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무운동성 정자를 가진 환자에서 수음으로 채취된 정자와 고환 조직 정자를 이용한 난자 세포질내 정자 직접주입술의 비교 연구
강은희(Eun Hee Kang),추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),강병문(Byung Moon Kang),안태영(Tai Young Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.1
N/A With the advent of intracytoplasmic sperm injection (ICSI), the fertiliution and pregnancy have been reported even in complete asthenozoospermia. However, the results of ICSI in men with totally immotile sperm was still disappointing. The reasons for the total lack of sperm movement are not yet determined. The immotility of ejaculated spermatozoa is probably caused by sperm degeneration during epididymal transport, therefore higher viable spermatozoa can be obtained by testicular sperm recovery in some cases with low viability and total lack of movement of ejaculated spermatozoa. Recourse to testicular spermatozoa for ICSI is thus an alternative treatment possibility in this kind of pathology. This clinical study was performed to investigate the efficacy of ICSI employing testicular and ejaculated spermatozoa. From December 1995 to March 1998, 35 couples with totally immotile spermatozoa were included in the study. In 14 patients, the ejaculated spermatozoa were used whereas in 21 patients the spermatozoa were recovered from the testis. There were no significant differences in the fertilization and cleavage rates between the testicular sperm group with 62.6%, 52.7% and the ejaculated sperm group with 56.1%, 74.3%. Two pregnancies were achieved, one in the testicular spnm poup and the other in the ejaculated group. A healthy child was delivered at term in the ejaculated sperm group, but a clinical abortion occurred in a pregnancy in the testicular sperm group. In conclusion, it was suggested that ICSI using ejaculated sperm might be a primary treatment in cases with totally immotile spermatozoa and, if failed, testicular sperm could be used as an alternative mode of heatment.
난자 세포질내 정자 주입술 시행시 기저 난포자극호르몬의 예후 인자로서의 유용성
강은희(Eun Hee Kang),추형식(Hyung Sik Chu),채희동(Hee Dong Chae),김정훈(Chung Hoon Kim),강병문(Byung Moon Kang),장윤석(Yoon Seok Chang),목정은(Jung Eun Mok),안태영(Tai Young Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.2
N/A Objective: To determine if basal serom follicle stimulating harmone (FSH) level could be a prognostic factor of the clinical outcome in in vitro fertilization and embryo transfer (IVF-ET) with intracytoplasmic sperm injection (ICSI) in the couples with male factor infertility. Materials and Method: From December 1995 to March 1998, total 118 patients with male factor infertility were included in this study. Patients were allocated to the low basal FSH group (>8.5 mIU/ml) and the high basal FSH group (>8.5 mlU/ml). The basal levels of FSH were measured in the 3rd day of menstrual cycle preceding ovarian stimulation cycle in total IVF cycles by immunoradiometric assay (IRMA). Statistical analysis was performed using Student's t-test, Fishers exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. Results: The total dose of exogeneous gonadotropin required in the patients of the high basal FSH group was significantly higher than that of the patients with the low basal FSH poup (p < 0.05). The numbers of retrieved oocytes, oocytes with grade I, II, fertilized oocytes, cleaved oocytes, embryos with grade I, II, and transferred embryos were significantly higher in the low basal FSH group (p < 0.05), The clinical pregnancy rate per cycle in the low basal FSH gmup (15.7%) seemed to be higher than that in the high basal FSH poup (3.4%) (p 0.08), however, there was no statistically significant difference between the two groups. Conclusion : These results suggested that the basal FSH levels could be predictive of pregnancy outcome and the results of ovarian stimulation in IVF-ET using ICSL.
