비수축 및 수축검사와 혈청 Estriol검사에 의한 고위험임시기의 태아예후예측

궁미경(MK Koong),김미영(MY Kim),양미혜(MH Yang),안정자(JJ Ahn),김정일(CI Kim),강신명(SM Kang) 대한산부인과학회 1986 Obstetrics & Gynecology Science Vol.29 No.9

위험도가 높은 인신에 있어서 태아의 예후를 판정하기위해 비수축 및 수축검사 (nonstress-con-traction stress test)와 혈청 estriol치를 검사를 실시하여 분석한 결과 다음과같은 결론을 얻었다 1 비수축검사(nonstress test)결과 무반응형(nonreactive)으로 나타났을 경우에는 44%, 즉 반수정도에서 현성태아장애(overt fetal distress)를 예측할 수 있었으며, 이와반면에 반응형(reactive)으로 나타났을 경우에는 93 3% 즉 대부분이 건강한 태아를 예측할 수 있었다 2 비수축검사에서 무반응형으로 나타난 예에 대하여 제2단계 검사인 수축검사(contraction stress test)를 실시한 결과, 혼합심박하강형(mixed deceleration)으로 나타난 군에서는 50%가, 만기하강형(late deceleration)으로 나타난 군에서는 100%에서 현성태아장애를 예측할 수 있었다 요컨대, 비수축검사와 수축검사를 병용함으로써 태아장애의 예측도를 현저하게 높일 수 있었다 (80%) 3 진통을 수반하지 않은 만삭임신에서 11ng/ml이하로 혈청 estriol치를 나타냈을 경우에는 대부분이 태아장애를 예측할 수 있었으나, 11ng/ml이상으로 높게 나타낸 군에서도 27%가 위음성(false negative) 즉 태아장애를 나타냈으므로 태아장애예측에 대한 신빙성이 적었다 또한, 일단 진통이 시작되면 혈청estriol치는 진통전에 비해 29∼65%가 감소되었다 5 연장임신시 태아예후를 예측하는 데 수축검사(contraction stress test)가 대단히 예민한 것으로 나타났으며 특히 과숙아인 경우에 혼합심박하강형(mixed deceleration)을 보였다 이때, 혈청 estriol치는 과숙아판정에 도움이 되지않았다 6 중증자간전증(severe preeclampsia)시의 태아예후 예측에서도 역시 수축검사(contraction stress test)가 대단히 실용적이였으며, 이때 혈청 estriol치에 의한 예측율도 비교적 높았다 The precise prenatal assessment of fetal wellbeing is still unsolved problem in modern obstetric practice, especially in high risk pregnancy The data presented are based on 40 cases of high risk pregnancy, including preeclampsia, prolonged labor, maternal medical illness associated with pregnancy and others In this study, we will discuss 16 cases of CST(contraction stress test), 24 cases of NST(nonstress test) followed by CST, and 40 cases of serum estriol test for prediction of fetal distress prenatally The results obtained were as follows: 1 When nonreactive pattern appeared in nonstress test, these may able to predict overt fetal distress 44% or nearly one half of the cases 2 When CST is added to the cases with nonreactive type in intial NST, the prediction rate of fetal distress was significantly high (80%); it was accounted for 50% by mixed deceleration and 100% by late deceleration 3 The applicability of the serum estriol level measured before labor was considered to be less practical, because of high false negative rate (27%) in serum estriol level higher than 11ng/ml 4 In the prediction of fetal distress among postdatism, CST was very valuable, and all the postmaturity showed mixed deceleration pattern The serum estriol level appeared to be a less useful parameter 5 In the prediction of fetal distress resulted from severe preeclampsia, CST was also considered to be very useful as well as serum estriol analysis

이상태아예측을 위한 비수축검사, 수축검사 및 혈청 Total Estriol치에 관한 연구

궁미경(MK Koong),우복희(BH Woo),강신명(SM Kang) 대한산부인과학회 1987 Obstetrics & Gynecology Science Vol.30 No.10

