남성의 불임

서주태,Seo, Ju-Tae 한국과학기술단체총연합회 2004 과학과 기술 Vol.37 No.10

간이정신진단 검사에 의한 남성 불임환자의 정신과적 문제

서주태,김경희,Seo, Ju-Tae,Kim, Kyung-Hee 대한생식의학회 1998 Clinical and Experimental Reproductive Medicine Vol.25 No.3

It has been well known that infertile women experience not only emotional disturbance but also stress. But there is no concern about male infertility patients. So phychiatric symptoms were studied with SCL-90 (Symptom Check List-90) in 30 infertile men who was operated testicular sperm extraction (TESE) in Samsung Cheil Hospital and in age matched 31 fertile men from Jan. 1998 to Aug. 1998. In 5 symptom dimensions (Obcessive-Compulsive, Interpersonal Sensitivity, Depression, Phobic anxiety, Psychoticisim) scores. The Infertile group scored significantly higher than the control group. The result revealed that infertile men also experienced substantially more psychiatric symptoms than fertile men. Considering this results, psychiatric evaluation and tender care by infertility specialist are necessary for infertile men during and after evaluation and treatment.

비폐쇄성 무정자증의 치료

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.

남성불임

서주태,Seo, Ju-Tae 대한생식의학회 2006 Clinical and Experimental Reproductive Medicine Vol.33 No.1

복압성 여성 요실금 환자에서 FES-Biofeedback과 new vaginal cone의 치료효과 비교

서주태(Ju Tae Seo),이재석(Jae Seok Lee),김종우(Jong Woo Kim),박정옥(Jeong Ok Park),윤하나(Ha Na Yoon),김영호(Young Ho Kim) 대한여성건강학회 2002 여성건강 Vol.3 No.2

고환조직 정자채취술과 세포질내 정자주입술을 이용한 고환조직 정자의 수정률과 임신율

박용석,서주태,전진현,변혜경,김종현,이유식,손일표,강인수,이호준,Park, Yong-Seog,Seo, Ju-Tae,Jun, Jin-Hyun,Byun, Hye-Kyung,Kim, Jong-Hyun,Lee, You-Sik,Son, Il-Pyo,Kang, Inn-Soo,Lee, Ho-Joon 대한생식의학회 1997 Clinical and Experimental Reproductive Medicine Vol.24 No.1

This study was carried to determine the possibility of finding motile spermatozoa and fertilization, pregnancy rate after testicular sperm extraction(TESE) with ICSI in obstructive and non-obstructive azoospermic patients. In 154 cases(132 patients), obstructive azoospermia was 77 cases and non-obstructive azoospermia was 77 cases. In obstructive azoospermia, patients generally showed normal spermatogenesis and included vas agenesis(n=8), multiple vas obstruction(n=7), epididymal obstruction (n=54). Total of 982 retrieved oocytes were obtained and 84.4% were injected. The fertilization rates with 2 PN and cleavage rate were 72.5% and 62.3%, respectively. 30 pregnancies(38.9%) were achieved and the ongoing pregnancies were 22 cases (28.6%). In non-obstructive azoospermia, patients showed hypospermatogenesis(n=49), maturation arrest(n=4), Sertoli cell only syndrome (n=24). The various stages of spermatogenic cell could be retrieved by TESE and could be reached normal fertilization and embryo development with ICSI. Total of 1072 retrieved oocytes obtained and 80.2% were injected. The fertilization rates with 2 PN and cleavage rate were 52.8% and 68.9%, respectively. 22 pregnancies(30.1%) were achieved and the ongoing pregnancies were 19 cases(26.0%). Conclusively, the combination of TESE with ICSI using testicular spermatozoa can achieve normal fertilization and pregnancy rate and effective method in obstructive and non-obstructive azoospermic patients.

