in 95 semen samples from patients participating in an IVF program. All patients had at least two mature oocytes. Of 95 patients, 84 had successful fertilization and 11 failed to fertilize all oocytes in vitro. The numbers of mature oocytes were similar between fertilization and nonfertilization groups. The mean AAI, measured using a commercially available (Accu-Sperm) acrosin activity assay, was greater in the fertilization group than in the nonfertilization group, but the difference was not significant. There was no correlation between AAI and the in vitro fertilization rate of mature oocytes. The relation between AAI and semen parameters also showed no significant difference. It would appear that measurement of AAI inaccurately reflects in vitro fertilizability of human sperm.
Journal of Assisted Reproduction and Genetics, 1994
The aim of this work was to evaluate the effect of a Vero cell coculture system on the developmen... more The aim of this work was to evaluate the effect of a Vero cell coculture system on the development of mouse embryos. Mouse embryos were randomly divided and cultured in human tubal fluid (HTF) medium with/without Vero cell monolayers, conditioned medium (CM) obtained from Vero cell cultures, and HTF medium supplemented with peptides extracted from CM. The concentrated CM was examined by SDS/PAGE. The development of mouse embryos was blocked at the blastocyst stage in pure HTF medium (1.4% hatching at day 5). This &amp;amp;amp;amp;amp;amp;amp;amp;quot;blastocyst block&amp;amp;amp;amp;amp;amp;amp;amp;quot; was overcome by coculture with Vero cell monolayers (48.1% hatching at day 5; 1.4 vs 48.1%; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). CM and the addition of 5% fetal bovine serum (24.1 and 34.9% hatching, respectively, at day 5) were also able to enhance the process of hatching. In the other experiment, the addition of peptides extracted from Vero cell cultures also overcame the blastocyst block (12.5%) compared with pure HTF medium (2.1%) (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Electrophoretic separation revealed several classes of polypeptides consistently secreted into CM obtained from Vero cell cultures. Most peptides occurred in the M(r) range between 6.5 kd and 35.9 kd. A developmental block (blastocyst block) of mouse embryos in a serum- and protein-free medium (HTF) was discovered in this study. This block was effectively overcome by HTF plus serum and coculture with Vero cell monolayers and also by the peptides extracted from Vero cell-conditioned medium. We speculate that certain factors secreted or converted by Vero cells may be critical in hatching of mouse embryos. Further study of these factors may be helpful in delineating its mechanism.
American Journal of Obstetrics and Gynecology, 1994
An abdominal pregnancy after superovulation with human menopausal and chorionic gonadotropins fol... more An abdominal pregnancy after superovulation with human menopausal and chorionic gonadotropins followed by intrauterine insemination of the husband&#39;s sperm is reported. The incidence of ectopic pregnancy increases with administration of human menopausal and chorionic gonadotropins. However, the role of human menopausal and chorionic gonadotropins as a cause of abdominal pregnancy has not been delineated. It appears that ultrasonography has become one of the most important aids in the diagnosis of early abdominal pregnancy.
We examined the lymphocytes of peripheral blood (PB) and peritoneal fluid (PF) of women with or w... more We examined the lymphocytes of peripheral blood (PB) and peritoneal fluid (PF) of women with or without endometriosis to investigate the alteration of cytotoxic activity of natural killer (NK) cells and activation of T cells in the peritoneal cavity of women with endometriosis. A total of 16 control women and 14 patients with stage III-IV endometriosis were selected on the basis of laparoscopic examination in National Taiwan University Hospital. The lymphocyte subpopulations (B cell, NK cell and T cell), including T-cell activation markers (CD69, CD25, HLA-DR), in PB and PF were analysed by dual-colour flow cytometry. The NK cytotoxicity of PB and PF mononuclear cells was evaluated by 51Cr release assay. There was a significant decrease of NK cytotoxicity and CD25+ CD3+ lymphocyte subpopulation in PF of women with endometriosis compared with those without endometriosis. However, there was no difference in the proportion of NK cells in both PB and PF between women with and without endometriosis. Therefore, the decreased NK cytotoxicity in PF of women with endometriosis was due to the functional defect, but not quantitative defect, of NK cells. The concomitant reduction of activated T cells in women with endometriosis might suggest its possible role in the defect of NK cytotoxicity.
The overall incidence of chromosomal abnormalities was 8%. There was no single distinctive featur... more The overall incidence of chromosomal abnormalities was 8%. There was no single distinctive feature of semen parameters predictive of the existence of a chromosomal anomaly. All of the patients with obstructive azoospermia had normal karyotypes and AZF. Three patients out of 13 (23%) with nonobstructive azoospermia without 47,XXY had AZF deletions, as well as two (5%) of 43 with severe oligozoospermia. Ninety-two couples underwent 112 ICSI cycles for which a pregnancy rate of 58% was achieved. Five patients with abnormal karyotypes underwent 6 cycles of ICSI that resulted in 1 successful pregnancy. Two patients with AZF deletions achieved pregnancies. One ICSI-derived male had the same AZF deletion as his father, and 1 female baby had no risk of AZF deletion. The authors recommend karyotyping, excluding those with obstructive causes, prior to ICSI for genetic counseling.