고위험임부 30예를 대상으로 비수축검사(nonstress test), 수축검사(contraction stress test) 및 모체의 혈청 total estriol검사에 의해 이상태아의 예후에 대한 판정의 신빙도는 다음과 같았다. 1. 비수축검사시에 나타나는 비반응형(nonreactive)이나, 수축검사시에 나타나는 심박변이(variavbility)가 결여된 음성형(negative) 또는 양성형(positive)으로 나타날 때는 이상태아에 대한 예측율이 각각 82%, 86% 및 100%로 모두 신빙성이 높았다. 2. 모체의 진통전 혈청 total estriol치가 160ng/ml미만으로 나타난 예에서는 이상태아 예측율이 비교적 높았으나(88%), 그 반면 160ng/ml 또는 그 이상으로 나타난 예에서는 위음성율이 42%로 높았다. 따라서, 이때는 비수축검사의 병용이 반드시 필요하며 이상태아의 예측에 대한 신빙도를 보완할 수 있었다(83%). 3. 임신성 고혈압을 동반한 임부에 있어서는 진통전 혈청 total estriol평균치가 정상임부의 평균치에 비하여 현저하게 낮았다(p<0.05). 특히 자궁내 성장지연을 동반한 임신성 고혈압임부에 있어서 그 평균치(152.5ng/ml)는 동반치 않은 단순 임신성 고혈압임부의 평균치(236.4ng/ml)에 비해 더 낮은 경향이 있었다. Level for the Prediction of Abnormal Fetal Outcome The precise evaluation of abnormal fetal outcome is still unresolved problem. In this paper, 30 cases of high risk term pregnancies including pregnancy induced hypertension with or without intrauterine growth retardation(12 cases), diabetes mellitus(2 cases) and others were studied. The abnormal fetal outcome was evaluated by means of nonstress test, contraction stress test and simultaneous measurement of maternal serum total estriol. The results obtained were as follows: 1. In the prediction of the abnormal fetal outcome among high risk term pregnancies, the nonreactive pattern of nonstress test, the negative pattern associated with no variability or positive pattern of contraction stress test all appeared to be highly reliable indicators. 2. The high risk pregnancies revealing serum total estriol concentration less than 160ng/ml before labor showed fairly high predictability of abnormal fetal outcome(88%). However, when the value of serum total estriol concentration was 160ng/ml or above, the false negative rate was very high(42%) and therefore, in such cases, we believe the additional nonstress test to be needed for the better prediction of the abnormal fetal outcome(83%). 3. The mean serum to total estriol concentration before labor in pregnancies complicated by hypertensive disorders was significantly lower compared with that of normal pregnancies(P<0.05). Especially, the mean value in pregnancy induced hypertension associated with intrauterine growth retardation(152.5ng/ml±) tended to be lower in comparison with that of without intrauterine growth retardation(236.4ng/ml±36.2).

인간의 난관수종액이 생쥐배아발달에 미치는 영향

궁미경,전진현 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

Recent studies reported that patients with hydrosalpinx have reduced pregnancy rates following in vitro fertilization and embryo transfer(IVF-ET). Hydrosalpingeal fluid(HSF) in the fallopian tube(s) can leak into the uterine cavity, and it may change the intrauterine microenvironment, and affect embryo development or implantation adversely. The objective of this study is to determine if HSF affects development or implantation adversely. The objective of this study is to determine if HSF affects development, hatching or implantation of mouse embryo in vitro. HSF was collected from 10 patients with hydrosalpinges undergoing salpingoneostomy. Collected fluid was centrifuged and supernatant was stored frozen at -20 C. For co-culture, human endometrial cells were obtained by endometrial biopsy and were cultured using Ham`s F-10 medium. Two-cell mouse embryos(ICR-strain) were cultured for 6 days in T6 medium containing 0, 10, 20, 50 % of HSF with or without human endometrial cells. Statistical analysis was done by chi-square test. The ratios of developing mouse embryo in 0, 10, 20 50 % of HSF in media(n=80 in each group) were 70, 75, 70, 59 % to blastocyst, 70,65, 60, 46 % to hatching, and 50, 44, 48, 36 % to outgrowth, respectively. This mean ratios showed decreasing tendency according to increasing HSF concentration( :p$lt;0.05). A similar tendency was observed in cluture with endometrial cell. The ratios of developing mouse embryo co-cultured with endometrial cells(n=40 in each group)were 82, 75, 65, 57 % to blastocyst, 78, 68, 63, 60 % to gatching, and 64, 55, 58, 58 % to implantation, respectively (:p$lt;0.05). These data suggest that HSF adversely affect mouse embryo development and hatching rather than outgrowing or implantation in vitro. Thus, the hydrosalpinx-associated reduction in pregnancy rates among IVF-ET patients may be related, at least in part, to the deleterous effects of HSF on embryo development. In this study, the final medium concentrations were varying also by adding HSF, however, this dilution effect is considerd to be anlogous to in vivo condition when HSF influxes into the uterine fluid.

