난자공여시술의 결과에 영향을 미치는 임상적 인자에 관한 연구
Clinical factors affecting the outcomes of oocyte donation cycles
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목적: 난자공여시술에서 공여자의 연령을 포함한 난자공여시술의 결과에 영향을 미칠 수 있는 임상적 인자들에 대하여 알아보 고, 또한 자궁내막수용성 평가에 이용되고 있는 자궁내막 두께와 내막형태의 초음파 소견이 임신의 예측가능지표로서 의미 를 가질 수 있는지 살펴보고자 하였다. 방법: 1992년 3월부터 2004년 2월까지 서울대학교병원 불임클리닉에서 난자공여시술을 시행받은 85명의 환자, 109주기를 대상 으로 연구를 시행하였다. 임신군과 비임신군, 공여자의 연령, 수혜자의 연령, 자궁내막 두께 및 형태에 따른 임상적인 특징들 을 후향적으로 비교하였으며, 통계적인 처리는 Student t-test와 One way ANOVA 그리고 Chi-square test를 시행하였다. 결과: 임상적 임신율은 주기당 38.5% (42/109), 환자당 48.2% (41/85)였다. 임신군과 비임신군 사이에 수혜자의 연령이나 자궁내 막의 두께 및 형태, hCG 투여일의 혈중 에스트라디올 농도, 획득된 난자의 개수, 수정률, 누적배아지수, 수혜자의 체질량지수 등은 통계적으로 유의한 차이가 없었으나, 공여자의 나이에 유의한 차이가 있었다 (30.2±3.6 vs 32.1±4.3, P=0.017). 공여자의 나이에 따라 대상군을 세분하여 분석해보면 hCG 투여일의 혈중 에스트라디올 농도, 획득된 난자의 개수와 수정률은 35세 이상군에서 유의하게 낮았으며, 임상적 임신율은 30세 미만군에서 35세 이상군에 비해 유의하게 높았다 (50.0% vs 18.2%, P=0.015). 또한 자궁내막 두께에 따른 임신율은 <7 mm군, 7~9 mm군, 10~13 mm군, ≥14 mm군에서 각각 50.0%, 38.1%, 42.9%, 11.1%였으며, 자궁내막 형태에 따른 임신율은 삼중층구조군과 비삼중층구조군에서 각각 41.6%, 31.3%로 나타나, 자 궁내막 두께와 형태 모두 임신율에 유의한 차이는 없었다. 결론: 난자공여시술에서 임신을 예측할 수 있는 가장 신뢰할만한 인자는 공여자의 연령이었고, hCG 투여일에 질식초음파로 측정한 자궁내막의 두께나 삼중층 구조는 임신가능성의 예측지표로서 의미를 가지지 못하는 것으로 나타났다. 수혜자의 연 령이나 누적배아지수 또한 임신율에 유의한 영향을 미치지는 않는 것으로 나타났다.
Abstract
Objective: Oocyte donation cycle has been a useful model for the assessment of potential factors affecting human pregnancy, such as uterine receptivity or oocyte quality. The purpose of this study was to investigate variable clinical factors affecting the outcomes of oocyte donation cycles. Methods: This study reviewed 109 cycles of 85 women who underwent oocyte donation in SNUH infertility clinic from March 1992 to February 2004. Variable clinical characteristics were compared between pregnant and non-pregnant group. Data was evaluated by student’s t-test, oneway ANOVA, and Chi-square test. Results: Clinical pregnancy rate was 38.5% per cycle and 48.2% per recipient. When pregnant and non-pregnant groups were compared, there was a significant difference in donor age between both groups. (30.2±3.6 vs. 32.1±4.3, P=0.017). On the other hand, there were no significant differences in mean age, BMI, gravidity of recipient, and peak estradiol level of donor. The number of oocytes retrieved, embryos transferred, fertilization rate, and cumulative embryo score were not different between pregnant and non-pregnant group. Among the various donor age groups, clinical pregnancy rate was significantly higher in <30 years group than ≥35 years (50.0% vs 18.2%, P= 0.015). There were no significant differences for both endometrial thickness and pattern in the pregnancy rate during the IVF-ET cycles by ovum donation. Conclusion: The most reliable predictive factor for pregnancy in oocyte donation cycles is the age of oocyte donor. The mid-cycle endometrial thickness and trilaminar patterns are insignificant predictors. The age of recipient and cumulative embryo score are also insignificant factors.
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