쌍각자궁의 쌍태임신 1예

윤태기(TK Yoon),조동제(DJ Cho) 대한산부인과학회 1983 Obstetrics & Gynecology Science Vol.26 No.1

결론 최근 저자등은 본교실에서 쌍각자궁의 양측 자궁각에 각각 착상된 쌍태임신 1예을 체험하였기에 문헌고찰과 함께 보고하는 바이다. Single pregnancy in association with uterine anomalies is not unusual, the assoc- iation of a double uterus and pregnancy is rare. The combination of a twin pregnancy with a pregnancy in each horn of a uterus is extremely unusual, only 19 cases having been previously reported· This paper reports the case of a patient with a pregnancy in each horn of a uterus Bicornis Unicollis, with a brief review of literature available.

높은 기저 난포 자극 호르몬 수치를 가지는 환자와 고령 환자의 체외수정시술을 위한 과배란 유도에서 GnRH antagonist 다회 투여법과 GnRH agonist 장기요법의 효용성에 대한 연구

김지연,김낙근,윤태기,차선희,김유신,원형재,조정현,차수경,정미경,최동희,Kim, JY,Kim, NK,Yoon, TK,Cha, SH,Kim, YS,Won, HJ,Cho, JH,Cha, SK,Chung, MK,Choi, DH 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.4

Objectives: To compare the efficacy of GnRH antagonist multiple dose protocol (MDP) with that of GnRH agonist long protocol (LP) in controlled ovarian hyperstimulation for in vitro fertilization in patients with high basal FSH (follicle stimulating hormone) level or old age, a retrospective analysis was done. Methods: Two hundred ninety four infertile women (328 cycles) who were older than 41 years of age or had elevated basal FSH level (> 8.5 mIU/mL) were enrolled in this study. The patients had undergone IVF-ET after controlled ovarian hyperstimulation using GnRH antagonist multiple dose protocol (n=108, 118 cycles) or GnRH agonist long protocol (n=186, 210 cycles). The main outcome measurements were cycle cancellation rate, consumption of gonadotropins, the number of follicles recruited and total oocytes retrieved. The number of fertilized oocytes and transferred embryos, the clinical pregnancy rates, and the implantation rates were also reviewed. And enrolled patients were divided into three groups according to their age and basal FSH levels; Group A - those who were older than 41 years of age, Group B - those with elevated basal FSH level (> 8.5 mIU/mL) and Group C - those who were older than 41 years of age and with elevated basal FSH level (> 8.5 mIU/mL). Poor responders were classified as patients who had less than 4 retrieved oocytes, or those with $E_2$ level <500 pg/mL on the day of hCG injection or those who required more than 45 ampules of exogenous gonadotropin for stimulation. Results: The cancellation rate was lower in the GnRH antagonist group than in GnRH agonist group, but not statistically significant (6.8% vs. 9.5%, p=NS). The amount of used gonadotropins was significantly lower in GnRH antagonist group than in agonist group ($34.8{\pm}11.3$ ampules vs. $44.1{\pm}13.4$ ampules, p<0.001). The number of follicles > 14 mm in diameter was significantly higher in agonist group than in antagonist group ($6.7{\pm}4.6$ vs. $5.0{\pm}3.4$, p<0.01). But, there were no significant differences in clinical pregnancy rate (24.5% in antagonist group vs. 27.4% in agonist group, p=NS) and implantation rate (11.4% in antagonist group vs. 12.0% in agonist group, p=NS) between two groups. Mean number of retrieved oocytes was significantly higher in GnRH agonist LP group than in GnRH antagonist MDP group ($5.4{\pm}3.5$ vs. $6.6{\pm}5.0$, p<0.0001). But, the number of mature and fertilized oocytes, and the number of good quality (grade I and II) and transferred embryos were not different between two groups. In each group A, B, and C, the rate of poor response did not differ according to stimulation protocols. Conclusions: In conclusion, for infertile women expected poor ovarian response such as who are old age or has elevated basal FSH level, a protocol including a controlled ovarian hyperstimulation using GnRH antagonist appears at least as effective as that using a GnRH agonist, and may offer the advantage of reducing gonadotropin consumption and treatment period. However, much work remains to be done in optimizing the GnRH antagonist protocols and individualizing these to different cycle characteristics.