난관수종 (Hydrosalpinx) 과 그의 수술적 교정이 체외수정시술시 임신율 및 착상율에 미치는 영향

궁미경,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.3

The aim of this study is to determine whether or not hydrosalpinx affects pregnancy rate and implantation rate adversely in human IVF-ET program. 110 infertile couples with tubal factor undertaken IVF-ET treatment from May 1995 through April 1996 were included. Patients with tubal factor combined with other factors were excluded from this study. The hydrosalpinx group included 35 patients who had unilateral or bilateral hydrosapinx. Fifty four patients with proximal tubal occlusion without hydrosalpinx served as a control. The corrected hydrosalpinx group included 21 patients hydrosalpinx served as a control The corrected hydrosalpinx group included 21 patients who had undertaken either salpingectomy(n=5) or salpingoneostomy(n=16) before IVF-ET cycle. Controlled ovarian hyperstimulation was performed using GnRH agonist/human menopausal gonadotropin or follicular stimulation hormone(FSG). Thirty four hours after intramuscular injection of 10,000 IU human chorionic gonadotropin(hCG), trasvaginal sonography-guided oocyte retrieval was done, The cleaved embryos were transferred to the uterus on day two or three after fertilization. There was no significant difference in age(mean +or- SEM; 32.9 +or- 0.4, 32.7 +or- 0.6, 31.4 +or- 0.6), basal FSH level(7.1 +or- 0.3, 7.2 +or0 0.3, 7.0 +or- 0.4 mIU/ml) and estradiol on the day of hCG injection(2674 +or- 219, 3239 +or- 304, 3376 +or- 360 pg/ml) among the control, hydrosalpinix and corrected hydrosalpinx group, respectively(p$gt;0.05). The number of trasferred embryos(5.1 +or- 0.3, 5.6 +or- 0.3 and 5.4 +or- 0.6) were similar between the groups. The clinical pregnancy rate of 8.3% in hydrosalpingeal group was significantly lower than 25.4% of control group (p=0.057). However, in corrected hydrosalpinx group, pregnancy rate of 27.3% compared well with the control group. The implantation rate showed a similar pattern with pregnancy rate, i.e., hydrosalpingeal group had the lowest implantation rate of 2.0%, which was significantly lower than 11.6% of control group. In the corrected hydrosalpinx group, implantation rate(9.3%) recovered as that of the control group. The ectopic pregnancy rate(11.1%) of the hydrosalpingeal group was higher than that of the control group(1.7%) and was intermediate(4.5%) in corrected hydrosalpinx group(p$gt;0.05). In conclusion, these data show that hydrosalpinx affects the pregnancy rate adversely in IVF-ET cycyle. Thus, it is suggested that surgical correction of the hydrosalpinx before the initiation of IVF-ET cycle may be beneficial in increasing the pregnancy rate as well as decreasing the ectopic pregnancy.

자궁내막증이 체외수정시술에 미치는 영향

강인수,궁미경,김정욱,손일표,최범채,유근재,송지홍,전진현,송인옥 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