동결-융해된 고환조직내 정자를 이용한 난자세포질내 정자주입술에 관한 연구
김정훈(Chung Hoon Kim),채희동(Hee Dong Chae),강은희(Eun Hee Kang),전용필(Yong Pil Cheon),홍석호(Seok Ho Hong),강병문(Byung Moon Kang),안태영(Tai Young Ahn) 대한산부인과학회 1999 Obstetrics & Gynecology Science Vol.42 No.9
목적: 동결-융해된 고환조직내 정자를 이용한 경우와 신선한 고환조직내 정자를 이용한 난자세포질내 정자주입술간의 난자 수정율, 임신율 등과 같은 시술 성적을 비교, 분석함으로써 동결-융해된 고환조직내 정자가 난자세포질내 정자주입술을 위한 정자로서 효용성이 있는지를 알아보고자 본 연구를 시행하였다. 연구방법: 1997년 1월부터 1999년 3월까지 무정자증으로 진단되어 울산대학교 의과대학 서울중앙병원 비뇨기과 남성의학크리닉과 산부인과 불임크리닉에서 고환조직내 정자채취술 및 난자세포질내 정자주입술을 시행받은 41명의 환자를 대상으로 본 연구를 시행하였다. 41명의 환자들을 대상으로 총 69주기의 시술이 이루어 졌는데, 난자세포질내 정자주입술을 위하여 사용된 정자가 동결-융해된 고환조직내 정자인지 또는 신선한 고환조직내 정자인지에 따라 동결-융해군 (n=30)과 신선군 (n=39)의 두군으로 분류되었다. 동결-융해군과 신선군간에 시술 결과를 비교 분석하였으며, 또한 정액 사출관의 폐쇄유무에 따라 그리고 비폐쇄성 무정자증 환자군내에서 회수된 정자의 상태에 따라 두군간의 시술 결과를 다시 재분석하였다. 결과: 고환조직내 정자채취술 및 난자세포질내 정자주입술시 수정된 난자의 수, 수정율, 1,2등급 배아의 수, 시술주기당 임상적 임신율, 다태임신율 그리고 자연유산율 등에 있어 모두 동결-융해군과 신선군간에 유의한 차이를 보이지 않았다. 폐쇄성 무정자증 환자군의 경우나 비폐쇄성 무정자증환자군에 있어서나 모두 수정된 난자의 수, 수정율, 그리고 1, 2등급 배아의 수 및 임상적 임신율 등에 있어 모두 동결-융해군과 신선군간에 유의한 차이를 보이지 않았다. 비폐쇄성 무정자증 환자군중 난자세포질내 정자주입술을 위하여 사용된 정자가 운동성 및 비운동성 정충이 혼재된 군이나 비운동성 정자만인 군 모두에서 난자세포질내 정자주입술 결과에 있어 어느 것도 동결-융해군과 신선군간에 유의한 차이를 보이지 않았다. 결론: 폐쇄성 또는 비폐쇄성 무정자증 환자들에서 동결-융해된 고환조직내 정자를 사용한 난자세포질내 정자주입술의 시도는 회수된 고환조직내 정자의 운동성 유무에 관계없이 신선한 고환조직내 정자를 사용한 경우와 유사한 성적을 보였다. 따라서 무정자증 환자들을 위한 고환조직내 정자채취술 및 난자세포질내 정자주입술을 시행함에 있어 회수된 고환조직을 가능한 많은 동결용기에 나누어 동결보존하고자 하는 노력이 필요할 것으로 사료된다. Objective: To investigate whether frozen-thawed testicular sperm obtained from men with azoospermia could serve as an efficacious sperm source for intracytoplasmic sperm injection (ICSI) by comparing to the results of ICSI using fresh testicular sperm. Methods: From January 1997 to March 1999, 41 patients with azoospermia who underwent ICSIs using fresh and/or frozen-thawed testicular sperm were included in the study. In 23 patients of 41, fresh testicular sperm was left after ICSI and therefore remaining testicular sperm was frozen and frozen testicular sperm was used in next ICSI cycles. The results of ICSI were compared in frozen-thawed testicular sperm (frozen-thawed group, 30 cycles) versus fresh testicular sperm (fresh group, 39 cycles). Results: The number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate were comparable in the frozen-thawed and fresh groups. There were also no differences in the miscarriage rate and multiple pregnancy rate between the two groups. In patient group with obstructive azoospermia, there were no significant differences in the number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate between the two groups. In patient group with non-obstructive azoospermia, all parameters of results of ICSI were comparable in both groups. In each non-obstructive azoospermic patient group with mixed motile/immotile sperm and patient group with only immotile sperm, there were also no significant differences in the number of fertilized oocytes, grade I/II embryos, fertilization rate, clinical pregnancy rate between the frozen-thawed and fresh groups. Conclusion: Our data demonstrate that using frozen-thawed and fresh testicular sperm gives rise to comparable results after ICSI irrespective of the status of sperm in patients with obstructive or non-obstructive azoospermia.