Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Effectiveness of Soft Stimulation Protocol, Compared with Conventional GnRH Antagonist Multiple dose Protocol in Patients Undergoing Controlled Ovarian Stimulation with Intrauterine Insemination

과배란유도하 자궁강내 인공수정시술을 받는 환자에서 연성자극요법과 성선자극호르몬 길항제 다회투여법의 효과 비교

  • Kim, Chung-Hoon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Hyuk-Jae (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, So-Ra (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeon, Gyun-Ho (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Hyang-Ah (Department of Obstetrics and Gynecology, Kangwon National University Hospital) ;
  • Kim, Sung-Hoon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chae, Hee-Dong (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kang, Byung-Moon (Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine)
  • 김정훈 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 강혁재 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 김소라 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 전균호 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 이향아 (강원대학교 의학전문대학원 강원대학교병원 산부인과) ;
  • 김성훈 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 채희동 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과) ;
  • 강병문 (울산대학교 의과대학 서울아산병원 산부인과 생식내분비 및 불임 분과)
  • Received : 2010.01.22
  • Accepted : 2010.03.29
  • Published : 2010.06.30
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Abstract

Objective: To evaluate the effectiveness of soft stimulation protocol using GnRH antagonist/clomiphene citrate (CC)/recombinant FSH (rFSH) in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI), compared with GnRH antagonist multiple dose protocol (MDP) using GnRH antagonist/rFSH. Methods: Eighty infertile women were randomized to soft stimulation protocol group (n=40) or GnRH antagonist MDP group (n=40). In both groups, IUI was performed 36~40 hours after hCG injection. Statistical analysis was performed using Student's t-test, $\chi^2$ test or Fisher's exact test as appropriate. Results: Total dose and days of rFSH required for COS were significantly fewer in soft stimulation protocol group (p<0.001, p<0.001). A premature LH surge did not occur in any patients of both groups. Clinical pregnancy rate per cycle was similar between the two groups. Conclusion: Soft stimulation protocol provides comparable pregnancy rates to GnRH antagonist MDP despite fewer total dose and days of rFSH, and so can become one of the patient-friendly, cost-effective alternatives for infertile patients undergoing COS with IUI.

목 적: 과배란유도하 자궁강내 인공수정시술을 받는 불임 환자들을 대상으로 연성자극요법의 효과를 성선자극호르몬분비호르몬 길항제 다회투여법과 비교, 평가하고자 본 연구가 시행되었다. 연구방법: 불임 환자 80명을 연성자극요법군 (n=40)과 성선자극호르몬분비호르몬 길항제 다회투여법군 (n=40)으로 무작위로 1:1로 배정하였다. 두 군 모두에서 질식초음파상 평균 직경이 18 mm에 도달한 난포가 1개, 또는 17 mm에 도달한 난포가 2개 이상 관찰될 때, 재조합 사람융모성성선자극호르몬 250 ${\mu}g$을 1회 투여했으며, 이 후 36~40시간째에 자궁강내 인공수정이 시행되었다. 결 과: 과배란유도를 위해 사용된 재조합 사람난포자극호르몬의 총용량과 투여일수는 연성자극요법군에서 유의하게 적었다 (p<0.001, p<0.001). 두 군 모두에서 조기 황체화호르몬 급상승은 관찰되지 않았다. 시술 주기당 임상적 임신율, 자연유산율, 다태임신율, 중증 난소과자극증후군의 발생빈도는 두 군간에 차이를 보이지 않았다. 결 론: 연성자극요법은 성선자극호르몬분비호르몬 길항제 다회투여법에 비하여 재조합 사람난포자극호르몬을 적은 용량, 짧은 기간 사용하면서도 유사한 임신율을 나타내므로, 과배란유도하 자궁강내 인공수정을 시행 받는 환자를 위한 환자 친화적이고 효과적인 과배란유도법이 될 수 있을 것이다.

Keywords

References

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