제왕절개술의 임상 및 통계학적 고찰

박금자(KZ Park),김재욱(JU Kim),곽인평(IP Kwak),윤태기(TK Yoon),노일병(IB Roh) 대한산부인과학회 1981 Obstetrics & Gynecology Science Vol.24 No.11

1972년 1월1일부터 1980년 12월31일까지 만 8년간 연세대학교 의과대학 부속 세브란스병원 에서 입원하여 1000gm 이상의 태아를 분만한 16194예의 산모중 2875예의 제절예와 8쌍의 쌍태아를 포함한 2901예의 출산아를 대상으로 다음과 같은 결론을 얻었다. 1. 제절의 빈도는 19.1%였고 이중 일차제절은 13.5%였다. 2. 적응중은 아두골반불균형의 38.8%로 가장 많았다. 3. 수술합병증은 모성이환이 17.1%로 가장 많았으며 출혈 4.3% 그의 마취로 인한 경우, 기 타 합병증의 순이었다. 4. 선행제왕절개술시에 자궁반혼파열은 총 2875예의 제절환자중 23예였으며 자궁체부 중절 개술시 15.38%로서 자궁협부 횡절개술시 0.25%에 비해 상당히 높은 파열빈도를 보였다. 5. 제왕절개술시 자궁적출술을 병행하였던 경우는 총 2875예중 21예로 0.7%를 차지하였으며 그 원인은 자궁이완과 기왕자궁반흔파열이 대부분이었다. 6. 모성사망율은 0.2%였으며 주산기 사망률 은 35.2%였다. In recent years the use of cesarean section has increased remarkably, in large measure because of the widespread emphasis that is directed toward reconition of the impairment, acutual or suspected of fetal well-being as well as because of maternal complications. Fetal distress is diagnosed over three times more often than in previous studies as a result of improved methods of fetal heart monitoring and fetal scalp blood sampling. Moreover traumatic vaginal and forceps deliveries are no longer performed and the role of the vaginal delivery of the breech is being challenged. It is obvious that an absolute and relative increase in the primary cesarean section rate has occured for three indications, cephalopelvic disproportion fetal distress, and breech presentation. The availability of safe and adequat anethesia, whole blood and even anitibiotics may have been sighnificant factors in increasing the cesarean section rate. Much progress has been made in reducing cesarean section complications. However cesarean section can potentially represent a serious major operation with all of its risks in spite of such efforts. This retrospective study was carried out for the further prevention and reduction of complications. It was based on the clinical records of 2875 patients who had cesarean section and 2901 newborn babies, including 8 pairs of the twins, delivered at the Dept. of Ob and Gyn. Yonsei University College of Medicine, from Jan. 1 1972 to Dec 31. 1979. 1. overall incidence of cesarean section was 19.1% for the period . The primary sectiorate was 13.5%. 2. Among the indication for the cesarean section, cephalopelvic disproportion was the most prevalent. 3. Of the postoperative complications maternal morbidity was the most common (17.1%) and the others were hemorrhage (4.3%) and anesthesia problems. 4. Of 23 women who had rupture or dehiscence of the previous cesarean section scars, the rupture of the low flap incision was 0.2% in contrast to the classical incision 15.38%. 5. The incidence of cesarean hysterectomy was 0.7%. Among the indication uterine atony and previous uterine scar rupture or dehiscence were common. 6. Maternal mortality was 0.2% and the perinatal mortality rate 35.2 for 1000 births.

