중증 자궁내막증의 수술적 치료 후 체외수정의 결과
IN VITRO FERTILIZATION OUTCOMES IN PATIENTS WITH ADVANCED ENDOMETRIOSIS AFTER SURGICAL TREATMENT
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목적중증 자궁내막증 환자에서 수술적 처치가 체외수정 결과에 미치는 영향을 평가하고, 특히 난소 자궁내막증과 복막 자궁내막증 환자의 수술적 처치 후 체외수정시술의 척도들을 비교해 보고자 한다. 연구방법1997년에서 2004년까지, 복강경검사로 중증 자궁내막증을 진단 받고 체외수정을 시행한 506주기를 대상으로 후향적 연구를 하였다. 170주기는 수술받지 않았고, 336주기는 수술적 치료(151주기는 난소 자궁내막증, 185 주기는 복막 자궁내막증) 후 체외수정시술을 받았다. 대조군은 동일 기간 내에 난관요인에 의해 체외수정시술을 받은 313주기를 대상으로 하였다. 결과자궁내막증의 수술적 처치를 한 그룹과 수술을 받지 않은 그룹에서, 채취된 난자 수(9.6 ± 7.3 vs. 11.2 ± 7.5 vs. 14.8 ± 7.0, P ＜ 0.0001)와 이식된 배아 수(3.5 ± 1.4 vs. 3.5 ± 1.4 vs. 3.9±0.9, P = 0.001)가 유의하게 대조군보다 낮았다. 하지만, 착상률(17.2% vs. 15.2% vs. 15.9%)과 임신율(36.9% vs. 35.9% vs. 39.6%), 태아생존율(32.1% vs. 28.2% vs. 29.7%)은 유사하였다. 수술받은 복막 자궁내막증 그룹의 체외수정에서는 채취된 난자 수(9.6 ± 7.9 vs. 9.8 ± 6.5), 이식된 배아수(3.4 ± 1.4 vs. 3.7 ± 1.3), 착상률(15.5% vs. 18.0%), 임신율(34.6% vs. 39.7%), 태아생존율(29.2% vs. 35.8%)이 수술받은 난소 자궁내막증 그룹과 유의한 차이를 보이지 않았다. 결론자궁내막증 환자는 과거의 수술적 치료 유무와 상관없이 체외수정시술 척도가 낮았으나, 임신율에는 차이가 없었다. 수술적 치료를 받은복막 자궁내막증 그룹은 난소 자궁내막증과 유사하게 낮은 체외수정시술 척도를 보였다. 따라서, 난소 자궁내막증 수술 여부와 관계없이자궁내막증 자체만으로 체외수정시술 척도에 안 좋은 영향을 미치는 것으로 생각된다.
Abstract
Objective The aim of this study is to evaluate in vitro fertilization (IVF) outcomes in advanced endometriosis with/without surgical treatment and to compare between cyst enucleation and surgically treated peritoneal lesions without endometrioma. Methods We performed a retrospective analysis of 506 IVF cycles (345 patients) with stage III-IV endometriosis (170 cycles without surgical treatment, 336 cycles with the surgical treatment) between 1997 and 2004. Among the surgical treatment, 151 cycles were performed previously cyst enucleation with endometrioma and 185 cycles were performed only resection of peritoneal lesions without endometrioma enucleation. 313 cycles (246 patients) with the tubal factor infertility were used as controls. Results In the endometriosis group with/without surgical treatment, the number of retrieved oocytes (9.6±7.3 vs. 11.2 ± 7.5 vs. 14.8 ± 7.0,P < 0.0001) and the transferred embryos (3.5 ± 1.4 vs. 3.5 ± 1.4 vs. 3.9 ± 0.9, P = 0.001) was significantly lower than controls. But, implantation rates (17.2% vs. 15.2% vs. 15.9%), pregnancy rates (36.9% vs. 35.9% vs. 39.6%) and live birth rates (32.1%vs. 28.2% vs. 29.7%) were similar. Surgically treated peritoneal lesions group showed no difference in the number of retrieved oocytes (9.6 ± 7.9 vs. 9.8 ± 6.5), the number of transferred embryos (3.4 ± 1.4 vs. 3.7 ± 1.3), implantation rates (15.5% vs. 18.0%),pregnancy rates (34.6% vs. 39.7%) and live birth rates (29.2% vs. 35.8%) with cyst enucleation group. Conclusion IVF parameters in the patients with endometriosis are inferior to tubal factor infertility, but IVF outcomes are comparable. Surgically treated peritoneal lesions group without endometrioma enucleation shows IVF parameters as bad as cyst enucleation group. We might be considered endometriosis itself worse IVF parameters regardless previous cyst enucleation.
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