정자의 획득 방법에 따라 얻어진 ICSI 배아의동결-융해 이식 후 임신 결과
Pregnancy Outcomes after Transfer of Frozen-thawed Embryos followingICSI with Ejaculated, Fresh and Frozen-thawed Testicular Sperm
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목적 : 본 연구는 사정정자, 고환정자, 동결 융해한 고환정자를 이용하여 세포질내 정자주입술 (intracytoplasmic sperm injection, ICSI)을 시행한 후 획득된 잉여의 배아를 동결하고, 이후 융해한 배아를 이식한 뒤의 임신율을 알아보고자 하였다. 연구 방법 : 1998년 1월부터 2002년 12월까지 삼성제일병원에서 동결란 이식을 시행한 695주기 중 전 주기에서 ICSI를 통해 체외수정 시킨 배아를 대상으로 하였으며 이중 사정 정자로 ICSI를 시행한 535주기, 고환정자로 시행한 98주기, 동결 융해한 고환정자로 시행한 62주기에서의 결과를 비교 분석하였다. 또한 잉여의 배아는 전핵시기와 8세포기까지 발달한 배아를 대상으로 하였으며 동결제제는 1,2-propanediol을 사용하였다. 결과 : 각 군의 생존율은 동결 융해한 고환정자군 (83.9%)이 사정정자군 (77.7%), 고환정자군 (76.6%)보다 통계적으로 의의있게 높은 생존율을 보였다 (p<0.01). 또한 양질의 배아율과 임신율은 사정정자군이 46.3%, 28.8%, 고환정자군이 49.2%, 36.6%, 동결 융해한 고환정자군이 46.2%, 34.9%로서 각 군간에 통계적인 유의성은 보이지 않았다. 결론 : 폐쇄성 또는 비폐쇄성 무정자증 환자의 고환 조직을 동결-융해한 후 획득된 정자로 ICSI를 시행하여 얻은 배아를 다시 동결-융해하여 배아이식을 시행하여도 고환정자군과 동결 융해한 고환정자군 간에 임신율과 착상율이 차이가 없음을 알 수 있었으며, 동결 융해 고환정자를 이용한 배아의 동결-융해 이식은 심한 남성 불임의 요인을 가지고 있는 불임 부부들에게 임신의 기회를 증가시킬 수 있는 유용한 방법이 될 것으로 결론지을 수 있다.
Abstract
Objectives : This study was performed to evaluate the pregnancy rate following the transfers of frozen- thawed embryos which was derived from intracytoplasmic sperm injection (ICSI) using sperm obtained by ejaculated, testicular sperm extraction (TESE), and frozen-thawed testicular sperm extraction (t-TESE). Methods : Frozen-thawed embryos were successfully transferred to the patients in 664 cycles among 695 cycles from January 1998 to December 2002, where ICSI was done with various origins of sperm. Subjects were divided into three groups according to the origin of sperm; ejaculated sperm group as a control (n=535), TESE group (n=98) and t-TESE group (n=62). After conventional ICSI, the supernumerary PN stage or developing embryos were cryopreserved by slow freezing protocol with 1, 2-propanediol as cryoprotectant. Results : The survival rate of frozen-thawed embryos was 77.7% (2515/3236) in ejaculated sperm group, 76.6% (441/576) in TESE group and 83.9% (292/348) in frozen-thawed TESE group, respectively. The difference of survival rate of between t-TESE group and other two groups was statistically significant (p<0.01). The good embryo formation rate and positive β-hCG rate was 46.3% (1164/2515), 28.8% (148/513) in ejaculated sperm group, 49.2% (217/441), 36.6% (34/93) in TESE group and 46.2% (135/292), 34.9% (22/63) in frozen-thawed TESE group, respectively. Conclusion : This study demonstrates that comparable pregnancy rate and implantation rate could be achieved after the transfer of frozen-thawed embryos following ICSI using various sources of sperm. As there was no statistically significant difference in pregnacy rate between ICSI with fresh testicular sperm and with frozen-thawed testicular sperm, the sequential cryopreservation of supernumerary testicular sperm and embryos may be a useful method for increasing pregnancy outcome in infertile couples with male factor.
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