현미경을 이용한 난관복원술의 임상적 고찰

윤태기,차광열,차선희,박종영,이우석 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.2

1989년 1월부터 1990년 12월까지 2년간 차병원 산부인과에서 시행한 미세수술에 의한 난관 복원술 265예중 1년이상 추적이 가능했던 180예를 대상으로 다음과 같은 결론을 얻었다. 1. 대상환자의 연령은 평균 32.2세 (25-42세)이며 불임수술후 복원수술까지의 기간은 평균 5 년 (2-10년)이었다. 2. 과거에 시술받았던 불임수술의 종류중 복강경시술이 91.7%로 대부분을 차지하였고, 그중에서도 전기소작을 한 경우가 현저히 많았다. 3. 시행된 난관문합술의 부위별 분포는 협부-팽대부 문합이 65.5%로 가장 많았으며, 그 다음으로는 협부-협부, 자궁각-협부의 순이었다. 4. 복원수술후 난관의 길이는 5.1-6cm가 27.8%로 가장 많았으며, 난관의 길이가 4.1cm이상인 경우는 전체의 77.2%를 차지하였다. 5. 추적조사가가 가능했던 180예중 150예에서 임신이 확인되어 83.3%의 임신성공률을 보였으며 그 결과를 보면 만삭분만 83.6 %, 조기분만 0.7%, 자궁내 태아사망 1.3%, 자연유산 9.2%, 난관임신 3.9%였다. 6. 복원수술후 임신이 성립될 때까지의 경과기간은 평균 4.5개월 (1-25개월)이었다. 7. 불임시술 종류에 따라 임신성공률은 복강경에 의한 ring삽입의 경우 80.0%, 전기소작술의 경우 84.9%로 두 방법간의 유의한 차이는 없었다. 8. 난관문합부위에 따른 임신성공률은 자궁각-협부 83.3%, 자궁각-팽대부 90.4%였으나 각 부위에 따른 임신율에는 차이가 없었다. 9. 수술후 난관길이에 따른 임신율은 7cm이상시 83.3%였으나 각 난관의 길이에 따른 임신 율에는 유의한 차이가 없었다. 10. 복원된 난관길이와 수술후 임신까지의 평균 경과기간은 4cm이하의 경우 4.3개월 4.1cm 이상의 경우 4.6개월로 난관의 길이가 임신경과기간에 유의한 영향을 주지 못하는 것으로 나타났다. During 2 year period from Jun. 1989 to Dec. 1990, 265 cases of microsurgical tubal reversal were performed and 180 cases of them were followed up for more than 1 year postoperatively in the Department of Obstetrics and Gynecology, Cha General Hospital. The results were as follows : 1. The reasons for requesting reversal of sterilization were a loss of children (25.6%), remarriage (28.9%), change of attitude (45.5%). 2. The mean age was 32.2 years and 91.7% of them had been sterilized by laparoscopic cauterization . 3. The most common site of the anastomosis was isthmic-ampullar portion (65.5%). 4. The postoperative tubal length was 4.1cm or more in 77.2%. 5. No statistical differences were found in pregnancy rate according to the method of previous sterilization, the site of tubal anastomosis and postoperative tubal length. 6. The tubal length did not influence the mean interval form operation to pregnancy. 7. The overall pregnancy rate after tubal reveral was 83.3% and the outcome of the pregnancy was as follows ; term pregnancy 83.6%, premature delivery 0.7%, IUFD 1.3%, spontaneous abortin 9.2%, ectopic pregnancy 3.9%.

복강경하 미세 난관복원수술에 대한 임상적 고찰

윤태기,차광열,차선희,성혜리,이정노 대한산부인과학회 1995 Obstetrics & Gynecology Science Vol.38 No.11

저자들은 1993년 12월부터 1994년 12월까지 차병원 불임센터에서 33예의 복강경하 미세 난 관복원수술을 시행하여 다음과 같은 결과를 얻었다. 1. 복강경하 미세 난관복원수술의 임신성공율은 73.3%(22/30) 이었고 이중 4명은 이미 분만 되었고 3명은 임신초에 자연유산되었고, 15명은 현재 임신이 지속중이다. 2. 불임시술의 종류에 따른 수술예는 ring이 19예, cautery는 9예, pomeroy는 5예였으며, 임신 성공예는 각각 11예, 7예, 4예였다. 3. 난관의 복원부위에 따른 수술에는 cornual-isthmic 3예, isthmic-istmic 3 예, cornual-isthmic 3예, isthmic-ampulla 24예, cornual-ampulla 2 예, ampulla-ampulla 1예였으며 임신예는 3예, 2 예, 14예, 2예, 1예였다. 4. 복원수술 후 난관의 길이에 따른 수술예는 4cm 이하에서 6예, 5cm는 3예, 6cm 이상에서 는 24예였으며 임신예는 각각 4예, 1예, 7예였다. 5. 복원수술후 임신까지의 평균기간은 2.1+-0.3개월이었고 본 추적 기간중 자궁외 임신은 한 예도 없었다. 이상의 결과로 보아 복강경한 미세 난관복원수술은 비교적 짧은 추적기간임에도 불구하고 높은 임신율을 나타내었고, 복강경한 수술이 개복술에 비하여 여러 장점이 많이 있음을 감 안할 때 향후 수술기법의 발달과 미세수술기구가 더욱 개발된다면 이 방법이 매우 유용하게 시행될 수 있을 것이라 사료된다. We evaluated 33 cases of laparoscopic microsurgical tubal anastomosis performed between December 1993 and December 1994 and the results are as follows; 1. The previous tubal sterilization method was bipolar cauterization in 9 cases tubal ring in 19 cases , and 5 cases of pomeroy method. 2. The anastomosis site in the favorable tube was isthmic-istmic in 3 cases , cornual isthmic in 3cases , cornual-isthmic in 3 cases isthmic-ampulla in 24 cases , cornual-ampulla in 2 cases , and ampulla-ampulla in 1 case. 3. The overall pregnancy rate was 73.3%(22/30) in a 4 month follow up period. 3 cases were excluded from pregnancy rate because 2 were in premartital status and one was lost during follow up. 4. The mean interval to conceiver from the operation was 2.1+-0.3 months 5. There was no ectopic pregnancy during our follow up period. 6. There were no intraoperative or postoperative complications . Considering the high pregnancy rate inspite of the short follow up period in our experience, this procedure could certainly replace the conventional open microsurgery.

