Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Affecting Factors of Outcome of CC/hMG Ovarian Stimulation and Intrauterine Insemination

CC/hMG 배란유도 인공수정시 치료 결과에 영향을 주는 요인

Yang, Yun-Seok;Park, Jang-Ok;Oh, Kwan-Young;Lee, Byung-Kwan;Park, Joon-Sook;Lee, Jin-Yong
양윤석;박장옥;오관영;이병관;박준숙;이진용

  • Published : 20040700
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Abstract

Objective : We have attempted to identify prognostic factors regarding CC/hMG ovarian stimulation and IUI in infertility and to seek factors valuable in planning infertility treatment and predicting the success rate of IUI therapy in individual couples. Methods : The variables selected for initial analysis were female age, duration of infertility, type and diagnosis of infertility, number of pre-ovulatory follicles ($\geq$16 mm, $\geq$18 mm follicles), thickness of the endometrium, number of the treatment cycles, result of semen analysis, ovarian stimulation protocol, number of IUI. A logistic regression method was used to identify significant variables that contribute to the success of CC/hMG/IUI treatment. Results : Logistic regression analysis revealed four predictive variables as regards pregnancy: duration of infertility (p=0.011), infertility etiology (p=0.049), number of IUI (p=0.004), method of ovarian stimulation (p=0.042). A cause of infertility, especially ovarian dysfunction other than tubal factor, a shorter duration of infertility (<6 years) and CC/hMG minimal ovarian stimulation protocol with double IUI resulted in better treatment success in CC/hMG with IUI cycles. Conclusion : We concluded that careful patient selection criteria coupled with successful ovarian stimulation and increased sperm count in female reproductive tract is the model for CC/hMG/IUI sucess.

목적 : 불임환자의 치료를 위한 CC/hMG/IUI 173주기를 후향적으로 분석하여 임신결과에 영향을 미치는 요인을 분석함으로서 보다 효율적인 불임치료 계획을 수립하고 환자 개개인에 대한 인공수정의 성공 가능성을 예측하는데 도움이 되고자 하였다. 연구 방법 : 2001년 3월부터 2003년 3월까지 2년 동안 총 173주기의 CC/hMG/IUI시 치료 결과에 영향을 미칠 수 있는 환자 나이 (35세 미만과 35세 이상), 불임 기간 (6년 미만과 6년 이상), 불임 형태 (일차성, 이차성), 불임 원인 (배란장애, 남성불임, 자궁인자, 원인불명, 난관인자), 자궁내막 두께 (6 mm 미만과 6 mm 이상), 성숙난포의 수 ($\geq$16 mm, $\geq$18 mm follicle), 정액검사 (WHO criteria, IUI threshold, Sub-IUI threshold), CC/hMG 복합투여 배란유도 방법 (Day 3 CC/hMG full stimulation, Day 5 CC/hMG full stimulation, CC/hMG minimal stimulation or enhancement protocol), 인공수정 횟수 (double IUI, single IUI, IUI & timed intercourse)등에 대하여 로지스틱 회귀분석을 하였다. 결과 : 총 임상적 임신율은 19.7%였고 이중 다태아 임신율은 26.4%, 유산율 14.7%, 자궁외 임신은 11.7%였다. 로지스틱 회귀분석에서 CC/hMG 복합투여 배란유도시 임신에 대한 예측변수로 불임 기간 (p=0.011), 불임 원인 (p=0.049), CC/hMG 배란유도 방법 (p=0.042), 인공수정 횟수 (p=0.004) 등을 얻었다. 불임 기간이 6년 미만 (versus $\geq$6 years), 배란장애 (versus tubal factor), CC/hMG 최소자극법 (versus Day 3 CC/hMG full stimulation), double IUI (versus single IUI)에 대한 odds ratio는 각각 19.87, 5.11, 2.59, 6.07이였다. 결론 : CC/hMG/IUI 시행하는 경우 불임 원인이 배란장애이고, 불임 기간이 6년 미만이며, CC/hMG 복합투여 배란유도 방법 중 CC/hMG 최소자극법을 사용하고, 인공수정 1번한 경우 보다 2번 한 경우에 보다 높은 치료 성공을 예측할 수 있었다. 그러므로 주의 깊게 환자를 선택하고 적절한 배란유도 방법을 사용하며 여성의 생식기관에 보다 많은 정자가 투입된 경우에 보다 좋은 CC/hMG/IUI 치료 결과를 얻을 수 있을 것이다.

Keywords

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