Journal of the Formosan Medical Association = Taiwan yi zhi, 1992
A case of combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization... more A case of combined cornual pregnancy and intrauterine twin pregnancy after in vitro fertilization (IVF) and transfer of six embryos is presented. The case was diagnosed as intrauterine triplets ultrasonographically at seven weeks of gestation. Unfortunately, the patient suffered from severe lower abdominal pain and hypovolemic shock at 10 weeks of gestation, and an emergent laparotomy was done. During the operation, a ruptured cornual pregnancy with accompanying hemoperitoneum was found. Because fetal heart beats were not detected by intraoperative ultrasonography in the other two intrauterine fetuses, evacuation of the gestational contents through the uterine defect was done, and the rupture site was repaired. The incidence, mechanism and management of heterotopic pregnancies after in vitro fertilization and embryo transfer are discussed.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2001
Treatment of endometriosis-associated infertility has not yet become standardized. Various protoc... more Treatment of endometriosis-associated infertility has not yet become standardized. Various protocols including surgical treatment, medical therapy, and a combination of both have been suggested but their use remains controversial. The objective of the present study was to determine whether postoperative adjuvant therapy for endometriosis is effective in improving reproductive outcome. Medical records of infertile patients with newly diagnosed endometriosis treated in a university teaching hospital during a 50-month period were reviewed. After exclusion of patients with other major infertility factors, a total of 209 patients were included in the retrospective analysis. These patients were divided into those receiving (n = 78) or not receiving (n = 131) peri- or postoperative adjuvant medical therapy. The adjuvant therapies included danazol (n = 62), gonadotropin releasing hormone analogues (n = 11), progestins (n = 3), oral contraceptives (n = 1), and mixed treatment (n = 1). The pr...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1999
Both microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI)... more Both microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) are great advances in assisted reproductive techniques. By using the ICSI technique, frozen sperm from the epididymis can result in successful fertilization. The epididymal sperm retrieved via MESA can be cryopreserved for an in-vitro fertilization (IVF) procedure, thus, making repeat surgical retrieval of sperm unnecessary. We report a retrospective analysis of 24 ICSI cycles in 16 patients with obstructive or nonreconstructable azoospermia. Fresh epididymal sperm was used in 13 ICSI cycles and frozen-thawed epididymal sperm was used in the other 11. We compared the fertilization capability of ICSI using frozen-thawed epididymal sperm with fresh epididymal sperm. Eleven patients became pregnant and five of these pregnancies resulted from frozen epididymal sperm. The fertilization rate per oocyte was 58% with fresh sperm, and 66% with frozen-thawed sperm. The rate of clinical pregnancy ...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1993
Fertilization failure is a serious problem in human in vitro fertilization (IVF) programs and des... more Fertilization failure is a serious problem in human in vitro fertilization (IVF) programs and deserves further investigation and management. Two hundred and ninety-four IVF cycles performed at the National Taiwan University Hospital from July 1989 to June 1991 were retrospectively analyzed. Thirty-seven (13%) of the 294 cycles were observed to have fertilization failure. The incidence of fertilization failure in male factor patients was significantly higher (p < 0.05) than in others. Patients with oligoasthenospermia tended to have a higher rate of fertilization failure than patients with oligospermia or asthenospermia alone. In non-male factor patients, a smaller number of oocytes and mature oocytes was found in patients with fertilization failure than in patients achieving fertilization. Sperm penetration assay (SPA) using zona-free hamster eggs was performed for 15 patients with fertilization failure; no correlation was found between SPA and the fertilizing ability of the sper...
Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association, 1989
One hundred and ten cases of hypertensive disorders in pregnancy were analyzed retrospectively. T... more One hundred and ten cases of hypertensive disorders in pregnancy were analyzed retrospectively. There were 16 cases of gestational hypertension, 36 cases of mild preeclampsia, 43 cases of severe preeclampsia, 6 cases of eclampsia, and 9 cases of chronic hypertension with superimposed severe preeclampsia. The principle of management was conservative in order to prolong pregnancy for patients remote from term. Corticosteroids were used to accelerate fetal lung maturity for patients with gestations of less than 36 weeks and magnesium sulfate was administered to prevent seizures. Fetal heart rate monitoring was done routinely and doppler blood flow velocity time wave form study of uterine and umbilical arteries was also performed in the latter part of the study. The cesarean section rate in gestational hypertension and mild preeclampsia was comparable to the general obstetric population in our institute (26.9% vs. 21.2%), but the rate of severe forms of the disease including severe pree...