ICSI를 실시한 2146예 중 수정란이식에 실패한 경우에 대한 원인 분석

이재호,윤태기,차광열,김현주,엄기붕,손지온 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.3

Since the introduction of intracytoplasmic sperm injection [ICSI] by Palermo et al.[1992], ICSI has been widely accepted in many IVF programs, including our own. Since our first successful pregnancy in 1993 using ICSI, we have continued to utilize the method in our IVF program to treat male factor patients. From January 1994 to December 1996, 2146 ICSI cycles were performed, most of the cases involving patients with severe male-factor infertility. The overall fertilization rate from the 2146 cycles was 76.0%. Embryo transfers failed in only 93 cycles[4.3%]. Details of the 93 failed ET`s were analysed. The fertilization rate of the ET failure group was 15.4% and the rates of 1PN and 3PN formation were 1.3% and 5.9%, respectively. A significant difference was found in the 3PN formation rate of the successful ET cycles [1.1%] compared with the 3PN rate of the failed embryo transfer group. The fertilization rate of small number[≤3] of oocyte group was slightly lower than the groups of oocyte number 4∼7 and more than 8. Forty eight cycles out of 93[51.6%] were categorized as having a poor quality oocyte with severe granulation, degenerative signs or abnormal morphology. In 24 cycles where non-motile sperm were used, fertilization did not occur. The women`s ages were not correlated with the fertilization rates. In conclusion, ET failures following ICSI for the treatment of severe male factor infertility was mainly caused by poor quality oocytes and/or poor viability of the spermatozoa used for injection into oocytes.

자연유산 환자에서 발견된 류마티스인자 1 예

최동희,윤태기,차광열,한세열,남윤성 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.5

저자들은 류마티스인자 양성을 보인 자연유산 환자 1 예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다. It is not clear whether fertility or parity are altered in patents with rheumatioid arthritis. Pregnancy outcome in rheumatoid arthritis is generally good. Although a small number of patients may be positive for antiphospholipid antibody, values tend to be low titer and not generally associated with complications. Most series find no increased risk of spontaneous abortion, premature labor, or difficult delivery. One older report suggested an increased risk of spontaneous abortion prior to diagnosis of clinical disease, and fetal growth retardation has been described in a case of severe rheumatoid arthritis with vasculitis. We have experienced a case of rheumatoid factor detected in spontaneous patient. So we report this case with a brief review of literatures.

난관복원수술 후 임신율과 임신에 영향을 미치는 인자에 관한 연구―1008 예에 대한 임상적 고찰―

이위현,윤태기,차선희,성혜리,이우식,박원식,이정노 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.6

