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저반응군의 체외수정에서 한 개의 배아 이식 시 임신에 영향을 주는 요인
김혜옥,김민지,연명진,차선화,궁미경,송인옥,Kim, Hye-Ok,Kim, Min-Ji,Yeon, Myeong-Jin,Cha, Sun-Wha,Koong, Mi-Kyoung,Song, In-Ok 대한생식의학회 2008 Clinical and Experimental Reproductive Medicine Vol.35 No.3
목 적: 난소기능이 저하된 저반응군 불임 여성에서 한 개의 배아를 이식할 때 임신율에 영향을 주는 요인에 대해 알아보고자 한다. 연구방법: 본원에서 1996년 6월부터 2006년 4월까지 시험관 시술을 받은 환자 중, basal FSH가 12 mIU/mL 이상, 획득된 난자가 4개 이하, hCG 투여일에 혈청 $E_2$가 500 pg/ml 미만인 저반응군 총 919주기에서 한 개의 배아만을 이식한 235주기를 대상으로 하였다. 여성의 연령, hCG 투여일에 혈청 $E_2$, basal FSH, 3일째 배아 이식 시 할구수, 과배란 유도 방법, 이식 횟수에 따른 임신율과 생존아 출생률을 비교하였으며, 통계학적인 방법은 Chi-square를 이용하여 p-value 0.05 이하인 경우를 유의하게 평가하였다. 결 과: 총 919주기 중 난자채취 취소율은 25.6% (235주기), 난자채취 실패율은 18.5% (170주기), 배아 이식 취소율은 14.0% (129주기)였다. 한 개의 배아를 이식한 군의 전체 임신율은 8.1% (19주기), 생존아 출생률은 4.7% (11주기)였고, 35세 미만의 여성에서 35세 이상의 여성보다 임신율과 생존아 출생률이 통계적으로 유의하게 높았다 (20% vs. 3.5% p<0.0001, 12.3% vs. 1.8%, p=0.002). hCG 투여일에 혈청 $E_2$, basal FSH, 3일째 배아 이식 시 할구수, 과배란 유도 방법에 따른 임신율과 생존아 출생률은 차이가 없었다. 이식 횟수에 따른 누적 임신율은 1회에 8.1%, 2회에 9.2%, 3회에 9.7%, 4회에 9.0%, 5회에 9.5%였다. 결 론: 저반응군의 체외수정에서 한 개의 배아를 이식할 때, 불임 여성의 연령이 35세 미만에서 임신율과 생존아출생률이 유의하게 증가함을 확인하였고, 이식 횟수에 따른 누적 임신율은 차이가 없었다. 이는 체외수정을 시도하려고 하는 난소기능 저하의 불임 여성에서 구체적인 상담 자료로 사용할 수 있겠다. Objective: To evaluate predictor of IVF outcomes following single embryo transfer in patients with decreased ovarian reserve. Methods: A retrospective review was performed in 919 IVF cycles with elevated basal serum FSH (${\geq}12\;mIU/mL$), the number of retrieved oocytes ${\geq}4$ and serum $E_2$ concentration on hCG day <500 pg/ml between Jan. 1996 and Dec. 2006. Two hundred thirty five IVF cycles following single embryo transfer were included. Pregnancy rates and live birth rates was evaluated according to maternal age, serum $E_2$ on hCG day, basal FSH level, the number of blastomere on day 3 ET, stimulation protocol, the number of cycles of ET. Statistical analysis was used SPSS 12.0 program. Results: OPU cancellation rates were 25.6% (235 cycles), OPU failure rates were 18.5% (170 cycles), embryo transfer cancellation rates were 14.0% (129 cycles). Pregnancy rates following single embryo transfer was 8.1% (19 cycles) and live birth rates was 4.7% (11 cycles). Pregnancy rates and live birth rates of women under 35 years old was statistically higher than those of women above 35 years old (20% vs. 3.5% (p<0.0001), 12.3% vs. 1.8%, (p=0.002)). There was no difference in basal FSH, serum $E_2$ on hCG day, and the number of blastomere on ET, and stimulation protocol. Cumulative pregnancy rates according to the number of cycles of ET were $1^{st}$ 8.1%, $2^{nd}$ 9.2%, $3^{rd}$ 9.7%, $4^{th}$ 9.0%, and $5^{th}$ 9.5%. Conclusion: Pregnancy rates and live birth rates of IVF-ET cycles following single embryo transfer in patients with decreased ovarian reserve are statistically increased in women under 35 yrs old. There is no difference in cumulative pregnancy rates. These data may be helpful for counseling women with decreased ovarian reserve in attempting IVF with their own eggs or when choosing donor oocytes.
클로미펜에 부적절한 반응을 보이는 다낭성 난소 증후군 환자에서 Aromatase Inhibitor의 유용성
김혜옥,양광문,허걸,박찬우,차선화,김해숙,김진영,송인옥,궁미경,Kim, Hye Ok,Yang, Kwang Moon,Hur, Kuol,Park, Chan Woo,Cha, Sun Hwa,Kim, Hae Suk,Kim, Jin Yeong,Song, In Ok,Koong, Mi Kyung 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.1
Objective: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. Material and Methods: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. Results: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (${\geq}15mm$) was lower in the AI group ($1.08{\pm}0.45$ vs. $1.64{\pm}0.75$) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group ($10.35{\pm}1.74$ vs. $9.23{\pm}1.61$) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group ($116.9{\pm}75.8$ vs. $479.5{\pm}300.8$) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed $10.6{\pm}1.6mm$ in the endometrial thickness and $106.6{\pm}66.8pg/ml$ in $E_2$ concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number ($1.25{\pm}0.5$) compared to prior CC cycle. Conclusions: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.
김혜옥,조영호,성연아,문일환,박이갑 梨花女子大學校 醫科大學 醫科學硏究所 1987 EMJ (Ewha medical journal) Vol.10 No.4
A Clinical study on 94 cases of primary liver cancer who were confirmed at Ewha Womans University Hospital from January 1984 to December 1986 was carried out. The result obtained are as follows: 1) The ratio of male to female is 3.9 : 1, and highest incidence rate is 42.6% in 6th decade. 2) The chief complaints are RUQ abdominal pain, epigastric discomfort, dyspepsia, weight loss in the decreasing order. Physical examination shows hepatomegaly, ascites and jaundice. 3) Clonorchis sinensis infestation reveals 8.5% of cases. 4) Liver function tests shows serum globulin elevation in 96.8%, AST(aspartate aminotransferase, SGOT) elevation in 91.5%, alkaline phoaphatese elevation in 86.2%, in order of frequency. 5) Alpha-fetoprotein is positive (>400ng/ml) in 72.3% of cases. 6) Serum HBsAg is positive in 75.0% of cases. 7) Alpha-fetoprotein is apt to be positive in the HBsAg positive cases. 8) Space occupying lesions are demonatrated by liver scanning in 93.6% of cases: 73.9% in the right lobe, 11.4% in the left lobe and 14.7% in the both lobes. 9) Twelve (70.6%) of cases are assoiated with cirrhosis of liver. Of cases 75.0% is macronodular.