다낭성난소증후군 환자에서 체질량지수가 체외수정시술에 미치는 영향
The effect of body mass index of on the outcome of in vitro fertilization and embryo transfer in patients with polycystic ovary syndrome
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연구 방법: 2003년 3월부터 2007년 7월까지 서울아산병원 산부인과 불임클리닉에서 다낭성난소증후군으로 진단된 환자들 중 첫 번째 체외수정시술 주기를 완료했던 96명의 환자를 대상으로 하였다. 선정된 환자를 체질량지수 23 kg/㎡를 기준으로 두 군으로 나누어 비교분석 후, 다시 23 kg/㎡ 이상인 군을 23~25 kg/㎡인 군과 25 kg/㎡ 이상인 군으로 나누어 세 군 간에 체외수정시술의 결과를 비교분석하였다. 결과: 체질량지수가 23 kg/㎡ 미만인 군과 23 kg/㎡ 이상인 두 군 간을 비교한 결과 환자의 나이, 기저 혈중 난포자극호르몬 농도, hCG 투여 당일 자궁내막 두께는 차이가 없었고, 채취된 난자 및 이식된 배아의 수에서도 통계적인 유의성은 없었다. 체질량지수가 23 kg/㎡ 미만인 군과 23 kg/㎡ 이상인 군에서 투여된 유전자 재조합 난포자극호르몬 (recombinant human follicle stimulating hormone, rhFSH)의 용량은 각각 1,007.87±391.08 IU와 1,863.64±678.55 IU였으며, 과배란유도 기간은 10.10± 1.03일, 11.02±1.80일로 23 kg/㎡ 이상인 군에서 통계적으로 유의하게 높았다 (P<0.001). 임상적 임신율은 체질량지수가 23 kg/㎡ 미만인 군에서 39.5%, 23 kg/㎡ 이상인 군에서 27.0%로 통계적으로 유의한 차이가 없었으나 (P=0.14), 착상률에서는 각각 17.3%, 7.83%로 23 kg/㎡ 미만인 군에서 유의하게 높았다 (P=0.024). 한편, 23 kg/㎡ 이상인 군을 다시 23~25 kg/㎡인 군과 25 kg/㎡ 이상인 군으로 나누어 세 군간 비교하였을 때에도 각 군간 임상적 임신율에서는 차이가 없었으나 rhFSH 투여 용량, 투여 기간은 25 kg/㎡ 이상인 군에서 유의하게 많았다. 착상률은 25 kg/㎡ 이상인 군에서 낮게 나타났으나 통계적으로는 경계성 유의성을 보였다 (P=0.069). 결론: 다낭성난소증후군 환자에서 체질량지수가 23 kg/㎡ 이상인 경우 과배란유도에 사용되는 rhFSG 용량 및 투여기간은 증가되고 착상률은 저하되는 것으로 나타나 체질량지수는 다낭성난소 증후군 환자들에서 체외수정시술의 결과에 영향을 미치는 것으로 보인다.
Abstract
Objective: This study was performed to evaluate the effect of body mass index (BMI) on the outcome of in vitro fertilization and embryo transfer (IVF-ET) in patients with polycystic ovary syndrome (PCOS). Methods: Ninety-six patients with PCOS who completed their first cycle of IVF-ET were included in this retrospective study. All patients were stimulated by GnRH antagonist multi-dose protocol. The patients were divided into one of two groups on the basis of BMI ≥23 kg/㎡ vs. BMI <23 kg/㎡, and their outcome of IVF-ET was compared. Additionally the patients with BMI ≥23kg/㎡ were divided into patient group with 23 ≤BMI <25 kg/㎡ and patient group with BMI ≥25 kg/㎡, and these three groups were also compared in regard to the outcome of IVF-ET. Results: The total amount and duration of rhFSH administration were significantly higher in PCOS women with BMI ≥23 kg/㎡ than in those with BMI <23 kg/㎡ (P<0.001 in both). The implantation rate was significantly lower in women with BMI ≥23 kg/㎡ (17.4% vs 7.8%, P=0.024). When compared three group divided on the basis of BMI <23 kg/㎡ vs BMI 23~25 kg/㎡ vs BMI ≥25 kg/㎡, similar results were showed in women with BMI ≥25 kg/㎡, although implantation rate in women with BMI ≥25 kg/㎡ was lower with borderline significance (P=0.069). Conclusion: Obesity (BMI ≥23 kg/㎡) has a detrimental effect on implantation rate and is associated with the increased total amount and duration of rhFSH administration for ovarian stimulation in IVF-ET cycle. Consequently BMI may be a predictor for IVF outcomes in patients with PCOS.
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