남성불임에서 세포질내 정자주입술 시술시 GnRH agonist를 이용한 long protocol과 GnRH antagonist를 이용한 minimal protocol의 비교연구
A Study for Clinical Efficacy of GnRH Antagonist (Cetrorelix) Combined Minimal Stimulation Protocol and GnRH Agonist Combined LongProtocol in Assisted Reproductive Techniques for ICSI Cycles
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목적 : 본 연구의 목적은 남성불임환자의 치료에 있어 배우자의 과배란유도방법으로 GnRH antagonist (Cetrorelix)에 의한 minimal stimulation protocol과 GnRH agonist에 의한 long protocol의 비교를 위한 연구이다. 연구 방법 : 2002년 1월부터 2003년 6월까지 중앙대학교 의과대학 산부인과 불임클리닉에서 ICSI 시술을 이용한 체외수정시술을 시행받은 연령 35세 이하인 환자를 대상으로 GnRH antagonist군 (실험군)은 minimal stimulation protocol을 이용한 30명 (30주기), GnRH agonist군 (대조군)은 long protocol을 이용한 35명 (35주기)을 대상으로 하였다. 임신률, hMG사용량, 주기당 체취된 난자수와 난소과자극증후군을 각각 비교하였다. 결과 : 주기당 체취된 난자의 수는 GnRH antagonist군에서 4.7±0.6이며 GnRH agonist군은 8.4±1.8이다. 수정률은 GnRH agonist군과 antagonist군에서 각각 82.5±17.7%, 79.4±20.2%이다. 치료 주기당 hMG사용량 (앰플/주기)은 GnRH antagonist군에서는 8.5±1.2앰플, GnRH agonist군은 39.4±10.7앰플로 GnRH agonist군에서의 사용량이 GnRH antagonist군의 사용량에 비해 유의하게 많았으며 (p<0.001) 난소 과배란 증후군 (OHSS)은 GnRH agonist군에서만 1 case에서 발생하였다. 임신률은 GnRH agonist군에서 31.4%, GnRH antagonist군에서 23.3%였다. 결론 : 남성불임의 원인으로 인한 보조생식술의 시행시 ICSI를 사용한 환자에서 과배란유도방법으로 GnRH antagonist를 병합한 minimal stimulation protocol은 새로운 과배란유도방법이라 하겠다.
Abstract
Objective : The aim of this study was to evaluate the outcomes of the GnRH antagonist (Cetrorelix) minimal stimulation protocol comparing with GnRH agonist combined with long stimulation protocol in male infertility patients. Methods : From Jan 2002 to Jun 2003, 65 patients (65 cycles) were performed in controlled ovarian hyperstimulation by using GnRH antagonist and GnRH agonist for male infertility patients. GnRH antagonist combined with minimal stimulation protocol was administered in 30 patients (30 cycles, Study Group) and GnRH agonist long stimulation protocol was administered in 35 patients (35 cycles, Control Group). We compared the pregnancy rate/cycle, total hMG(A)/cycle, retrieved oocyte/cycle, and the incidence of ovarian hyperstimulation syndrome between the two groups. Student-t test was used to determine statistical significance. Statistical significance was defined as p<0.05. Results : The mean number of oocytes retrieved per cycle was 4.7±0.6 in the GnRH antagonist group and 8.4±1.8 in the GnRH agonist group. Fertilization rates were 82.5±17.7% and 79.4±20.2% in the GnRH antagonist and agonist group, respectively. The GnRH antagonist group used a lower dose of hMG (8.5±1.2 vs 39.4±10.7 ample/cycle) and none of them developed OHSS. Clinical pregnancy rates per cycle were 23.3% in GnRH antagonist group and 31.4% GnRH agonist group. Conclusion : GnRH antagonist protocol may be presented as a new controlled ovarian hyperstimulation protocol which has been applied to male-factor infertility undergoing ICSI.
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