남성 불임 환자에서 Y 염색체 미세 결손이 체외 수정 결과에 미치는 영향

최노미,양광문,강인수,서주태,송인옥,박찬우,이형송,이현주,안가영,한호섭,이희정,김나영,유승연,Choi, Noh-Mi,Yang, Kwang-Moon,Kang, Inn-Soo,Seo, Ju-Tae,Song, In-Ok,Park, Chan-Woo,Lee, Hyoung-Song,Lee, Hyun-Joo,Ahn, Ka-Young,Hahn, Ho-Suap,Lee, H 대한생식의학회 2007 Clinical and Experimental Reproductive Medicine Vol.34 No.1

목 적: 무정자증이나 심한 희소정자증이 있는 남성 불임 환자에서 Y 염색체 미세 결손을 동반하는 경우 체외 수정 및 세포질내 정자 주입술과 배아 이식의 결과에 미치는 영향을 알아보고자 하였다. 연구방법: 후향적 실험군 -대조군 연구로, Y 염색체 미세 결손이 동반된 무정자증이나 심한 희소정자증이 있는 남성 불임 부부 14 쌍을 실험군으로 하였고 대조군으로는 남성 배우자가 무정자증이나 심한 희소정자증이 있지만 Y 염색체는 정상인 12 쌍의 불임 부부를 대상으로 하였으며, 이 두 군을 다시 정자 채취 방법에 따라 사정된 정자를 이용한 군과 고환 내 정자 추출술을 통해 정자를 채취한 군으로 분류하였다. 연구 결과로는 수정률, 등급이 우수한 배아 수, 착상률, 융모막성 성선자극호르몬 양성률, 초기 임신 소실률, 출생률을 비교하였다. 결 과: 등급이 우수한 배아 수, 착상률, 융모막성 성선자극호르몬 양성률, 초기 임신 소실률, 출생률은 Y 염색체 미세 결손이 있는 군과 정상 Y 염색체를 갖는 군 간에 차이가 없었으나, 수정률은 Y 염색체 미세 결손이 있는 불임 부부 (61.1%) 에서 정상 Y 염색체를 갖는 불임 부부 (79.8%, p=0.003) 보다 낮았다. 정자 채취의 방법에 따라 비교하였을 때, 고환 내 정자 추출술을 통해 정자를 채취한 경우 실험군 (52.9%) 에서 대조군 (79.5%, p=0.008) 보다 유의하게 수정률이 낮게 나타났으나 사정된 정자를 이용한 경우에는 실험군에서 대조군 보다 수정률이 더 낮은 경향을 보였으나 유의한 차이는 없었고, 나머지 결과들은 두 군 간에 차이가 없었다. 결 론: Y 염색체 미세 결손이 동반된 무정자증이나 심한 희소정자증이 있는 불임 부부에서 고환 내 정자 추출술을 통해 정자를 채취할 경우 체외 수정 및 세포질내 정자 주입술 결과 정상 Y 염색체를 갖는 불임 부부에서 보다 수정률이 더 낮게 나타났으나, 사정된 정자를 이용하는 경우나 고환 내 정자 추출술을 통해 정자를 채취하여 수정이 된 후에는 Y 염색체의 미세 결손이 체외 수정 및 세포질내 정자 주입술과 배아 이식의 결과에 영향을 주지 않는 것으로 보인다. 그러나 향후 대규모의 전향적 연구가 더 필요할 것으로 사료된다. Objective: To determine whether the presence of Y-chromosome microdeletion affects the outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. Methods: Fourteen couples with microdeletion in azoospermic factor (AZF)c region who attempted IVF/ICSI or cryopreserved and thawed embryo transfer cycles were enrolled. All of the men showed severe oligoasthenoteratoazoospermia (OATS) or azoospermia. As a control, 12 couples with OATS or azoospermia and having normal Y-chromosome were included. Both groups were divided into two subgroups by sperm source used in ICSI such as those who underwent testicular sperm extraction (TESE) and those used ejaculate sperm. We retrospectively analyzed our database in respect to the IVF outcomes. The outcome measures were mean number of good quality embryos, fertilization rates, implantation rates, $\beta$-hCG positive rates, early pregnancy loss and live birth rates. Results: Mean number of good quality embryos, implantation rates, $\beta$-hCG positive rates, early pregnancy loss rates and live birth rates were not significantly different between Y-chromosome microdeletion and control groups. But, fertilization rates in the Y-chromosome microdeletion group (61.1%) was significantly lower than that of control group (79.8%, p=0.003). Also, the subgroup underwent TESE and having AZFc microdeletion showed significantly lower fertilization rates (52.9%) than the subgroup underwent TESE and having normal Y-chromosome (79.5%, p=0.008). Otherwise, in the subgroups used ejaculate sperm, fertilization rates were showed tendency toward lower in couples having Y-chromosome microdeletion than couples with normal Y-chromosome. (65.5% versus 79.9%, p=0.082). But, there was no significance statistically. Conclusions: In IVF/ICSI cycles using TESE sperm, presence of V-chromosome microdeletion may adversely affect to fertilization ability of injected sperm. But, in cases of ejaculate sperm available for ICSI, IVF outcome was not affected by presence of Y-chromosome AZFc microdeletion. However, more larger scaled prospective study was needed to support our results.

