Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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COH-IVF Outcomes for Infertile Patients With Borderline Ovarian Tumor After Conservative Treatment

경계성 난소 종양의 보존적 수술 후 불임 환자에서 체외수정시술의 유용성

  • Lee, Hyun-Joo (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Ahn, Ka-Yougng (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Hahn, Ho-Suap (Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Park, Chan-Woo (Division of Reproductive Endocrinology & Infertility, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Yang, Kwang-Moon (Division of Reproductive Endocrinology & Infertility, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Lee, In-Ho (Division of Gynecology Oncology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Kim, Tae-Jin (Division of Gynecology Oncology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Lim, Kyung-Taek (Division of Gynecology Oncology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Lee, Ki-Heon (Division of Gynecology Oncology, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine) ;
  • Kang, Inn-Soo (Division of Reproductive Endocrinology & Infertility, Cheil General Hospital and Women's Healthcare Center Kwandong University, College of Medicine)
  • 이현주 (관동대학교 의과대학 제일병원 산부인과) ;
  • 안가영 (관동대학교 의과대학 제일병원 산부인과) ;
  • 한호섭 (관동대학교 의과대학 제일병원 산부인과) ;
  • 박찬우 (관동대학교 의과대학 제일병원 생식내분비 및 불임분과) ;
  • 양광문 (관동대학교 의과대학 제일병원 생식내분비 및 불임분과) ;
  • 이인호 (관동대학교 의과대학 제일병원 부인종양분과) ;
  • 김태진 (관동대학교 의과대학 제일병원 부인종양분과) ;
  • 임경택 (관동대학교 의과대학 제일병원 부인종양분과) ;
  • 이기헌 (관동대학교 의과대학 제일병원 부인종양분과) ;
  • 강인수 (관동대학교 의과대학 제일병원 생식내분비 및 불임분과)
  • Published : 2007.06.30
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Abstract

Objective: To examine determinants of successful pregnancy and evaluate COH-IVF outcomes of infertile patients after conservative surgical treatment of borderline ovarian tumor (BOT). Methods: In women of BOT (n=93), from January 1995 to December 1999, 44 of 93 women underwent conservative surgical treatment. From theses 44 women, patients characteristics, surgical and histological parameters were compared between 14 women who conceived and 30 women who failed to conceive. For 5 infertile women of 30 women who failed to conceive, 10 attempt IVF cycles were analysed; clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR). Results: Women who conceived tend to be younger (25.9 vs 27.0 years) and lower serum CA-125 level (59.7 vs 72.9) compared to women who failed to conceive without significant difference. For 8 cycles out of 10 attempt IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range 2$\sim$16) with a mean fertilization rate of 74.4%. The CPR, IR and LBR per embryo transfer were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. During the mean follow-up period after COH-IVF initiation, 29.6 (range 14$\sim$61) months, no recurrence was found. Conclusion: No determinant of successful pregnancy was found after conservative treatment for BOT. COH-IVF may be considered for infertile patients after conservative treatment of BOT. However, larger clinical studies with longer follow-up are necessary to evaluate the safety and efficacy of COH-IVF. All patients should be informed of the potential risks associated with ovarian hyperstimulation and close follow-up is necessary after COH-IVF.

목 적: 경계성 난소 종양 환자에 있어서 보존적 수술 후 임신에 성공한 군과 비임신 군간 환자의 특성에 차이가 있는지 알아 보았으며, 경계성 난소 종양의 보존적 수술 후 체외수정시술의 유용성에 대해 알아 보았다. 연구방법: 1995년 1월부터 1999년 10월까지 경계성 난소 종양으로 보존적 술을 시행 받은 가임 여성 가운데 임신에 성공한 군 (14명)과 비임신 군 (30명)간 환자의 특성에 차이가 있는지 알아 보았으며, 비임신 군 가운데 불임을 주소로 내원하여 체외수정시술을 시행 받은 5명의 10주기를 대상으로 체외수정시술 결과 및 체외수정시술 후 난소 종양의 재발 유무를 추적 관찰하였다. 결 과: 경계성 난소 종양의 보존적 수술 후 임신에 성공한 군과 비임신 군간 환자의 평균 나이는 25.9세와 27.0세이었으며 혈청 CA-125 수치는 59.7 U/m와 72.0 IU/ml로 비임신 군에서 높은 경향을 보였으나 통계적 유의성은 없었다. 불임을 주소로 체외수정시술을 시행 받은 5명의 10주기 (attempt IVF cycle) 가운데 취소된 2주기를 제외하고 (attempt cycle cancellation rate, 20.0%) 채취된 난자 수는 평균 5.6개 (2$\sim$16개)이었으며 수정율은 14.5% (50.0$\sim$100.0%)이었다. 평균 2.4개 (1$\sim$4개)의 배아를 이식하였으며 배아이식 주기당 임신율과 착상율 및 출생율은 각각 50.0% (4/8 cycle), 31.6% 및 50.0% (4/8 cycle)이었다. 체외수정시술 후 평균 29.6개윌 (14$\sim$61개월)의 추적 관찰 기간 동안 난소 종양이 재발된 경우는 없었다. 결 론: 경계성 난소 종양의 보존적 수술 후 임신에 성공한 군과 비임신 군간 환자의 특성에 차이가 없으며, 보존적 수술 후 체외수정시술의 결과는 비교적 만족할 만한 수준으로 체외수정시술은 경계성 난소 종양의 보존적 수술후 고려될 수 있으나 향후 많은 환자를 대상으로 한 장기간의 추적 관찰을 필요로 한다.

Keywords

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