Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Efficacy of Frozen-Thawed ET in Patients with Old Age or Non-Pregnant in Fresh ET Cycles

고령 환자와 신선주기 배아이식에서 임신에 실패한 환자에서 동결-융해 배아이식의 효용성

  • Choi, Su Jin (Laboratory of Reproductive Biology & Infertility, Cheil General Hospital & Women's Healthcare Center) ;
  • Lee, Sun Hee (Laboratory of Reproductive Biology & Infertility, Cheil General Hospital & Women's Healthcare Center) ;
  • Song, In Ok (Department of Ob/Gyn, Sungkyunkwan University School of Medicine) ;
  • Koong, Mi Kyoung (Department of Ob/Gyn, Sungkyunkwan University School of Medicine) ;
  • Kang, Inn Soo (Department of Ob/Gyn, Sungkyunkwan University School of Medicine) ;
  • Jun, Jin Hyun (Laboratory of Reproductive Biology & Infertility, Cheil General Hospital & Women's Healthcare Center)
  • 최수진 (제일병원 생식생물학 및 불임연구실) ;
  • 이선희 (제일병원 생식생물학 및 불임연구실) ;
  • 송인옥 (성균관대학교 의과대학 산부인과학교실) ;
  • 궁미경 (성균관대학교 의과대학 산부인과학교실) ;
  • 강인수 (성균관대학교 의과대학 산부인과학교실) ;
  • 전진현 (제일병원 생식생물학 및 불임연구실)
  • Published : 2006.12.31
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Abstract

Objective: The aim of this study was to evaluate the efficacy of frozen-thawed ET in poor prognosis patients such as the old age (38~44 years; OA group) and the patients who did not achieve clinical pregnancy with the first fresh ET cycle (non-pregnant patients; NP group). Methods: Laboratory and clinical data were collected from fresh and frozen-thawed ET cycles of OA and NP group. Controlled ovarian hyperstimulation (COH) and conventional insemination or ICSI, in vitro culture and ET were performed by routine procedures. Supernumerary embryos were frozen by the slow freezing method, and frozen embryos were thawed by the rapid thawing method. Embryo development, pregnancy and implantation rates were statistically analyzed by Student t-test and chi square test Results: Mean ages were similar between fresh ET ($40.0{\pm}1.8$ years, n=206) and frozen-thawed ET ($39.9{\pm}1.9$ years, n=69) cycles in OA group. However, the clinical pregnancy and implantation rate of subsequent frozen-thawed ET significantly higher than those of fresh ET cycles (29.0% and 11.2% vs. 16.5% and 7.0%, p<0.05). In NP group, there was no difference in the mean age between fresh ET ($31.2{\pm}2.3$ years, n=40) and frozen-thawed ET ($31.9{\pm}3.1$ years, n=119) in subsequent cycles. The clinical pregnancy and implantation rates were similar between the subsequent fresh ET (42.5% and 22.6%) and the frozen-thawed ET (40.3% and 18.8%). Conclusion: In old age patients, higher pregnancy rate of frozen-thawed ET compared to fresh ET cycles in this study. It may be related that better uterine environments for implantation in frozen-thawed ET cycles than that of non-physiological hormonal condition in uterus of fresh COH cycles.

목 적: 동결-융해 배아이식은 보조생식술에서 환자들에게 보다 많은 임신의 기회를 제공해줄 수 있는 방법으로 이용되고 있다. 본 연구에서는 예후가 좋지 않은 환자들에서 동결-융해 배아이식의 효용성을 알아보고자 하였다. 연구방법: 나이가 많은 고령 환자군 (38~44세)과 신선주기 배아이식에서 임신 실패군을 연구대상으로 하였다. 과배란 유도를 통해 채취한 난자를 일반적인 체외수정 또는 세포질내 정자주입술을 시행하여 수정을 유도하고, 잉여의 전핵 또는 난할 시기의 배아를 완만동결법으로 동결하였다. 동결보관 배아는 급속융해법으로 융해하여 호르몬요법을 시행한 환자의 자궁에 이식하였다. 신선 배아이식과 동결-융해 배아이식 과정에서의 배아 상태, 임신율, 착상률 등을 통계적인 방법으로 분석하였다. 결 과: 나이가 많은 고령군에서 신선 배아이식을 시행한 환자들과 동결-융해 배아이식을 시행한 환자들의 평균 연령은 $40.0{\pm}1.8$세 (n=206)와 $39.9{\pm}1.9$세 (n=69)로 통계적으로 유의한 차이가 없었으나, 임상적인 임신율과 착상률은 동결-융해 배아이식에서 29.0%와 11.2%로 신선 배아이식의 16.5%와 7.0%에 비해 통계적으로 유의하게 높게 나타났다. (p<0.05). 첫 번째 신선 배아이식에서 임신 실패군의 연속되는 신선 배아이식 환자군 ($31.2{\pm}2.3$, n=40)과 동결-융해 배아이식 환자군 ($31.9{\pm}3.1$, n=119)에서의 평균 연령은 차이가 없었으며, 임상적 임신율 (42.5% vs 40.3%)과 착상률 (22.6% vs 18.8%)도 유사하였다. 결 론: 본 연구에서는 동결-융해 배아이식이 고령 환자들에서 효과적으로 임신율과 착상률을 높일 수 있음을 보여주고 있다. 이러한 결과는 과배란 유도에 따른 자궁의 착상 환경 변화가 고령 환자들에서 임신율과 착상률을 저하시키는 것과 관련이 있을 것으로 생각된다.

Keywords

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