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).

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

궁미경(MK Koong),송인옥(IO Song) 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>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>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.

인간의 난관수종액이 생쥐배아발달에 미치는 영향

궁미경(MK Koong),전진현(JH Jun) 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<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<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.

미세난관복원수술 후 누적 임신율에 관한 임상적 고찰

이문섭(MS Lee),궁미경(MK Koong),함경렬(KR Ham),현우영(WY Hyun),유근재(KJ Yoo),송지홍(JH Song),홍수정(SJ Hong),백은찬(EC Baik),이경상(KS Lee),전종영(JY Jun) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.10

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.

체외수정시술시 난소과자극증후군 예방을 위한 알부민 투여나 모든 배아를 동결하는 방법의 효용성과 임신율에 미치는 영향

송인옥(IO Song),송지홍(JH Song),홍수정(SJ Hong),유근재(KJ Yoo),백은찬(EC Baik),최범채(BC Choi),궁미경(MK Koong),손일표(IP Son),전종영(JY Jun),강인수(IS Kang),박인서(IS Park) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of controlled ovarian hyperstimulation. Although there have been several protocols for prevention of OHSS, it has not been completely preventable until now. This study was performed to evaluate the efficacy of prophylactic administration of albumin on the day of oocyte retrieval or elective cryopreservation of all embryos for the prevention of OHSS in patients at high risk after ovarian stimulation for in vitro fertilization and to assess the impact of the two protocols of treatment on the pregnancy rates. We analyzed a total of 60 IVF-ET cycles in which the serum E2 concentration on the day of hCG administration was >4000 pg/ml and less than 15 oocytes were retrieved during the period of January 1995 to September 1997. The incidence of OHSS and pregnancy rates in 46 cycles in which fresh embryos transfer was done after prophylactic albumin (albumin group) were compared with 14 cycles in which embryo transfer was cancelled with cryopreservation of all embryos (cryopreservation group). Two to three months later, cryopreserved-thawed embryo transfer was done in artificially prepared cycle using estrogen and progesterone. There was no significant difference between the two groups in the mean age (31.1±0.6 vs 32.0±0.6, mean±SEM), total dosage of gonadotropin (21.1±1.3 vs 17.4±1.5 ampules), endometrial thickness on the day of hCG administration (10.5 ±0.3 vs 11.4±0.5 mm), number of oocytes retrieved (24.9±0.9 vs 28.1±3.1), up number of fertilized oocytes (13.4±0.8 vs 14.8±1.1) and number of good embryos transfered (2.4±0.2 vs 2.6±0.5). However, mean serum E2 concentration on the day of hCG administration in the cryopreservation gro (8,507±747 pg/ml) was significantly higher (p<0.05) than albumin group (5,885±177 pg/ml). The average incidence of OHSS was similar in both groups (8.7% vs 14.3%; p>0.05). But, there was no severe OHSS (0/14) in cryopreservation group, whereas incidence of severe OHSS was 4.3% (2/46) in albumin group. The clinical pregnancy rate was significantly higher in cryopreservation group than in albumin group (64.3% vs 23.9%; p<0.05) These data suggest that administration of albumin may not reliably protect against the development of OHSS. However, withholding embryo transfer may reduce the incidence of severe OHSS even in cases with extremely high serum E2 level and yield significantly higher clinical pregnancy rate subsequent thawed embryo transfer cycle. Therefore, we suggest that cancellation of embryo transfer with cryopreservation of all embryos could be an effective alternative protocol to the administration of prophylactic albumin in patients at risk of developing severe OHSS.

과배란유도와 동결보존배아를 이용한 체외수정시술에서 난관수종이 임신율에 미치는 영향에 관한 연구

송인옥(IO Song),연혜정(HJ Yeon),이종표(JP Lee),유근재(KJ Yoo),김계현(KH Kim),백은찬(EC Baik),궁미경(MK Koong),손일표(IP Son),전종영(JY Jun),강인수(IS Kang) 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.

불임여성에서 생화학적 임신이 향후 성공적 임신을 예측할 수 있는 인자로서의 유용성에 관 한 연구

이재훈(JH Lee),연혜정(HJ Yeon),김의숙(ES Kim),한정렬(JY Han),송인옥(IO Song),궁미경(MK Koong),강인수(IS Kang),전종영(JY Jun) 대한산부인과학회 1996 Obstetrics & Gynecology Science Vol.39 No.11

The objective of this study is to test the hypothesis that the occurrence of biochemical pregnancy is a good prognostic indicator in the future pregnancy performance in subfertile women. A total 174 cycles of conservative treatment in 50 patients infertile for more than one year were included in the analysis. Patients with tubal factor, severe male factor, moderate to severe peritoneal adhesions or patients having assisted reproductive technology were excluded. Serum level of hCG on postovulation day 12 or 13 was measured by immunoradiometric assay using duplicates with sensitivity of 3 mIU/ml and serial measurements were done if hCG>3 mIU/ml. Biochemical pregnancy was defined as serum hCG>3 mIU/ml without gestational sac monitored by vaginal ultrasonography. No-Biochem group was defined as patients having at least three cycles of hCG less than 3 mIU/ml and Biochem group as patients having at least one cycle of biochemical pregnancy. In survival analysis, Kaplan-Meier method was used. The occurrence of viable pregnancy, defined as pregnancy maintaining beyond 20 weeks, was regarded as a terminal event. The patients who were lost to follow up or remaining not experiencing viable pregnancy were regarded as censored. Log rank test was done to determine the difference of cumulative pregnancy rates between the two groups. In this setting, the incidence of biochemical pregnant cycle in infertile women was 10%. There was no significant difference between No-Biochem and Bio- chem group in age, duration of infertility and duration of observation. The 40-month cumulative viable pregnancy rate in No-Biochem was similar to that of Biochem group. By survival analysis, there was no significant difference between the two groups in the cumulative viable pregnancy rate. From these data, the occurrence of biochemical pregnancy dose not appear to be a good prognostic indicator for developing a viable pregnancy via conservative treatment in subfertile patients. Biochemical pregnancy may have two different aspects, one is a success of initiating pregnancy, and the other is a failure of maintaing pregnancy. Thus, it is speculated that in subfertile women, the potential merit of biochemical pregnancy may be counter-balanced by the intrinsic factor(s) which may prevent a viable pregnancy. Further studies are needed to delineate these two different aspects using specific subgroup of patients.

자궁내막증이 체외수정시술에 미치는 영향

유근재(KJ Yoo),송지홍(JH Song),송인옥(IO Song),최범채(BC Choi),전진현(JH Jun),손일표(IP Son),궁미경(MK Koong),김정욱(JW Kim),강인수(IS Kang) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.4

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

유근재(KJ Yoo),송지홍(JH Song),이종표(JP Lee),송인옥(IO Song),연혜정(HJ Yeon),백은찬(EC Baik),손일표(IP Son),궁미경(MK Koong),전종영(JY Jun),강인수(IS Kang) 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.