Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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The Clinical Outcome of Twin Pregnancies after IVF

체외수정 후 출산한 쌍태아의 임상적 고잘

  • 한명석 (동아대학교 의과대학 산부인과학교실) ;
  • 박은구슬 (동아대학교 의과대학 산부인과학교실)
  • Published : 2007.09.30
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Abstract

Objective: To compare the outcome of twin pregnancies after in-vitro fertilization (IVF) with that of spontaneously conceived twins. Methods: We analyzed 146 twins retrospectively, who had been delivered between January 2000 and July 2005. After reviewing their obstetric medical records, 72 twins conceived with IVF (IVF group) and 51 spontaneously conceived twins (spontaneous group), whose gestational age was over 24 weeks, were recruited for this study. Results: There were no significant statistical differences of demographic features such as maternal age, gestational age and fetal weight between the two groups. However, the risk of pregnancy-induced hypertension (PIH) and gestational diabetes (G-DM) had significantly increased in the group of IVF (OR 2.59; 95% CI 1.01$\sim$6.66). The risk of fetal weight discordancy rate (>20%) and fetal-sex homology rate in IVF group were decreased (OR 0.37; 95% CI 0.14$\sim$0.96, OR 0.45; 95% CI 0.21$\sim$0.99). Conclusion: In this comparative study, maternal PIH and G-DM risks of IVF group are higher than that of spontaneous group. But, fetal-weight discordancy risk and fetal-sex homology rate were lower in IVF group.

목 적: 체외수정으로 출산한 쌍태아와 자연임신으로 출산한 쌍태아 간의 산과적 결과의 차이를 비교하고자 한다. 연구방법: 2000년 1월부터 2005년 6월까지 출산한 146건의 쌍태아에 관한 산과적 기록을 검토한 후, 출생 시 재태연령이 24주 이상이며 체외수정으로 임신한 72건을 연구군 (체외수정군), 자연임신한 51건을 대조군 (자연임신이군)으로 나누어 연구를 시행하였다. 결 과: 두 군 간에 산모 연령, 출산 시 재태 연령, 태아체중 등의 차이는 없었지만, 임신성 고혈압과 임신성 당뇨의 발생 위험도는 체외수정군에서 높았다 (OR 2.59; 95% CI 1.01$\sim$6.66). 20% 이상 태아 체중 차이와 같은 성의 쌍태아 발생의 위험도는 체외수정군에서 낮았다 (OR 0.37; 95% CI 0.14$\sim$0.96, OR 0.45; 95% CI 0.21$\sim$0.99). 결 론: 본 연구의 결과로는 체외수정으로 출생한 쌍태아는 자연임신으로 출생한 경우보다 태아 체중 차이의 빈도 및 같은 성 출생의 빈도가 낮았다.

Keywords

References

  1. Olivennes F, Kadhel P, Rufat P, Fanchin R, Fernandez H, Frydman R. Perinatal outcome of twin pregnancies obtained after in-vitro fertilization: comparison with twin pregnancies obtained spontaneously or after ovarian stimulation. Fertil Steril 1996; 66: 105-9 https://doi.org/10.1016/S0015-0282(16)58395-2
  2. 한국 보조생식술의 현황: 2003년. 대한산부인과학회잡지 2006; 49: 2480-97
  3. Cunningham FG, et al. Williams Obstetrics 21st ed. US McGrawhill Companies
  4. Tanbo T, Dale PO, Lunde O, Moe N, Abyholm T. Obstetric outcome in singleton pregnancies after assisted reproduction. Obstet Gynecol 1995; 86: 188-92 https://doi.org/10.1016/0029-7844(95)00159-O
  5. Seoud MA, Toner JP, Kruithoff C, Muasher SJ. Outcome of twin, triplet, and quadruplet in vitro fertilization pregnancies: the Norfolk experience. Fertil Steril 1992; 57: 825-34 https://doi.org/10.1016/S0015-0282(16)54966-8
  6. Anonymous. Pregnancies and births resulting from in vitro fertilization: French national registry, analysis of data 1986 to 1990: FIVNAT (French in Vitro National). Fertil Steril 1995; 64: 746-56 https://doi.org/10.1016/S0015-0282(16)57850-9
  7. Moise J, Laor A, Armon Y, Gur I, Gale R. The outcome of twin pregnancies after IVF. Hum Reprod 1998; 13: 1702-5 https://doi.org/10.1093/humrep/13.6.1702
  8. Lambalk CB, Van Hooff M. Natural verus induced twinning and pregnancy outcome; a Dutch nationwide survey of primiparous dizygotic twin deliveries. Fertil Steril 2001; 75: 731-6 https://doi.org/10.1016/S0015-0282(01)01679-X
  9. Conde-Agudelo A, Belizan JM, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol 2000; 95: 899-904 https://doi.org/10.1016/S0029-7844(99)00640-7
  10. McDonald S, Murphy K, Beyene J, Ohlsson A. Perinatal outcomes of in vitro fertilization twins: A systematic review and meta-analyses. Am J Obstet Gynecol 2005; 193: 141-52 https://doi.org/10.1016/j.ajog.2004.11.064
  11. Daniel Y, Ochshom Y, Fait G, Geva E, Bar-Am A, Lessing JB. Analysis of 104 twin pregnancies conceived with assisted reproductive technologies and 193 spontaneously conceived twin pregnancies. Fetil Steril 2000; 74: 683-9 https://doi.org/10.1016/S0015-0282(00)01491-6
  12. Zaib-un-Nisa S, Ghazal-Asward S, Badrinath P. Outcome of twin pregnancies after assisted reproductive techniques-a comparative study. Eur J Obstet Gynecol Reprod Biol 2003; 109: 51-4 https://doi.org/10.1016/S0301-2115(02)00468-2
  13. Bair DD, Wilcox AJ, Kramer MS. Why might infertile couples have problem pregnancies? Lancet 1999; 353: 1724-5 https://doi.org/10.1016/S0140-6736(99)90050-8
  14. Santema JG, Koppelaar I, Wallenburg HC. Hypertensive disorders in twin pregnancy. Eur J Obstet Gynecol Reprod Biol 1995; 58: 9-13 https://doi.org/10.1016/0028-2243(94)01982-D
  15. Anderson AN, Gianroli L, Felberbaum R, de MJ, Nygren KG. Assisted reproductive technology in European registers by ESHRE. Hum Reprod 2005; 20: 1158-76 https://doi.org/10.1093/humrep/deh755
  16. 남수현, 이지은, 문성오, 최석주, 김형선, 오수영 등. 융 모막성에 따른 쌍태아와 체외수정 쌍태아의 임신 및 신 생아 예후 비교. 대한산부회지 2006; 49: 1638-45