난관 불임환자에서 난관 개통술시 진단복강경의 효용성

박찬우,김혜옥,허걸,양광문,김진영,송인옥,유근재,전종영,이경상,강인수,궁미경,Park, Chan-Woo,Kim, Hye-Ok,Hur, Kuol,Yang, Kwang-Moon,Kim, Jin-Young,Song, In-Ok,Yoo, Keun-Jae,Jun, Jong-Young,Lee, Kyung-Sang,Kang, Inn-Soo,Koong, Mi-Kyoung 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.2

Objective: To evaluate whether diagnostic laparoscopy before transcervical fallopian tube catheterization (TFTC) would improve tubal recanalization rate and pregnancy rate in patients with bilateral proximal tubal blockage in hysterosalpingogram (HSG). Methods: The retrospective study was performed in those underwent TFTC from January 1998 to December 2001. A total of 50 patients with bilateral proximal tubal blockage in HSG were subjected to TFTC sequentially using repeated HSG (rHSG), selective salpingography (SS) followed by tubal catheterization (TFTC). Each procedure was terminated once patency had been achieved without proceding to the next technique. In Group A patients (n=35, 64 tubes), diagnostic laparoscopy was performed before TFTC was taken to exclude the tube combined with peritubal adhesion or distal tubal pathology. In Group B, patients (n=15, 26 tubes) were performed TFTC without diagnostic laparoscopy. Results: There were significant difference in clinical pregnancy rate (45.7% vs 15.4%, p=0.034) but no differences were found in recanalization rate (75.0% vs 73.1%) and complication rate (8.6% vs 13.3%). Although there is no signficant difference, more tubes were canalized by SS, which means tubal obstruction rather than occlusion, in Group A (25.0% vs 5.3%, p=0.069). Conclusion: Diagnostic laparoscopy would be effective in the selection of tube for the relatively inexpensive and less invasive TFTC or patients in need of assisted reproductive technologies. With the tubes without combined peritubal adhesion or distal tubal pathology, pregnancy rate was significantly increased.

37세 이상의 환자에서 체외수정시술시 GnRH Agonist 주기와 GnRH Antagonist 주기의 비교 연구

박찬우,차선화,김해숙,김혜옥,양광문,김진영,송인옥,유근재,강인수,궁미경,Park, Chan Woo,Cha, Sun Wha,Kim, Hae Suk,Kim, Hye Ok,Yang, Kwang Moon,Kim, Jin Young,Song, In Ok,Yoo, Keun Jae,Kang, Inn Soo,Koong, Mi Kyoung 대한생식의학회 2005 Clinical and Experimental Reproductive Medicine Vol.32 No.3

Objective: To compare the clinical results and pregnancy outcomes of in vitro fertilization (IVF) between GnRH antagonist cycles and GnRH agonist (GnRH-a) cycles including flare-up and long protocol in women with advanced age. Materials and Methods: Retrospective clinical study. From January 2001 to September 2003, IVF cycles of female patient 37 years over were included in this study. GnRH-a long protocol (62 cycles, 61 patients) and GnRH antagonist multi-dose flexible protocol (66 cycles, 51 patients) were compared with the control group of GnRH-a flare-up protocol (151 cycles, 138 patients). IVF cycles for non-obstructive azoospermia (NOA), endometriosis III, IV and polycystic ovarian syndrome (PCOS) were excluded in this study. Clinical results such as total gonadotropin dose, serum E2 on hCG administration, the number of retrieved oocytes and the pregnancy outcomes - clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) per embryo transfer - were compared. Results: There were significant differences in the total dose of gonadotropin (GnRH-a flare-up vs. GnRH-a long vs. GnRH-antagonist; 41.8 vs. 54.7 vs. 24.8), serum E2 on hCG administration (1787.2 vs. 1881.6 vs. 788.0), the numbers of retrieved oocytes (8.1 vs. 11.1 vs. 4.5) and endometrial thickness (9.1 vs. 10.4 vs. 8.0) which were significantly lower in GnRH-antagonist cycles. But pregnancy outcomes shows no significant differenced in CPR (25.0% vs. 35.8% vs. 24.5%), IR (11.7% vs. 12.3% vs. 10.1%) and LBR (15.8% vs. 28.3% vs. 15.1%) Conclusion: In women with advanced age, GnRH-antagonist cycles can result in comparable pregnancy outcomes to GnRH-a cycles including flare-up and long protocol. GnRH-a long protocol show higher CPR, IR and LBR than GnRH antagonist multi-dose flexible protocol and flare-up protocol without significant differences.