산전 진단된 연골무발생증 제2형

최노미 ( Noh Mi Choi ),김문영 ( Moon Young Kim ),양재혁 ( Jae Hyug Yang ),류현미 ( Hyun Mee Ryu ),정진훈 ( Jin Hoon Chung ),최준식 ( June Seek Choi ),문민환 ( Min Hwan Moon ) 대한주산의학회 2009 Perinatology Vol.20 No.1

We present a case of achondrogenesis type II demonstrating increased nuchal translucency on the first trimester ultrasound, which was confirmed in the second trimester ultrasound. Achondrogenesis type II is characterized by micromelia, varied ossification of spine, an enlarged calvarium with normal ossification, variable shortening of the ribs, and lack of rib fractures. In this case, ultrasonographic examination in the second trimester revealed a normally ossified cranium with relatively short long bones and a mildly protuberant abdomen due to small thorax and scanty ossified vertebral bodies. All these findings were compatible with the diagnosis of achondrogenesis type II. We further confirmed the diagnosis of achondrogenesis type II with postmortem radiographic examination.

저체중아의 출생 시 제대혈에서 adiponectin, IGF-I, IGFBP-1, insulin 및 Leptin에 관한 연구

최노미 ( Noh Mi Choi ),박미혜 ( Mi Hye Park ),김영주 ( Young Joo Kim ),안정자 ( Jung Ja Ann ),전선희 ( Sun Hee Chun ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.4

Objective: Intrauterine growth is influenced by multiple factors like genetic, nutritional, environmental and hormonal factors. As birth weight is reported to be related to perinatal morbidity and mortality, we aimed to compare umbilical cord blood adiponectin, IGF-I, IGFBP-1, insulin and leptin levels between small for gestational age (SGA) and appropriate for gestational age (AGA) neonates at birth to investigate the influence of these factors on birth weight and ponderal index. Methods: We investigated retrospectively 30 pregnant women with SGA and 30 pregnant women with AGA who delivered at Ewha Womans University Hospital and their babies from January 2007 to December 2007. Fetal umbilical cord venous blood adiponectin, IGF-I, IGFBP-1, insulin and leptin levels from SGA and AGA neonates were obtained at the time of delivery. The definition used to identify cases of SGA was individual birth weight ratio of less than 10th percentile and the definition of ponderal index (PI) was [BW (g)/(height (cm))3]×100. Results: Umbilical cord blood adiponectin, IGF-I and IGF/IGFBP ratio were significantly lower (P<0.05) in SGA than AGA. And umbilical cord blood IGFBP-1 were significantly higher (P<0.05) in SGA than AGA. But there was no significant difference in umbilical cord blood insulin and leptin levels between SGA and AGA neonates. Positive correlation was noted between adiponectin and IGF-I, IGF/IGFBP ratio, insulin and leptin. Negative correlation was noted between adiponectin and IGFBP-1, IGF-I and IGFBP-1. On multiple regression analysis, adiponectin and IGF-I were significant factors associated with body weight (BW), but only IGFBP-1 was significant factor associated with PI. Conclusion: These results suggest that fetal adiponectin, IGF-I, IGFBP-1 may have an important role in regulation of intrauterine growth and we will expect that evaluation of adiponectin and IGF-I in SGA may be helpful in prediction of neonatal outcome, and IGFBP-1 may be useful in diagnosis of asymmetric intrauterine growth retardation (IUGR).

