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대한생식의학회지 제32권 제4호 2010년
높은 기저 난포자극호르몬 수치를 가지는 환자와 고령 환자의 체외수정시술을 위한 과배란 유도에서 GnRH Antagonist 다회투여법과 GnRH Agonist 장기요법의 효용성에 대한 연구
포천중문 의과대학교 산부인과학교실, 차병원 여성의학연구소1
김지연,, 김낙근,윤태기,차선희,김유신,원형재,조정현,차수경1,정미경1,최동희
Comparison of IVF-ET Outcomes between GnRH Antagonist Multiple Dose Protocol and GnRH Agonist Long Protocol in Patients with High Basal FSH Level or Advanced Age
JY Kim, NK Kim, TK Yoon, SH Cha, YS Kim, HJ Won, JH Cho, SK Cha1, MK Chung1, DH Choi
Department of Obstetrics and Gynecology, Pochon CHA University, College of Medicine, Seoul, Korea, 1Fertility Center of CHA General Hospital
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Objectives: To compare the efficacy of GnRH antagonist multiple dose protocol (MDP) with that of GnRH agonist long protocol (LP) in controlled ovarian hyperstimulation for in vitro fertilization in patients with high basal FSH (follicle stimulating hormone) level or old age, a retrospective analysis was done. Methods: Two hundred ninety four infertile women (328 cycles) who were older than 41 years of age or had elevated basal FSH level (> 8.5 mIU/mL) were enrolled in this study. The patients had undergone IVF-ET after controlled ovarian hyperstimulation using GnRH antagonist multiple dose protocol (n=108, 118 cycles) or GnRH agonist long protocol (n=186, 210 cycles). The main outcome measurements were cycle cancellation rate, consumption of gonadotropins, the number of follicles recruited and total oocytes retrieved. The number of fertilized oocytes and transferred embryos, the clinical pregnancy rates, and the implantation rates were also reviewed. And enrolled patients were divided into three groups according to their age and basal FSH levels; Group A - those who were older than 41 years of age, Group B - those with elevated basal FSH level (> 8.5 mIU/mL) and Group C - those who were older than 41 years of age and with elevated basal FSH level (> 8.5 mIU/mL). Poor responders were classified as patients who had less than 4 retrieved oocytes, or those with E2 level <500 pg/mL on the day of hCG injection or those who required more than 45 ampules of exogenous gonadotropin for stimulation. Results: The cancellation rate was lower in the GnRH antagonist group than in GnRH agonist group, but not statistically significant (6.8% vs. 9.5%, p=NS). The amount of used gonadotropins was significantly lower in GnRH antagonist group than in agonist group (34.8¡¾11.3 ampules vs. 44.1¡¾13.4 ampules, p<0.001). The number of follicles > 14 mm in diameter was significantly higher in agonist group than in antagonist group (6.7¡¾4.6 vs. 5.0¡¾3.4, p<0.01). But, there were no significant differences in clinical pregnancy rate (24.5% in antagonist group vs. 27.4% in agonist group, p=NS) and implantation rate (11.4% in antagonist group vs. 12.0% in agonist group, p=NS) between two groups. Mean number of retrieved oocytes was significantly higher in GnRH agonist LP group than in GnRH antagonist MDP group (5.4¡¾3.5 vs. 6.6¡¾5.0, p<0.0001). But, the number of mature and fertilized oocytes, and the number of good quality (grade I and II) and transferred embryos were not different between two groups. In each group A, B, and C, the rate of poor response did not differ according to stimulation protocols. Conclusions: In conclusion, for infertile women expected poor ovarian response such as who are old age or has elevated basal FSH level, a protocol including a controlled ovarian hyperstimulation using GnRH antagonist appears at least as effective as that using a GnRH agonist, and may offer the advantage of reducing gonadotropin consumption and treatment period. However, much work remains to be done in optimizing the GnRH antagonist protocols and individualizing these to different cycle characteristics.
키워드 : GnRH antagonist, GnRH agonist, Advanced age, Elevated basal FSH level
교신저자 : artchoi83@medimail.co.kr
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