임신 제 1삼분기에 자연유산 된 환자에서 질식초음파로 확인된 태아심장박동 유무에 따른 자연유산 수태물의 핵형 비교

양광문 ( Kwang Moon Yang ),송인옥 ( In Ok Song ),유근재 ( Keun Jae Yoo ),허걸 ( Kuon Hur ),한국선 ( Kuk Sun Han ),전진현 ( Jin Hyun Jun ),박소현 ( So Yeon Park ),김진영 ( Jin Young Kim ),전종영 ( Jong Young Jun ),강인수 ( Inn Soo 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.12

목적 : 수정란의 유전적 결함은 배아발달의 이상과 자연유산의 가장 흔한 원인이다. 일단 태아의 심장박동이 확인되면 향후 자연유산의 가능성은 5% 이내로 보고되고 있다. 임신초기 태아 심장박동 확인 후의 자연유산이 염색체 이상과 더 관계가 깊다고 보고되고 있으나 보고자들에 따라 의견이 분분하다. 이 연구의 목적은 임신 제 1 삼분기에서 질식초음파로 확인된 태아심장박동 유무와 자연 유산된 이상 핵형과의 관련성을 보기 위함이다. 대상 및 방법 : 2001년 Objective : Genetic defects of the zygote, such as chromosome aberration, are the most frequent cause of abnormal embryonic development and spontaneous abortion. Recent advances in ultrasonographic technology have allowed documentation of early embryonic

동결보존 배아이식에서 분비기 자궁내막 유도시 프로게스테론 투여 방법에 따른 착상율과 임신율의 비교

박찬우,허걸,김문영,송현정,김혜옥,양광문,김진영,송인옥,유근재,천강우,변혜경,궁미경,강인수,Park, Chan-Woo,Hur, Kuol,Kim, Moon-Young,Song, Hyun-Jung,Kim, Hye-Ok,Yang, Kwang-Moon,Kim, Jin-Yeong,Song, In-Ok,Yoo, Keun-Jae,Cheon, Kang-Woo,Byun, 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.3

Objective: To evaluate the difference of implantation rate (IR) and clinical pregnancy rate (CPR) between two protocols of endometrial preperation in women undergoing frozen-thawed embryo transfer (FET) cycles. Methods: This study was performed during the different time periods: A retrospective study from January 2000 to June 2001 (phase I) and a prospective study from July 2001 to March 2002 (phase II). All the patients received estradiol valerate (6 mg p.o. daily) starting from day 1 or 2 of the menstrual cycle without pituitary down regulation. Progesterone was administered around day 14 after sonographic confirmation of endometrial thickness $\geq$7 mm and no growing follicle. In Group A (n=88, 99 cycles) of phase I, progesterone was administered i.m. at a dose of 50 mg daily from one day prior to thawing of pronuclear (PN) stage frozen embryo or three days prior to thawing of 6-8 cell stage frozen embryo and then each stage embryos were trasnsferred 2 days or 1 day later after thawing. In Group B (n=246, 299 cycles) of phase I, patients recieved progesterone 100 mg i.m. from one day earlier than group A; two days prior to PN embryo thawing, four days prior to of 6-8 cell embryo thawing. During the phase II, to exclude any differences in embryo transfer procedures, in Group 1 (n=23, 28 cycles) of phase II embryo was transfered by one who have used the progesterone protocol since the phase I. In Group 2 (n=122, 139 cycles) of phase II embryo was transfered by one who use the progesterone protocol from the phase II. Results: When compared across the phase and group, there were no significant differences in the characteristics. During the phase I, there were significant increase in IR (14.4% vs 5.9%, p=0.001) and CPR (28.3% vs 14.5%, p=0.000) in group A. During the phases II, IR (11.8% vs 10.6%) and CPR (27.6% vs 27.3%) show no differences between two groups. Conclusions: In FET cycles, IR and CPR are increased significantly by the change of dosage and timing of progesterone administraton. And the timing is considered to be more important factor because the dosage of progesterone did not affect implantation window in previous studies. Therefore, we suggest that progesterone administration in FET cycle should begin from one day prior to PN stage embryo thawing and three days prior to 6-8 cell stage embryo thawing.