목적: 자궁내막증이 체외수정시술에 미치는 영향을 파악하고 시술의 결과를 향상시킬 수 있는 방법을 알아보고자 하였다. 연구방법: 1995년 1월 부터 1996년 12월간에 삼성제일병원 산부인과 불임클리닉을 방문하여 체외수정시술을 받은 불임환자중 자궁내막증만을 갖는 환자 94주기 [단기과배란유도 42명 71주기, 장기과배란유도 19명 23주기]와 난관요인만을 갖는 환자 254주기 [단기과배란유도 172명]에서 소요된 성선자극호르몬의 양, 획득난자수, 양질의 난자수, 전체 배아수, 양질의 배아수, 배아이식당 임상적 임신율 등을 비교 분석하였으며 p$lt;0.05 인 경우 통계적으로 의의있다고 판정하였다. 결과: 환자의 평균 나이는 자궁내막증환자에서 31.7±0.3 세 [평균±표준오차], 난관요인 불임환자에서 31.3±0.2 세였고 과배란유도에 소요된 성선자극호르몬의 양은 자궁내막증에서 더 많은 성선자극호르몬이 필요하였으며 [27.7±1.2 대 24.0±0.6, p=0.004, t-검정], 자궁내막증이 있는 경우 더 적은수의 배아가 얻어졌다 [7.0±0.5 대 9.0±0.4, p=0.0014, t-검정]. 자궁내막증이 있는 경우 단기과배란유도와 장기 과배란유도후 배아이식당 임신율은 각각 21.4 % [15/70], 13.0 % [3/23]로 두군간에 통계적으로 유의한 차이는 없었으나 소요된 성선자극호르몬의 양은 각각 27.7±1.2 앰플, 36.1±2.2 앰플로 단기과배란유도시 유의하게 적은 양의 성선자극호르몬이 소요되었다 [p=0.001, t-검정]. 체외수정시술전 치료를 전혀 하지 않았던 경우 임신율은 21.1 % [4/19], 자궁내막종이 있어서 골반경수술로 이를 제거만 한 경우 0.0 % [0/9], 내과적 약물치료만을 하였던 경우 14.6 % [7/45], 골반경수술과 약물치료를 병행하였던 경우 28.6 % [6/212]였으며, 시술전 치료를 한 경우 골반경수술과 약물치료를 병행한 그룹에서 임신율이 약간 높았으나 통계적으로 유의한 차이에는 도달하지 못하였다. 결론: 자궁내막증은 난자의 성숙, 수정에 영향을 미치며 장기과배란유도 보다는 단기과배란유도가 임상적으로 더 유익하리라고 사료되며 체외수정시술전 내과적, 외과적 치료를 시행하는 데에 있어서는 더 많은 연구가 있어야 할 것이다. Objective: The aim of this study was to evaluate the clinical impact of endometriosis on the outcome of controlled ovarian hyperstimulation [COH] in IVF-ET cycle. Methods: Ninety-four IVF-ET cycles [71 by short protocol in 42 women, 23 by long protocol in 19 women] in patients with endometriosis only and 254 cycles [all by short protocol in 172 women] in infertile patients with tubal factor only were included in this study. The patients with endometriosis were divided into two groups according to the disease stage: group I [ endometriosis stage I, II], group II [endometriosis stage III, IV]. Results: The mean [31.7±0.3; SEM] age of the patients with endometriosis was not significantly different from that [31.3±0.2] of the patients with tubal factor only. More gonadotropin ampules were used in the patients with endometriosis than in the patient with tubal factor only [ 27.7±1.2 vs. 24.0±0.6; p=0.004, Student`s t-test]. The mean number of cleaved embryos was significantly less [p=0.0014, t-test] in the patients with endometriosis than that of tubal factor group [ 7.0±0.5 vs. 9.0±0.4]. The clinical pregnancy rate per transfer in the patients with endometriosis were 21.4 % [15/70] in short protocol, 13.0 % [3/23] in long protocol, but it did not reach statistically significant level [p=0.68, Chi-square test]. But significantly less gonadotropin ampules were used in short protocol than in long protocol [27.7±1.2 vs.36.1±2.2; p=0.001]. The clinical pregnancy rate per transfer were 15.8 % [9/57] in group I, 22.2 % [8/36] in group II, respectively and there was no statistical significance [p=0.58, Chi-square test]. The clinical pregnancy rates per embryo transfer of the patients with endometriosis was 21.1 % [4/19] in the patients with no treatment before IVF-ET, 0.0 % [0/9] in the patients undergone laparoscopic surgery, 14.6 % [7/45] in the patients of having medication and 28.6 % [6/21] in the patients of having combined therapy [laparoscopic surgery plus medication] respectively, even though the clinical pregnancy rate was higher in the patients undergone combined therapy, there was no statistical significance [p=0.41, Chi-square test] among the different treatment modalities. Conclusion: We conclude that endometriosis may affect COH adversely, in terms of number of retrieved good quality oocytes and cleaved embryos and short prtotol could be more useful clinically. Even though there was no significant difference in the clinical pregnancy rate and some limitation with relatively small sample size, combined therapy before IVF-ET would be more helpful for the improvement of the reproductive outcome in the patient with endometriosis but further study would be needed.