난관복원수술 후에 임신 결과에 영향을 줄 수 있는 예후인자들을 살펴보고자 1989년 1월부터 1994년 4월까지 5년 3개월간 미세난관복원수술을 시행받은 1008예를 검토하여, 그 중 1년 이상 추적 관찰이 가능했던 764예를 대상으로 다음과 같은 결과를 얻었다. 1. 난관복원술을 받게 된 이유로서는 아이를 더 가지려는 경우(44.5%), 자녀의 잃음(36.8%), 재혼(18.7 %) 등이 주 원인이었다. 2. 대상 환자의 평균 연령은 34.1세였으며, 그들 중 복강경 전기소작으로 불임시술을 받았던 경우가 51.4% 였다. 3. 난관문합시술의 가장 흔한 부위는 협부-팽대부 (66.8%)였으며, 다음으로 협부-협부, 자궁각-팽대부의 순 이었다. 4. 복원수술 후의 잔여 난관의 길이는 71.5%에서 4.1cm 이상을 보였다. 5. 복원수술 후의 임신율은 75.0%를 보였고, 그 임신의 결과 만삭분만이 80.5%, 분만안된 경우가 11.2%, 조산 0.3%, 자궁내 태아 사망 0.3%, 자연유산 4.9%, 그리고 자궁외임신이 2.9% 였다. 6. 기왕의 불임수술 방법과 난관문합시술의 위치 그리고 술후의 잔여 난관의 길이에 따른 임신율의 유의한 차이는 없었다. 7. 수술 후 연령별 임신율은 40세 이상에서 통계적으로 유의한 감소를 보였다(p=0.0001). 8. 수술 후 임신까지의 평균 기간은 4.8개월이었으며, 4 cm를 기준으로 하였을 때 난관의 길이에 따른 임신율의 차이는 없었다. 결론적으로, 본 연구에서는 환자의 연령이 임신에 영향을 미치는 중요한 요인으로 사료된다. Objective: The purpose of this study is to evaluate the factors influencing the pregnancy outcomes of microsurgical tubal reanastomosis. Study design: During 64 months from Jan. 1989 to Apr. 1994, 1008 cases of microsurgical tubal reversal were performed and 764 cases of them were followed up and analysed retrospectively for more than 1 year postoperatively. Results: The overall pregnancy rate was 75.0%, ectopic pregnancy was 2.7%(not involved in overall pregnancy rate) and spontaneous abortion was 4.9%. No statistical differences were found in pregnancy rates according to the method of previous sterilization, the site of tubal reanastomosis and postoperative tubal length. The tubal length did not influence the mean interval from operation to pregnancy and pregnancy rate. But the pregnancy rate decrease was statistically significant at the age of over fourty. Conclusions: The age was the only factor influencing the pregnancy outcomes of microsurgical reanastomosis of tubal sterilization.

Hashimoto씨 갑상선염과 동반된 희발월경 1 례

최동희,윤태기,차광열,한세열,남윤성 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.5

저자들은 희발월경을 가진 불임환자에서 매우 높은 항갑상선 항체 역가를 보인 Hashimoto씨 갑상선염 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Thyroid hormone deficiency is among the most common diseases affecting women. Two percent of women suffer overt hypothyroidism and five percent develop subclinical hypothyroidism during their lives. An additional six percent of women have transient postpartum hypothyroidism. Furthermore, complaints consistent with thyroid hormone deficiency[e.g.,fatigue and weight gain] are common in euthyroid individuals and must be distinguished from actual thyroid dysfunction. Finally, clinical manifestations of hypothyroidism may include significant disturbances of reproductive physiology: both precocious and delayed puberty, menstrual dysfunction, and ovulatory disorders that can contribute to infertility. We have experienced a case of Hashimoto`s thyroiditis which was found in infertile patient with oligomenorrhea. So we report this case with a brief review of literatures.

시험관아기 시술시 정자직접주입법을 이용한 2146 예의 임상 결과

최동희,윤태기,차광열,한세열,정형민,엄기붕,고정재,오종훈,손지온 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.1

Since Palermo and coworkers(1992) reported the first ICSI-baby, ICSI has been widely accepted as a treatment of male factor infertility. ICSI techniques have also been used to treat abnormal semen parameters in order to overcome fertilization failures and to increase clinical outcomes. From January 1994 to December 1996, 2146 ICSI cycles were performed at the Infertility Center of Cha General Hospital and we achieved a 75.1% of fertilization rate with 713 subsequent pregnancies(34.8%). The ICSI fertilization rate using 1-day old oocytes which failed to fertilize using conventional IVF method was lower than the ICSI fertilization rate using fresh oocytes(75.7% vs 65.9%). However, we achieved 13 pregnancies out of 125 embryo transfers from the total fertilization failure group. There was no statistical difference in the fertilization rates using normal semen or semen with single defect, but statistical differences were observed between normal semen and semen with two or more defects. No statistical difference was found in pregnancy rates between normal and defective semen groups. In our MESA, PESA and TESE programs, we achieved high fertilization rates(69.2∼82.5%) and a 45.8%(mean) pregnancy rate. Categorizing the female patients by age, ie., ≤29, 30∼34, 35∼39, ≥40, fertilization rates were consistently in the range of 74.5∼ 75.7%, but pregnancy rates significantly decreased in patients older than 35 yrs(31.3%) or 40 yrs(14.2%). Of the 713 pregnancies, we were able to obtain follow-up information of the babies in 527 cycles, of which we found 8abnormalities.