Effect of Testicular Histopathology on Pregnancy Outcomes in Non-Obstructive Azoospermia

박찬우,서주태,박용석,김혜옥,양광문,김진영,궁미경,강인수,송인옥,Park, Chan-Woo,Seo, Ju-Tae,Park, Yong-Seog,Kim, Hye-Ok,Yang, Kwang-Moon,Kim, Jin-Young,Koong, Mi-Kyoung,Kang, Inn-Soo,Song, In-Ok The Korean Society for Reproductive Medicine 2008 Clinical and Experimental Reproductive Medicine Vol.35 No.4

목 적: 비폐쇄성 무정자증 환자에서 고환의 조직병리학적 진단에 따라 고환조직내 정자채취술 (Testicular sperm extraction, TESE) 후 난자세포질내 정자주입술 (Intracytoplsmic sperm injection, ICSI)의 체외수정시술 결과를 알아보고자 하였다. 연구방법: 비폐쇄성 무정자증으로 고환조직내 정자채취술 후 난자세포질내 정자주입술을 이용하여 배아 이식을 시행한 122주기를 분석하였다. 고환의 조직병리학적 진단에 따라 Germ-cell aplasia (GA, 40주기), Maturation arrest (MA, 32주기) and severe hypospermatogenesis (S-HS, 50주기)로 구분하여 체외수정시술 결과를 비교하였으며, 이들 결과를 난자세포질내 정자주입술을 이용한 폐쇄성 무정자증 환자의 체외수정시술 결과와 비교하였다. 결 과: 고환조직내 정자채취술 후 난자세포질내 정자주입술시 수정율은 각각 58.1% in GA, 42.2% in MA and 48.0% in S-HS로 조직병리학적 진단에 따른 차이는 없었으며, 폐쇄성 무정자증 환자의 72.9%에 비해 유의하게 낮은 수정율을 보였다 (p<0.001). 고환조직내 정자채취술시 채취된 정자 (spermatozoa, 94주기)로 난자세포질내 정자주입술을 시행한 주기의 배아 이식 후 임신율은 각각 22.6% in GA, 29.4% in MA와 26.1% in S-HS이었으며, 출생률은 각각 16.1%, 29.4%와 19.6%로 조직병리학적 진단에 따른 차이는 없었다. 정자세포 (spermatid, 16주기)를 사용하여 난자세포질내 정자주입술을 시행한 주기의 임신율은 각각 0.0% (0/3 주기), 9.1% (1/11주기)와 0.0% (0/2주기)이었으며, 출생률은 각각 0.0%이었다. 정모세포 (spermatocyte, 12주기)를 사용한 주기의 임신율은 각각 0.0% (0/6주기), 0.0% (0/4주기)와 0.0% (0/2주기)이었으며, 출생률도 각각 0.0%이었다. 결 론: 비폐쇄성 무정자증환자의 배아이식을 시행한 주기에서 고환의 조직병리학적 진단에 따른 난자세포질내 정자주입술시 수정율은 차이가 없었으며, 폐쇄성 무정자증 환자에 비해 유의하게 낮은 수정율을 보였다. 비폐쇄성 무정자증환자에서 고환조직내 정자채취술시 정자를 채취하여 난자세포질내 정자주입술을 시행한 주기의 체외수정시술 결과는 고환의 조직병리학적 진단에 따라 차이를 보이지 않는다. Objective: To evaluate outcomes of patients with non-obstructive azoospermia (NOA) undergoing the testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI) with different histopathologic subgroups. Method: A total of 122 embryo-transferred TESE/ICSI cycles were compared among NOA subgroups; Germ-cell aplasia (GA, 40 cycles), Maturation arrest (MA, 32 cycles) and severe hypospermatogenesis (S-HS, 50 cycles). Obstructive azoospermia (OA, 667 cycles) patients were served as a control. TESE/ICSI outcomes such as fertilization rate (FR), clinical pregnancy rate (CPR) and live birth rate (LBR) were evaluated. Results: The 2PN FR of embryo-transferred TESE/ICSI cycle was 58.1% in GA, 42.2% in MA and 48.0% in S-HS, which was significantly lower than that of OA (72.9 %, p<0.001). For ICSI-spermatozoa cycles, there were no significant differences in CPR (22.6%, 29.4% and 26.1%) and LBR (16.1%, 29.4% and 19.6%) among NOA subgroups. The CPR of ICSI-spermatid cycles was 0.0%, 9.1% and 0.0% without a live birth. For ICSI-spermatocyte cycles, no clinical pregnancies occurred in any group. Conclusion: There was no significant difference in the FR of embryo-transferred TESE/ICSI cycles among NOA subgroups. The FR among all NOA subgroups was significantly lower than that of OA. Testicular histopathology in NOA did not affect successful pregnancy if spermatozoa extraction from the testis is successful and embryo transfer is possible.