체외수정시술후 질식초음파로 확인된 정상임신에 있어서 산모의 연령이 임신의 결과에 미치는 영향

전종영,강인수,궁미경,손일표,백은찬,연혜정,유근재,이종표,송지홍,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.10

In infertile patients, the pregnancy loss rate after demonstration of fetal heart beat ranges about 7 % to 11 %, which is relatively higher than that of normal population(about 1.5∼3.3 %). But scanty data are available in evaluation of the influence of maternal age on pregnancy outcomes in IVF-ET patients. Thus, this study was done to assess the imp-act of maternal age on pregnancy loss rate after the early sonographic detection of fetal cardiac activity following IVF-ET. Pregnancy outcomes of 338 IVF-ET cycles from January 1, 1994 through December 31, 1995 were analyzed. Trans vaginal ultrasonography was done serially from the day 21 postconception and the presence of fetal heart activity was documented using a Samsung 125-MAX scanner with a 6.5-MHz transvaginal probe. Logistic regression analysis was done to determine the possible effects of various independent factors such as treatment pr- otocol, infertility factors, basal LH, FSH and E2, multifetal pregnancy reduction, and age of the wife, on probability of spontaneous pregnancy loss after confirmation of positive fetal heart beat. The overall pregnancy loss rate was 8.0 %(27/338). The probability of pregnancy loss after positive fetal heart beat increased with age of the wife(logistic regression analysis, P<0.05). The probability of spontaneous pregnancy loss at a given age was expressed as the following formula:probability=ex/(1+ex), in which χ=-3.9+0.2×age. The older women age over 35 had approximately twice the pregnancy loss rate compared to the younger women;14.9 %(7/47) vs. 6.9 %(20/291). The pregnancy loss rate after multifetal pregnancy reduction was 9.8 %(6/61), which was not significantly different from tht 7.6 %(21/277) without multifetal pregnancy reduction(p>0.05). We conclude that spontaneous pregnancy loss rate after documentation of fetal cardiac activity increases as a function of the maternal age and a profound effect was observed after age 35. Thus, older patients should be counselled on the higher risk of spontaneous pregnancy loss.

미세난관복원수술 후 누적 임신율에 관한 임상적 고찰

홍수정,전종영,궁미경,백은찬,유근재,송지홍,현우영,이문섭,함경렬,이경상 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

목적: 미세난관복원수술에 영향을 미치는 인자와 추적 관찰 기간 중 누적 임신율과 임신가능성을 알아보고자 하였다. 연구 방법: 1993년 4월부터 1995년 3월까지 삼성제일병원 불임클리닉에서 한 사람의 수술자에 의해 미세난관복원수술을 받은 119명을 대상으로 logistic regression analysis와 life-table analysis를 하였다. 결과: 추적 관찰된 대상의 전체 임신율은 77.9%(67/86)이였고 여기에는 생화학적 임신 1.2%, 자궁외임신 4.7%, 자궁내임신 72.1%이 포함된다. 임신율에 영향을 미치는 인자는 수술 후 난관 길이와 추적 관찰기간이었다. 수술 후 24개월 내에 임신할 가능성은 0.75이었고 수술 후 임신되기까지의 median interival은 6.6개월이었다. 결론: 수술 후 24개월 내에 임신할 가능성은 0.75이고, 수술 후 난관 길이가 임신율에 미치는 중요한 인자였으며 추적 관찰기간이 길수록 누적 임신율은 증가하였다. Objective: To evaluate what factors can influence the pregnancy outcome of the patients who underwent microsurgical of tubal sterilization and to calculate cumulative preganncy rate and probability of pregancny by period of follow-up. Design: Retrospective clinical study. Patient(s): One hundred nineteen patients who had sterilized and had operated microsurgical tubal reversal by one operator in our hospital between April 1993 and March 1995. Main Outcome Measure(s): Clinical characteristics of patients, influencing factors and cumulative pregnancy rates by logistic regression analysis and life-table analysis. Results: Pregancny outcomes were identified in 72.3% of the total patients (86/119). The overall pregancny rate was 77.9% (67/86), which included biochemical pregnancy (1/86, 1.2%), ectopic pregnancy (4/86, 4.7%) and intrauterine pregnancy (62/86, 72.1%). The factors influencing pregnancy outcome in this study by logistic regression analysis were tubal length after operation and interval from operation to achieving pregnancy. The probability that pregnancy would occur within first 24 months in total patients was 0.75. The median interval from tubal reversal to pregnancy was 6.6 months. Conclusion: The overall probability of pregnancy was 0.75 within first 24 months. The tubal length reconstructed after operation was the major factor affecting the pregnancy outcome according to result of this study.

