체외수정시술에서 rFSH를 사용한 과배란 유도시 GnRH antagonist 다회 투여요법과 GnRH agonist 장기요법의 임상적 효용성 비교연구
Clinical efficacy of GnRH antagonist multiple dose protocol and GnRH agonist long protocol in controlled ovarian hyperstimulation using rFSH in IVF-ET patients
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목적: 체외수정이나 난자 세포질내 정자 직접 주입술에 의해 불임치료를 시행 받은 환자 중 과배란유도시 GnRH antagonist를 사용하였을 경우에 GnRH agonist 장기요법과 비교하였을 때 임상적 효용성이 있는지 알아보고자 하였다. 연구 방법: 2003년 1월부터 2004년 12월까지 체외수정이나 난자 세포질내 정자 직접 주입술에 의해 불임치료를 시행 받은 환자 중 유전자 재조합에 의해 생산된 난포자극호르몬 (r-FSH)만을 사용하여 과배란을 실시했던 583주기의 환자를 대상으로 하였다. 연구군은 (n=447주기) GnRH antagonist 다회 투여요법을 사용하였으며 대조군 (n=136주기)은 GnRH agonist 장기요법을 사용하였다. 결과: 대상 환자군의 특성 및 기저 호르몬은 양군간에 차이가 없었다. 성선자극호르몬의 투여기간에 있어서 연구군은 평균 12.8±1.5일로 대조군의 13.7±1.7일에 비해 통계적으로 유의하게 짧았다 (p<0.05). 크기에 따른 난포의 갯수, hCG 투여당일의 E2의 농도, 자궁내막의 두께는 차이를 보이지 않았다. 임신율에 있어서 연구군은 32.4%로 대조군의 35.4%에 비해 낮은 경향을 보였으나 통계적으로 유의한 차이는 보이지 않았다. 그 외 채취된 난자의 수, 성숙 난자의 수, 수정된 난자의 수, 이식된 배아의 수는 양군간에 차이가 없었다. 결론: GnRH antagonist 다회투여요법을 이용한 과배란유도는 기존의 GnRH agonist 장기요법을 이용한 과배란유도와 비교했을 때 임신율에 차이는 없었지만 유의하게 배란유도의 기간이 짧아져 환자의 편리성과 경제적인 효과를 기대할 수 있으며 임신율에 있어서도 유의한 차이를 보이지 않아 효과적인 과배란유도법이라 생각된다.
Abstract
Objective: To compare the efficacy of GnRH antagonist multi dose protocol in controlled ovarian hyperstimulation (COH) for IVF-ET or ICSI with GnRH agonist long protocol. Methods: From January 2003 to December 2004, total of 583 cycles which underwent IVF-ET or ICSI using r-FSH were enrolled in this study. 447 cycles of the study group were performed in controlled ovarian hyperstimulation by using GnRH antagonist multi dose protocol and 136 cycles of the control group were performed by using GnRH long protocol. We compared patients characteristics, controlled ovarian hyperstimulation outcomes and IVF-ET outcomes between two groups. Results: Patients characteristics and baseline hormone levels were not different between the two groups. The duration of stimulation was significantly shorter in study group comparing with control group (12.8±1.5 days vs 13.7±1.7 days, p<0.05). There were no differences between the two groups in the number of follicles, endometrial thickness and serum E2 level on hCG day. The pregnancy rate seemed to be lower in the study group (32.4% vs 35.4%), but the difference was not statistically significant. There were also no differences in number of oocytes retrieved, matured oocytes, fertilized oocytes and transferred embryos between two groups. Conclusion: GnRH antagonist multi dose protocol in COH might be a simple and effective method compared with GnRH agonist long protocol.
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