Journal of the Formosan Medical Association = Taiwan yi zhi, 1991
In this study, we determined whether there was a correlation between sperm penetration assay (SPA... more In this study, we determined whether there was a correlation between sperm penetration assay (SPA) and acrosome reaction (AR) in sperm after being treated with human follicular fluid (hFF). Sperm specimens were obtained from 13 men participating in our in vitro fertilization program. After washing and preincubation, aliquots of sperm samples were treated with either hFF or Ham's F-10 medium (control). Approximately 1.0 x 10(6) motile sperm from the control and hFF-treated samples were coincubated individually with zona-free hamster eggs for SPA. Sperm remaining in the suspension after coincubation with eggs were taken to determine the incidence of AR by a triple-stain technique. The data revealed that an increased SPA score in hFF-treated samples was related to a higher incidence of acrosome-reacted sperm.
Asia-Oceania Journal of Obstetrics and Gynaecology, 2010
Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyt... more Forty-six couples with various causes of infertility were treated by tubal embryo transfer. Oocyte retrievals were carried out under ultrasound guidance transvaginally and embryos were transferred 48 hours later by laparoscopy into fallopian tubes. Totally 52 cycles were stimulated and 45 retrievals were performed with an average of 8.1 oocytes per retrieval. The average fertilization rate was 54.8%. The implantation rate was 23.8% and the pregnancy rate was 53.5% per transfer. The pregnancy rate per transfer was comparable whether 3 or 4 embryos were transferred. Nine (39.1%) of the 23 pregnancies had multiple pregnancies. Six cases (26.1%) aborted in the first trimester and the remaining 17 were ongoing or term delivery.
By using harmonic generation microscopy, we are able to noninvasive evaluate the health of pre-im... more By using harmonic generation microscopy, we are able to noninvasive evaluate the health of pre-implantation mammalian embryos after in vitro fertilization (IVF) and before transferring to a mother with a high 3D resolution.
To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (... more To evaluate the predicting value of sperm acrosin activity in human, the acrosin activity index (AAI) was measured in 95 semen samples from patients participating in an IVF program. All patients had at least two mature oocytes. Of 95 patients, 84 had successful fertilization and 11 failed to fertilize all oocytes in vitro. The numbers of mature oocytes were similar between fertilization and nonfertilization groups. The mean AAI, measured using a commercially available (Accu-Sperm) acrosin activity assay, was greater in the fertilization group than in the nonfertilization group, but the difference was not significant. There was no correlation between AAI and the in vitro fertilization rate of mature oocytes. The relation between AAI and semen parameters also showed no significant difference. It would appear that measurement of AAI inaccurately reflects in vitro fertilizability of human sperm.
Journal of Assisted Reproduction and Genetics, 1994
The aim of this work was to evaluate the effect of a Vero cell coculture system on the developmen... more The aim of this work was to evaluate the effect of a Vero cell coculture system on the development of mouse embryos. Mouse embryos were randomly divided and cultured in human tubal fluid (HTF) medium with/without Vero cell monolayers, conditioned medium (CM) obtained from Vero cell cultures, and HTF medium supplemented with peptides extracted from CM. The concentrated CM was examined by SDS/PAGE. The development of mouse embryos was blocked at the blastocyst stage in pure HTF medium (1.4% hatching at day 5). This &amp;amp;amp;amp;amp;amp;amp;amp;quot;blastocyst block&amp;amp;amp;amp;amp;amp;amp;amp;quot; was overcome by coculture with Vero cell monolayers (48.1% hatching at day 5; 1.4 vs 48.1%; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). CM and the addition of 5% fetal bovine serum (24.1 and 34.9% hatching, respectively, at day 5) were also able to enhance the process of hatching. In the other experiment, the addition of peptides extracted from Vero cell cultures also overcame the blastocyst block (12.5%) compared with pure HTF medium (2.1%) (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Electrophoretic separation revealed several classes of polypeptides consistently secreted into CM obtained from Vero cell cultures. Most peptides occurred in the M(r) range between 6.5 kd and 35.9 kd. A developmental block (blastocyst block) of mouse embryos in a serum- and protein-free medium (HTF) was discovered in this study. This block was effectively overcome by HTF plus serum and coculture with Vero cell monolayers and also by the peptides extracted from Vero cell-conditioned medium. We speculate that certain factors secreted or converted by Vero cells may be critical in hatching of mouse embryos. Further study of these factors may be helpful in delineating its mechanism.
American Journal of Obstetrics and Gynecology, 1994
An abdominal pregnancy after superovulation with human menopausal and chorionic gonadotropins fol... more An abdominal pregnancy after superovulation with human menopausal and chorionic gonadotropins followed by intrauterine insemination of the husband&#39;s sperm is reported. The incidence of ectopic pregnancy increases with administration of human menopausal and chorionic gonadotropins. However, the role of human menopausal and chorionic gonadotropins as a cause of abdominal pregnancy has not been delineated. It appears that ultrasonography has become one of the most important aids in the diagnosis of early abdominal pregnancy.
Uploads
Papers by Yu-shih Yang