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다태임신 감수술 (Multifetal Pregnancy Reduction) 후 완전태아손실에 영향을 미치는 인자
김혜옥,김문영,송현정,박찬우,허걸,김진영,양광문,유근재,송인옥,전종영,궁미경,강인수,Kim, Hye-Ok,Kim, Mun-Young,Song, Hyun-Jeong,Park, Chan-Woo,Hur, Girl,Kim, Jin-Yeong,Yang, Kwang-Mun,You, Keun-Jae,Song, In-Ok,Jun, Jong-Young,Koong, Mi-K 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.1
Objective : To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). Design: Retrospective clinical study. Methods : A total of 256 consecutive treatments of MFPR in IVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. Results: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean ($\pm$SEM) gestational age at delivery was $36.2{\pm}1.0$ and $34.1{\pm}0.5$ weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses -12.07), (p<0.05). Conclusions: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in IVF pregnancy.
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서주태,박용석,김종현,이유식,전진현,이호준,손일표,강인수,전종영,Seo, Ju-Tae,Park, Yong-Seog,Kim, Jong-Hyun,Lee, You-Sik,Jun, Jin-Hyun,Lee, Ho-Joon,Son, Il-Pyo,Kang, Inn-Soo,Jun, Jong-Young 대한생식의학회 1997 Clinical and Experimental Reproductive Medicine Vol.24 No.1
Irreparable obstructive azoospermic patients can be treated successfully with microsurgical epididymal sperm aspiration(MESA) or testicular sperm extraction (TESE) by intracytoplasmic sperm injection(ICSI). Obstructive azoospermic patients generally have normal spermatogenesis. The aim of this study was to see if any spermatozoa could be retrieved from non-obstructive azoospermia and to assess the efficacy of ICSI with TESE in germinal failure. 42 non-obstructive azoospermic patients revealed no spermatozoa at all in their ejaculates, even after centrifuge. The histology of 42 patients revealed 15 Sertoli cell only Syndrome, 4 maturation arrest and 23 severe hypospermatogenesis. All patients underwent extensive multiple testicular biopsy for sperm retrieval. These patients were scheduled for ICSI using testicular spermatozoa. In 25 out of 42 non-obstructive azoospermic patients, spermatozoa were recovered from multiple testicular biopsy specimen and 11 ongoing pregnancies were achieved. There are usually some tiny foci of spermatogenesis which allow TESE with ICSI in non-obstructive azoospermia. Also these patients may have sufficient sperm in the testes for ICSI, despite extremely high FSH level and small testes.
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김은정 ( Eun Jeong Kim ),임하정 ( Ha Jung Lim ),유근재 ( Keun Jai Yoo ),송지홍 ( Ji Hong Song ),송인옥 ( In Ok Song ),김진영 ( Jin Yeong Kim ),허걸 ( Kuol Hur ),궁미경 ( Mi Kyoung Koong ),강인수 ( Inn Soo Kang ),전종영 ( Jong You 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.9
목적 : 입원을 요하는 중증 난소과자극증후군 환자에서 난자 채취 시 예방적 알부민 투여가 임상결과에 미치는 영향에 대해서 알아보고자 하였다. 연구 방법 : 1995년 1월부터 2000년 12월까지 삼성제일병원 불임센터에서 체외수정 및 배아 이식술을 시행 받은 환자 중 입원치료를 시행한 중증 난소과자극 증후군 86명을 대상으로 하였으며, 이중 난자 채취시 예방적 정맥내 알부민 주사를 시행한 21명과 시행하지 않은 65명으로 구분하여 그 임상결과를 후향적으로 비교 분석하였다. 결과 : 난소반응을 알 수 있는 여러 지수들 중 배란유도를 위한 hCG투여 당일의 혈중 estradiol (E_2) 농도는 알부민을 투여한 군 (5805.2+1604.4 pg/㎖)이 투여하지 않은 군 (4125.2+1921.5 pg/㎖)에 비해 유의하게 높은 반면 (p<0.05), 임상경과를 알아보는 여러 지수들 (복수천자의 횟수와 양, 입원 후 사용한 알부민의 양, 증상발현기간, 입원기간 등)은 알부민을 사용한 군에서 오히려 낮은 경향을 보였으나 통계적인 차이는 보이지 않았다. 결론 : 본 연구에서 저자들은 중증의 난소과자극증후군이 우려되는 환자에서 난자 채취 당일에 예방적 정맥 내 알부민의 사용이 임상경과를 호전시키는 유용한 방법일 것으로 결론지을 수 있었다. Objective : The purpose of this study is to evaluate the efficacy of prophylactic intravenous albumin in patients with severe ovarian hyperstimulation syndrome (OHSS) who needed hospitalization. Methods : From January, 1995 to December, 2000, 86 women who underwent COH for IVF-ET were hospitalized for the management of severe OHSS in Samsung Cheil hospital. Among them, twenty one patients were treated with prophylactic intravenous albumin at the day of ovum retrieval, and 65 were not. We analysed clinical symptoms, signs, and hospital courses in the records of 86 patients retrospectively. We compared above variables of prophylactic albumin used group (n=21) with those of non-used group (n=65). Results : Among the indices of ovarian response to ovarian stimulation, serum estradiol (E_2) level at the day of hCG injection was significantly higher in prophylactic albumin used group (5805.2±1604.4 pg/ml) than non-used group (4125.2±1921.5 pg/ml, p<0.05). But the variables which indicate clinical progress (number and amount of paracentesis, amount of used albumin after hospitalization, duration of symptoms, hospital days) showed less severe tendency in prophylactic albumin used group but was not significantly different between two groups. Conclusion : Our results indicates that the use of prophylactic intravenous albumin in patients who have risk of severe OHSS had some advantages in favorable clinical progress.
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