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대한생식의학회지 제32권 제1호 2010년
클로미펜에 부적절한 반응을 보이는 다낭성 난소 증후군 환자에서 Aromatase Inhibitor의 유용성
성균관대학교 의과대학 삼성제일병원 산부인과 불임 및 생식내분비
김혜옥, 양광문, 허걸, 박찬우, 차선화, 김해숙, 김진영, 송인옥, 궁미경,
Effect of Aromatase Inhibitor (AI) in Polycystic Ovary Syndrome Patients with an Inadequate Response to Clomiphene Citrate
Hye Ok Kim, Kwang Moon Yang, Kuol Hur, Chan Woo Park, Sun Hwa Cha, Hae Suk Kim, Jin Yeong Kim, In Ok Song, Mi Kyung Koong
Department of Obstetrics and Gynecology, Samsung Cheil Hospital & Women's Healthcare Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Objective: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. Material and Methods: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. Results: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (≥15 mm) was lower in the AI group (1.08±0.45 vs. 1.64±0.75) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group (10.35±1.74 vs. 9.23±1.61) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group (116.9±75.8 vs. 479.5±300.8) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed 10.6±1.6 mm in the endometrial thickness and 106.6±66.8 pg/ml in E2 concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number (1.25±0.5) compared to prior CC cycle. Conclusions: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.
키워드 : Aromatase inhibitor, PCOS, Ovulation induction
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