사정 정자를 이용한 세포질내 정자주입술에서 수정률과 임신율에 영향을 미치는 요인

전종영,강인수,궁미경,김정욱,손일표,최범채,백은찬,유근재,전진현,이호준,임천규,변혜경,한미현 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.4

본 연구에서는 1994년 5월부터 1996년 12월까지 제일병원 불임크리닉에서 사정 정자를 이용하여 IC SI를 시행한 975 주기를 대상으로 수정률과 임신율에 영향을 줄 수 있는 여러 가지 요인들을 비교, 분석하였으며 그 결과는 다음과 같다. 1. ICSI를 시행한 975주기, 10,927개의 난자 중에 서 8,809개(69.7%)가 수정되었고, 933주기에서 배아 이식을 시행하여 213주기(22.8%)에서 태아의 심박동이 확인되었다. 2. 수정률은 채취 난자 수, 성숙 난자 수, 난자의 성숙율 그리고 정자의 상태 등에 따라 유의한 차이를 나타내었지만 모든 비교군에서 64% 이상의 양호한 수정률을 나타내었다. 3. 임신율은 환자의 연령이 낮을수록(35세 이하), 채취 난자와 성숙 난자의 수가 많을수록(6개 이상) 그리고 ICSI 후 수정률이 높을수록(61% 이상) 그렇지 않은 경우에 비해 유의하게 높게 나타났다. 결론적으로 사정 정자를 이용한 ICSI의 임신율은 정자의 상태보다는 환자의 연령, 채취 난자와 성숙 난자의 수와 ICSI 후 수정률 등에 따라 차이가 있음 을 알 수 있었다. Intracytoplasmic sperm injection (ICSI) has been reported as the most successful technique to obtain high fertilization and pregnancy rate in infertile couples who could not be helped by traditional in vitro fertilization or previously described techniques of assisted fertilization. We performed retrospective analysis, in relation to the number of retrieved (NRO) and injected oocytes (NIO), sperm parameters, maturation rate of retrieved oocytes (MRO), fertilization rate after ICSI (FRI) and age of patient (AGP) in 975 ICSI cycles using ejaculated sperm during 1994∼1996. The purpose of this study was to determine the important factors affecting fertilization and ongoing pregnancy rate in the ICSI cycles using ejaculated sperm. A total of 8,809 injected oocytes, 6,138 (69.7%) oocytes were normally fertilized and 213 (22.8%) ongoing pregnancies were achieved in 933 cycles of embryo transfer. The fertilization rates were significantly different in relation to NRO (from 67.3% to 75.0%), NIO (from 68.5% to 73.9%), sperm parameters (from 64.4% to 73.0%), MRO (from 64.6% to 73.9%)and AGP (from 67.8% to 74.4%), respectively. The ongoing pregnancy rates were significantly different in relation to NRO (from 10.0% to 26.6%), NIO (from 10.4% to 27.9%), FRI (from 18.5% to 30.6%) and AGP (from 6.7% to 25.4%), respectively. From these results, it can be concluded that ICSI using ejaculated sperm can provide high normal fertilization rates (above 64%) in all groups analyzed and NRO, NIO, FRI and AGP are important factors determining a successful ongoing pregnancy.

