Clinical and Experimental Reproductive Medicine

  • 제34권3호
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  • Pages.197-205
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  • 2007
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  • 2233-8233(pISSN)
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  • 2233-8241(eISSN)
대한생식의학회 (The Korean Society for Reproductive Medicine)
권호 표지

과배란 유도에서의 혈중 에스트라디올 농도에 따른 신선주기와 동결-융해 배아이식 주기에서의 임신율과 착상율

Pregnancy and Implantation Rates Related to Serum Estradiol Concentrations of Controlled Ovarian Hyperstimulation in Fresh IVF-ET and Frozen-thawed ET Cycles

  • 김묘경 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실) ;
  • 최수진 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실) ;
  • 최혜원 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실) ;
  • 방경희 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실) ;
  • 김혜옥 (관동대학교 의과대학 제일병원 생식생물학 및 산부인과학교실) ;
  • 양광문 (관동대학교 의과대학 제일병원 생식생물학 및 산부인과학교실) ;
  • 궁미경 (관동대학교 의과대학 제일병원 생식생물학 및 산부인과학교실) ;
  • 전종영 (관동대학교 의과대학 제일병원 생식생물학 및 산부인과학교실) ;
  • 전진현 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실)
  • Kim, Myo-Kyung (Laboratory of Reproductive Biology and Infertility, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Choi, Su-Jin (Laboratory of Reproductive Biology and Infertility, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Choi, Hye-Won (Laboratory of Reproductive Biology and Infertility, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Bang, Kyoung-Hee (Laboratory of Reproductive Biology and Infertility, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Kim, Hye-Ok (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Yang, Kwang-Moon (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Koong, Mi-Kyoung (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Jun, Jong-Young (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine) ;
  • Jun, Jin-Hyun (Laboratory of Reproductive Biology and Infertility, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine)
  • 발행 : 2007.09.30
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초록

목 적: 본 연구에서는 과배란 유도과정에서 나타나는 고농도의 에스트라디올이 임상 결과에 미치는 영향을 알아 보기 위해, 신선주기 배아이식과 동결-응해 배아이식의 임신율, 착상률과 분만율을 살펴보았다. 연구방법: 2003년부터 2005년까지 제일병원 아이소망센터를 내원한 불임 환자에서 신선주기 배아이식 1,565주기와 동결-융해 배아이식 670주기를 대상으로 조사하였다. 과배란 유도 시 hCG투여 당일 에스트라디올 농도에 따라 일차적으로 네 그룹으로 (A: 1,000$\sim$2,000 pg/ml, B: 2,000$\sim$3,000 pg/ml, C: 3,000$\sim$4,000 pg/ml, D: 4,000 pg/ml 이상) 구분하였으며, 이차적으로 환자의 나이에 따라 35세 미만인 군과 이상인 군에서 각각의 임신율, 착상률과 분만율을 통계적으로 분석하였다. 결 과: 전체적으로 신선주기 배아이식과 동결-융해 배아이식에서의 임신율, 착상률 및 분만율에는 유의한 차이가 없었다. 그리고 35세 미만인 환자들에서도 에스트라디올 농도에 따른 각 군에서의 신선주기와 동결-응해 배아이식의 임상결과에는 차이가 없었다. 그러나 35세 이상의 환자들에서는 에스트라디올 농도가 높은 Group-D에서 동결-융해 배아이식의 임신율이 신선주기 배아이식에서보다 유의하게 높게 나타났다 (51.3% vs 25.0%, p<0.05). 결 론: 결론적으로 나이가 많은 환자에서 과배란 유도에 의해 과도하게 높아진 고농도의 에스트라디올은 자궁내막의 착상 환경과 임상 결과에 좋지 않은 영향을 줄 수 있으므로, 이러한 경우 당 주기에 이식하는 신선주기 배아이식보다는 동결-융해 배아이식을 시도하는 것이 높은 임신율을 기대할 수 있는 방법으로 사료된다.

Objective: This study evaluated the pregnancy and implantation rates in fresh IVF-ET cycles or frozen-thawed ET (F-ET) cycles based on serum estradiol concentrations of controlled ovarian hyperstimulation (COH). Methods: Clinical outcomes of 1,565 cycles of fresh IVF-ET with COH and 670 cycles of F-ET were retrospectively analyzed. Serum estradiol levels on the day of human chorionic gonadotropin (hCG) administration were categorized into Group-A (1,000$\sim$2,000 pg/ml), Group-B (2,000$\sim$3,000 pg/ml), Group-C (3,000$\sim$4,000 pg/ml) and Group-D (> 4,000 pg/ml). Clinical pregnancy (CPR), implantation (IR) and delivery rates (DR) were compared among four groups subdivided into younger (< 35 years) and older ($\geq$ 35 years) women. Statistical analysis was performed by Student's t-test and chi-square test. Results: Overall clinical outcomes with fresh IVF-ET and F-ET cycles were similar: 41.2% vs 44.8% of CPR, 18.8% vs 19.6% of JR, and 33.2% vs 34.5% of DR, respectively. There were no significant differences in the clinical outcomes of all four groups between fresh IVF-ET and F-ET cycles of younger women according to the estradiol levels. However, the clinical outcomes of F-ET cycles of older women in Group-D were significantly higher than those of fresh IVF-ET cycles (51.3% vs 25.0% of CPR*, 18.6% vs 9.9% of IR and 33.3% vs 19.4% of DR;* p<0.05). Conclusion: Our results demonstrated that supraphysiological levels of estradiol during COH in fresh IVF-ET cycles of older women ($\geq$ 35 years) may be detrimental to implantation environments of endometrium and clinical outcomes, which could be improved by F-ET cycles.

키워드

참고문헌

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