저성선자극호르몬 성선저하증 (Hypogonadotropic Hypogonadism)으로 진단된 남성불임 환자에서 성선자극호르몬 (Gonadotropin) 치료가 정자형성 및 임신에 미치는 영향

주영민,김태홍,서주태,Joo, Young-Min,Kim, Tae-Hong,Seo, Ju-Tae 대한생식의학회 2009 Clinical and Experimental Reproductive Medicine Vol.36 No.3

목 적: 저성선자극호르몬 성선저하증은 남성불임의 흔치 않은 원인이다. 저자들은 성선자극호르몬 특히 인간융 모성선자극호르몬 (Human chorioinc gonadotropin: hCG)/인간폐경성선자극호르몬 (Human menopausal gonadotropin: hMG) 치료가 정자형성 및 임신에 미치는 영향에 대해 알아보았다. 연구방법: 2001년 11월부터 2007년 3월까지 불임을 주소로 내원하여 저성선자극호르몬 성선저하증으로 진단되어 성선자극호르몬 (hCG/hMG) 치료를 받은 10명의 진료 기록을 후향적으로 분석하였다. 치료 후 임신 여부를 알아보았으며, 치료 전 고환의 용적에 따라 10 cc 미만인 군 (n=4)과 10 cc 이상인 군 (n=6)으로 나누어 치료 전후의 정액지표와 혈중 FSH, LH 및 testosterone 등의 호르몬 검사를 시행하여 비교하였다. 결 과: 10명의 환자 중 7명 (70%)에서 임신에 성공하였으며 치료 후 혈중 FSH, testosterone 수치가 의미있게 증가하였다. 고환 용적이 큰 군에서 치료 후 정액량, 정자수, 운동성 및 testosterone이 유의하게 증가하였다. 결 론: 불임을 주소로 온 환자에게 흔치는 않지만 면밀한 검사를 통해 저성선자극호르몬 성선저하증을 진단할 수 있어야 하며, hCG/hMG 병합요법은 자연임신 뿐만 아니라 최근의 보조생식술과 연계하여 충분히 성공적인 치료에 도달할 수 있다. Objective: Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility. We investigated the outcome of gonadotropin therapy for restoring fertility and pregnancy outcomes in patients with HH. Methods: Medical charts of 10 infertile male patients with HH treated with gonadotropin were reviewed. Initial testicular volume were estimated. Semen analysis parameters (semen volume, sperm counts, motility), serum leutenizing hormone (LH), follicle stimulating hormone (FSH), total testosterone were determined before and after human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) treatment. Differences were analyzed statistically. Results: Of 10 patients, 7 (70%) succeed at pregnancy (nature pregnancy in 4). Semen analysis parameters, serum FSH, and testosterone were increased significantly after treatment. The population was stratified according to initial testicular volume into a small testis subset (testicular volume less than 10 cc in 4) and a large testis subset (testicular volume 10 cc or greater in 6). Semen analysis parameters and serum testosterone were increased significantly after treatment in large testis subset. Conclusion: Infertile men with HH initiate and maintain spermatogenesis with gonadotropin (hCG/hMG alone or combined) therapy, thus gonadotropin therapy is good choice in infertile men with HH.

한국인 남성 불임환자에서 Y염색체내 미세결실의 분자유전학적 분석

윤현수,이정현,서주태,김해정,이동률,전종식,조정현,김문규,이무상,노성일,Yoon, Hyun-Soo,Lee, Jeong-Hen,Seo, Ju-Tae,Kim, Hae-Jung,Lee, Dong-Ryul,Jeon, Jong-Sik,Cho, Jung-Hyun,Kim, Moon-Kyoo,Lee, Moo-Sang,Roh, Sung-Il 대한생식의학회 1996 Clinical and Experimental Reproductive Medicine Vol.23 No.3