다태임신 감수술 (Multifetal Pregnancy Reduction: MFPR) 전의 초기태아의 수가 임신결과에 미치는 영향

전종영,강인수,궁미경,손일표,김계현,백은찬,연혜정,유근재,이종표,송인옥,현우영 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.8

Multifetal pregnancy reduction(MFPR) appears to be an efficacious method for impro-ving the perinatal outcome of high order multifetal pregnancies(three or more fetuses). But it is controversial that larger initial fetal number before MFPR affects pregnancy outcomes adversely. The purpose of this study is to determine the affects of the initial fetal numbers on pregnancy outcomes and to compare the obstetrical outcomes according to the initial fe-tal numbers. Eighty four patients who conceived triplet or more by assisted reproductive technology(ART) in our infertility clinics and underwent MFPR to twins between January 1993 and December 1995. Sixteen patients were lost follow-up. Among the remaining 68 patients, four pateints were excluded from this study because of the pregnancy loss before 20 weeks gestation. The patients(n=64) were divided into three groups by the initial fetal number before reduction. 33 patients with triplet gestations(group 1), 18 patients with qua-druplets gestations(group 2), and 13 patients with quintuplet or more gestations(group 3) were retrospectively enrolled. Gestational age at delivery and birthweights were compared according to the initial fetal numbers. The mean maternal age was similar in each three groups. The results were as follows:1) Although there was a trend of decreasing gestati-onal weeks at delivery and decreased birthweight in each groups(mean±SEM:36.9±0.3, 34.7±1.3, 32.7±1.9 and 2,600±58, 2,161±215, 1,855±249 respectively), there were no stati-stical difference between group 1 and group 2, but there were significantly lower in group 3, compared with group1(p<0.05). 2) The incidence of birth before 36 weeks gestation in each group 1, group 2, and group 3 were 12.1%, 38.9%, and 53.8% respectively(p<0.05). 3) The incidence of low birthweight(<2,500gm) in each group 1, group 2, and group 3 were 30.3%, 55.6%, and 69.2% respectively(p<0.05). In conclusion, although MFPR reduced the high order multifetal pregnancy into twin pregnancy, the duration of gestation and the birth weight of newborn were still had a tendency of shortening and low respectively in high order multifetal pregnancy. Therefore strict control of the number of dominant follicles during superovulation and the number of transfered embryo in in vitro fertilization(IVF) is required for improving the pregnancy outcomes in ART.

과배란유도와 동결보존배아를 이용한 체외수정시술에서 난관수종이 임신율에 미치는 영향에 관한 연구

전종영,강인수,궁미경,손일표,김계현,백은찬,연혜정,유근재,이종표,송인옥 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.6

This study was performed to determine the effect of hydrosalpinx on the outcome with in vitro fertilization and embryo transfer(IVF-ET). Hydrosalpingeal fluid may leak into the uterine cavity during or after ovarian hyperstimulation and can cause deletorious effect on embryo or implantation. Herein, we reported the effect of hydrosalpinx on the cycle outcome of IVF in controlled ovarian hyperstimulation cycles and cryopreserved-thawed embryo transfer cycles. In controlled ovarian hyperstimulation cycles, comparisons were made between 59 IVF cycles of 54 patients having tubal disease without hydrosalpinx(control group) and 36 IVF cycles of 35 patients carrying hydrosalpinx(hydrosalpinx group). Both clinical pregnancy and implantation rates were significantly lower in hydrosalpinx group(25.4 versus 8.3%, and 11.6 versus 2.0% respectively). Four ectopic pregnancies were noted in hydrosalpinx group compared to one in the control group. In cryopreserved-thawed embryo transfer cycles, comparisons were made between 27 IVF cycles of 25 patients having tubal disease without hydrosalpinx(control group) and 13 IVF cycles of 13 patients carrying hydrosalpinx(hydrosalpinx group). There was a tendency of decreased pregnancy and implantation rates in hydrosalpinx group compared to the control (37.0 versus 15.4%, and 9.9% versus 4.0% respectively). One ectopic pregnancy was noted in the hydrosalpinx group compared to none in the control group. These data indicate that the presence of hydrosalpinx may negatively affect IVF outcome. We suggest that patients presenting with hydrosalpinx should consider surgical correction to optimize their outcome with IVF procedure.