혈중 E2 농도가 체외수정술의 임신율에 미치는 영향
Effect of serum E2 levels on the pregnancy outcome of IVF-ET
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목적: hCG 투여 당일 혈중 E2 농도가 체외수정술의 임신결과에 미치는 효과를 조사하고자 한다. 방법: 체외수정시술을 시행받은 455 주기를 대상으로 hCG 주사 당일 측정한 E2 농도에 따라 A군 (<1,000 pg/mL), B군 (1,000~2,000 pg/mL), C군 (2,000~3,000 pg/mL), D군 (3,000~4,000 pg/mL), E군 (≥4,000 pg/mL)으로 나눈 다음 체외수정술 결 과를 비교하였다. 결과: hCG 투여 당시 혈중 E2 농도는 평균 3,745.3 pg/mL였으며, 채취된 평균 난자수는 10.1개였다. 148주기 (32.5%)에서 임상적 임신이 확인되었으며, 착상률 12.2%, 분만율 18.7%였다. E2 농도가 증가할수록 채취된 난자수는 증가된 경향을 나타냈다. 임신율 또한 E2 농도가 증가함에 따라 점차 증가하다가 D군 (50.0%)에서 가장 높은 다음, E군에서 다시 감소하였다. 38세 미만 여성에서는 전체 환자 군에서와 유사한 결과를 보인 반면, 38세 이상 여성에서는 임신율과 분만율 모두 C군에서 유의 하게 가장 높았다. 결론: 이러한 결과는 혈중 E2 농도가 농도 의존적으로 임신결과에 영향을 미칠 수 있으며, 임신결과와 양성적 상관관계를 가지 는 최적의 E2 농도 범위가 있음을 시사하고 있다. 과도한 E2 농도에 의한 임신결과의 저해는 여성 나이가 38세 이상일 경우 더욱 민감하였다.
Abstract
Objective: To evaluate the effects of serum E2 levels on the day of hCG administration on the pregnancy outcome of IVF-ET after controlled ovarian hyperstimulation (COH). Methods: Data of 455 cycles of fresh IVF-ET with COH were retrospectively investigated. Serum E2 levels on the day of hCG administration were categorized into 5 groups; A (<1,000 pg/mL), group B (1,000~2,000 pg/mL), group C (2,000~3,000 pg/mL), group D (3,000~4,000 pg/mL), and group E (≥ 4,000 pg/mL). Results: Mean E2 levels on the day of hCG administration were 3,745.3 pg/mL and mean number of retrieved oocytes were 10.1. Of 455 cycles, 148 (32.5%) cycles were clinically pregnant. Implantation rate was 12.2% and delivery rate was 18.7%. The number of obtained oocytes increased with increasing levels of serum E2. Pregnancy rate gradually increased as E2 levels increased up to the group D, but began to fall in the group E. In younger women (<38 yrs), the IVF-ET outcomes were similar to those of total patients but in older women (≥38 yrs), pregnancy rate and delivery rate were significantly higher in the group C than other groups. Conclusions: This result shows that serum E2 levels have a concentration-dependent effect on the pregnancy outcome and there is an optimal range of E2 levels to achieve for a successful pregnancy. Excessive E2 levels seem more deleterious to the pregnancy outcome in older women aged ≥38 years.
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