Genes on the long arm of Y chromosome, particularly interval 6, are believed to playa critical role in human spermatogenesis. The objective of this study was to validate a sequenced-tagged site(STS)-mapping strategy for the detection of Yq microdeletion and to use this method to determine the proportion of men with Yq microdeletions in idiopathic, obstructive, nonobstructive azoospermia, severe OATS and in normal males. We analyzed three STS markers mapped to interval 6 within long arm of the Y chromosome from 106 nonobstructive, 30 obstructive azoospermia, 15 severe OATS patients, and normal 42 males in Korean men. By PCR, we tested leukocyte DNA, for the presences of STS markers(DAZ, sY129 and sY134) and SRY gene as internal control. And PCR results were confirmed by Southern hybridization, and were investigated by SSCP analysis for DAZ gene mutation. None of 42 normal males and 30 obstructive azoospermia had microdeletions, Of the 15 severe OATS typed with DAZ, sY129 and sY134, 3(20.0%) patients failed to amplify 1 or more STS markers, and of the 106 nonobstructive azoospermia typed with DAZ, sY129 and sY134, 12(11.3%) patients failed to amplify 1 or more STS markers. From these results, high prevalence(12.4%) of Yq deletion(DAZ, sY129, sY134) in men with nonobstructive idopathic azoospermia and severe OATS were observed in Korean infertility patients. To avoid the infertile offspring by assisted reproductive technique using ICSI or ROSI, genetic diagnosis will be needed in IVF-ET program.

Differential Expressions of Apoptosis Regulators and Protein Profiling by SELDI-TOF Mass Spectrometry in Human Testis with Obstructive and Non-obstructive Azoospermia

김슬기,김호승,이호준,박용석,서주태,윤용달,Kim, Suel-Kee,Kim, Ho-Seung,Lee, Ho-Joon,Park, Yong-Seog,Seo, Ju-Tae,Yoon, Yong-Dal The Korean Society for Reproductive Medicine 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.2

연구목적: 본 연구에서는 비폐쇄성 무정자증 환자에서 나타나는 정자형성과정의 이상과 고환세포의 세포자연사와의 연관관계 여부를 확인하였다. 또한 SELDI-TOF MS 분석을 통하여 고환 내 단백질 발현 양상을 확인하고, 질환에 따른 효과적인 biomarker 개발 가능성 여부를 확인하였다. 재료 및 방법: RT-PCR 및 면역조직화학법을 사용하여 고환에서의 Fas, FasL, Bcl-2, Bax와 Caspase-3의 발현 양상을 확인하고, in situ DNA 3'-end-labelling 방법으로 고환세포의 세포자연사 양상을 확인하였다. SELDI-TOF MS 분석법에 의한 고환의 병리학적 소견에 따른 단백질 발현 변화는 소수성 칩 ($H_4$)을 사용하여 분자량 10~100 kDa 범위 내에서 분석하였다. 결?과: 정상적인 정자형성과정을 보이는 폐쇄성 무정자증 환자의 고환에 비해 지주세포 증후군 (Sertoli cell only syndrome)과 성숙정지 (maturation arrest)를 보이는 고환 내 생식세포와 지주세포에서 세포자연사가 현저하게 증가한 것을 확인할 수 있었다. 세포자연사 관련인자들의 발현 양상을 확인한 결과, 지주세포 증후군과 성숙정지 환자군에서 Fas와 FasL mRNA의 발현이 증가하였으나, bcl-2, bax와 caspase-3 mRNA 발현의 경우에는 두 질환 모두에서 유의한 차이를 확인할 수 없었다. FasL 단백질 발현의 경우, 세포자연사의 증가가 관찰되었던 지주세포 증후군과 성숙정지를 보이는 환자의 간질세포와 지주세포에서 증가하는 양상을 나타내었다. SELDI-TOF MS 분석 결과에서 폐쇄성 무정자증 환자군에 비해 전체적인 단백질 발현양이 지주세포 증후군과 성숙정지 환자의 고환에서 감소하는 양상을 보였으며, 특히, 16.730 kDa 단백질의 현저한 감소를 확인할 수 있었다. 결?론: 본 연구결과를 통해 비폐쇄성 무정자증 환자에서 나타나는 정자형성과정의 장애는 생식세포의 비정상적인 세포자연사와 연관되어 있으며, 고환 내 Fas와 FasL의 비정상적인 발현이 주된 원인인 것을 확인할 수 있었다. 또한, SELDI-TOF MS 분석법을 통한 단백질 발현 양상의 연구는 무정자증 환자에서의 다양한 병리학적 소견을 쉽게 파악할 수 있는 biomarker 발굴뿐만 아니라 질환의 원인규명을 위한 연구에도 유용하게 이용될 수 있을 것으로 사료된다.