자궁경관무력증의 임상양상

김창헌 ( Chang Heon Kim ),김계현 ( Kye Hyun Kim ),허걸 ( Kuol Hur ),김희철 ( Hee Chul Kim ),유근재 ( Keun Jai Yoo ),송인옥 ( In Ok Song ),한정열 ( Jyung Yeol Han ),양재혁 ( Jae Hyug Yang ),최범채 ( Bum Chae Choi ) 대한주산의학회 2000 Perinatology Vol.11 No.2

정자의 획득 방법에 따라 얻어진 ICSI 배아의 동결-융해 이식 후 임신 결과

김수경 ( Soo Kyung Kim ),변혜경 ( Hye Kyung Byun ),최수진 ( Su Jin Choi ),박용석 ( Yong Seok Park ),송상진 ( Sang Jin Song ),전진현 ( Jin Hyun Jun ),궁미경 ( Mi Kyoung Koong ),송인옥 ( In Ok Song ),유근재 ( Keun Jae Yoo ),양광문 ( 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.11

자궁내막증을 갖는 불임환자에서 체외수정시술시 내과적 외과적 치료의 유용성

최규홍,김계현,강인수,이재훈,송지홍,유근재,송인옥,최범채,궁미경,양광문 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.3

목적: 자궁내막증을 갖는 불임환자에서 내과적 외과적 치료가 체외수정시술후 임신율을 높일 수 있는지 알아보고자 하였다. 연구방법: 1995년 1월부터 1998년 12월간에 삼성제일병원 산부인과에 내원하여 자궁내막증만을 불임원인으로 진단되고 35세이하, 혈중 기저 난포자극호르몬농도가 10IU/ml이하인 불임여성중 내과적/외과적 치료후 1년동안 임신시도에 실패한 191명에서 단기 또는 장기 과배란 유도후 체외수정시술을 시행하여 배아이식이 취소된 18주기를 제외한 296주기를 연구대상으로 하였다. 내과적 치료는 다나졸 (danazole, 영풍, 한국) 600mg/일 을 4-6개월간 경구투여하였으며 간장장애가 발생한 경우 유사성선분비호르몬 (GnRh agonist, decapeptyl, Ferring, Germany)을 3.75mg/월 용량으로 잔여기간동안 근주 하였다. 자궁내막증의 병기는 1985년 미국불임학회에서 정한 바에 따랐다. 연구대상은 체외수정시술전 치료를 하지 않은 경우 그룹 1, 골반경수술을 시행한 경우 그룹 2, 내과적 치료를 한 경우 그룹 3, 내과적/외과적 병합치료를 한 경우 그룹 4로 하여 각 그룹간에 소요된 성선자극호르몬의 양, 획득된 난자수, 배아수 및 임신율간에 유의한 차이가 있는지 알아보았으며 DBSTAT Ver. 2.0을 사용하여 t 검정 및 카이제곱검정을 시행하여 p $lt; 0.05 인 경우 통계적으로 유의하다고 판정하였다. 결과: 평균연령 (±평균의 표준오차)은 각 그룹에서 31.5±0.3, 31.6±0.5, 31.5±0.2, 31.7±0.4였으며 평균 불임기간 (개월)은 각각 57.7±3.3, 64.5±4.8, 59.1±1.9, 52.0±3.7이었다. 임신 28주 이상의 생존 가능임신율은 12.5% (10/80), 13.5% (5/37), 14.3%(20/140), 30.8% (12/39)로 그룹4에서 가장 높았으며 (p=0.03) 소요된 성선자극호르몬의 양 (ampule)은 단기과배란요법에서 28.2±0.6 (평균±평균의 표준오차), 장기과배란요법에서 35.5±1.2로 장기과배란유도시 많은 양이 소요되었으나 (p$lt;0.0001) 생존가능임신율은 각각 16.1% (37/230), 14.5% (10/69)로 두 군간에 유의한 차이가 없었다. 결론: 자궁내막증을 갖는 불임여성에서 체외수정시술전 내과적 외과적 치료는 체외수정시술후 임신율을 향상시킬 수 있는 유용한 방법이며 과배란 유도시에는 단기과배란유도가 유익하리라고 사료된다. Objective: The aim of study was to evaluate the efficacy of medical and/or laparoscopic surgical treatment for improvement of reproductive outcome of in vitro fertilization and embryo transfer (IVF-ET) in the patients with endometriosis. Methods: 296 IVF-ET cycles except 18 cycles of cancelled embryo-transfer (unfertilization; 16 cycles, high risk of ovarian hyperstimulation syndrome; 2 cycles) in 191 infertile women with endometriosis from January 1, 1995 to December 31, 1998 were included in this study. All women's ages were ≤ 35 and the factor for infetility was endometriosis only and day 3 follicle stumulating hormone (FSH) level of all the cycles was ≤ 10 mIU/ml in this study. All the baseline study about infertility was done before initiating treatment of infertility. The stage of endometriosis was recorded during diagnostic laparoscopy by WHO critera. Medical treatment (GnRH agonist or danazole) or laparoscopic surgery was done independently or combinedly by the physician's decision according to the disease entity and symptoms. Short or long protocols were used for controlled ovarian hyperstimulation and 3 day embryos were transferred (maximally 4 embryos) by standard procedures in our institute. We classified the cases as 4 groups : group 1 (without pre-treatment, 80 cycles), goup 2 (laparoscopic surgery only, 37 cycles), group 3 (medication only, 140 cycles), group IV (combined pre-treatment, 39 cycles). Results: The mean age (years old, mean ± SEM) was 31.5 ± 0.3 (group 1), 31.6 ± 0.5 (group 2), 31.5 ± 0.2 (group 3), 31.7 ± 0.4 (group 4) respectively. The duration of infertility (months) was 57.7 ± 3.3, 64.5 ± 4.8, 59.1 ± 1.9, 52.0 ± 3.7 respectively among groups. The viable pregnancy rate (over 28 gestational weeks, VPR) was 12.5 % (10/80) in goup 1, 13.5 % (5/37) in goup 2, 14.3 % (20/140) in group 3, 30.8 % (12/39) in group 4 and there was statistically significant difference between group 1 and group 4 (P=0.03, Chi square test). The total used gonadotropins (ampules) for controlled ovarian hyperstimulation were 28.2 ± 0.6 (mean ±SEM) in short protocol group, 35.5± 1.2 in long protocol group and there was statistically significant difference(p$lt;0.0001,Chi square test). The viavle pregnancy rate(VPR) was 16.1%(37/230), 14.5%(10/69) respectively and there was no statistically significant difference. Conlusion: We concluded that combined pre-treatment(laparsoscopic surgery plus medical treatment)would be better than no treatmecnt for the increase of pregnancy nate after IVF-ET.