양성 자궁병변에 대한 세 가지 다른 자궁적출술 접근 방법

한호섭 ( Ho Suap Hahn ),최규홍 ( Kyu Hong Choi ),김주명 ( Joo Myung Kim ),이현주 ( Hyun Joo Lee ),최노미 ( No Mi Choi ),유원식 ( Won Sik Yoo ),김경연 ( Kyung Yeon Kim ),김남숙 ( Nam Sook Kim ),조수희 ( Soo Hee Jo ),홍준식 ( Jun Sh 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.5

Objective: To evaluate the rates and clinical outcomes between abdominal hysterectomy (AH), laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH). Methods: Medical records of 236 patients who underwent hysterectomy (by one surgeon) for benign uterine pathology between march 2004 and april 2006 were reviewed. Primary outcome measure was the rate of each method of hysterectomy. Secondary outcome measures included perioperative and postoperative outcomes between groups. Results: The mean age, weight, height, body mass index, and parity in three groups showed no difference. In two hundred and twenty two cases of hysterectomies, the rate of AH was 13.5%, LH 34.2%, and VH 52.3%. Perioperative outcomes of AH, LH and VH were as follows : operative time (83.2±27.1 min, 94.2±25.2 min, and 50.8±15.5 min, respectively), change in hemoglobin (2.3±1.5 g/dL, 2.0±0.9 g/dL, and 1.3±1.1 g/dL, respectively), duration of urinary catheterization (2.0±0.2 days, 1.0±0.0 days, and 1.0±0.4 days, respectively), postoperative hospitalization (5.7±1.2 days, 4.7±0.9 days, and 4.3±1.0 days, respectively), uterine weight (733±665 g, 340±213 g, and 300±156 g, respectively). Uterine weight in the AH group was significantly heavier than in the LH and VH. The benefits of LH versus AH were shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus AH were shorter operative time, a smaller drop in hemoglobin, shorter duration of urinary catheterization and postoperative hospitalization (p<0.05). The benefits of VH versus LH were shorter operative time, a smaller drop in hemoglobin, and postoperative hospitalization (p<0.05). There were no differences in complications of AH, LH and VH (13.3%, 10.5%, and 9.5%, respectively p=0.825). Conclusions: Eighty six point five percent of hysterectomy can be done vaginal or laparoscopic approach. When there is a concerted effort to increase laparoscopic or vaginal hysterectomy, abdominal hysterectomy can decrease without increasing complication rate.

자궁탈출증에서 자궁적출술은 필수적인가?

안가영 ( Ka Young Ahn ),홍재식 ( Jae Shik Hong ),김나영 ( Na Young Kim ),이현주 ( Hyun Joo Lee ),이희정 ( Hee Jung Lee ),최노미 ( Noh Mi Choi ),한호섭 ( Ho Seup Han ),성석주 ( Suk Joo Sung ),김주명 ( Joo Myung Kim ),주관영 ( Kwan 대한산부인과학회 2006 Obstetrics & Gynecology Science Vol.49 No.6

Objective: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. Methods: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). Results: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5±33.4 min, 2.4±0.7 ㎎/dL, 5.2±1.4 days, 7.6±2.2 days vs. Group B 135.3±33.9 min, 2.9±0.8 ㎎/dL, 6.1±2.1 days, 9.4±3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. Conclusions: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.