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대한생식의학회지 제22권 제2호 2010년
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서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;
문신용;이경순;노재숙;서창석;김석현;최영민;신창재;김정구;이진용;장윤석;,
Assisted Reproductive Technology in Infertile Patients with Endometriosis
Moon, Shin-Yong;Lee, Kyung-Soon;Roh, Jae-Sook;Suh, Chang-Suk;Kim, Seok-Hyun;Choi, Young-Min;Shin, Chang-Jae;Kim, Jung-Gu;Lee, Jin-Young;Chang, Yoon-Seok;
Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;Department of Obstetrics and Gynecology, Seoul National University School of Medicine;
Though the endometriosis is not always related with infertility, endometriosis causes infertility in some patients. There are many treatment modalities of infertile patients who have endometriosis. In recent years, Assisted Reproductive Technology(ART) have been widely accepted as being a useful tool for the treatment of infertile endometriotic patients. The objective of this study was to evaluate the outcome of ART in infertile endometriotic patients who have been carried out IVF-ET from Jan, 1992 to Dec, 1994 and to compare the results between COH/IUI and IVF-ET in the patients with endometriosis stage I. Tubal disease only patients were grouped(308 patient, 956 cycles) as a control. Endometriosis group was subdivided into 4 groups according to American Fertility Society classification; endometriosis stage I (45 patients, 61 cycles), stage II (26 patients, 39 cycles), stage III (26 pateitns, 37 cycles), stage IV (33 patients, 50 cycles). The outcomes of IVF-ET in endometriosis patients were as follows; The oocyte recovery rates were significantly lower in stage III, IV endometriosis. In case of stage III endometriosis, the fertilization rate was significantly lower than other stages of endometriosis. Clinical pregnancy rates per cycle were not different between the tubal group(22%) and the endometriosis group(25%). According to endometriosis stage, the implantation rate and clinical pregnancy rate were significantly lower in stage IV (5.6%, 16%) compared with other stages (I; 10.0%, 26%, II;9.8%, 31%, III;12.6%, 32%). It suggests that some factor like autoantibodies may inhibit implantation of embryos in stage IV endometriosis. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles and CC cycles between 1992 and 1994 in the women with endometriosis stage 1. In case of stage I endometriosis, though the COH/IUI group showed lower FSH level and lesser age profile than IVF-ET group, IUI group has resulted in lower pregnancy rates(19.2%) compared with the IVF-ET group(26.2%). In conclusion, endometriotic infertile patients can get comparable pregnancy rates with the tubal factor infertility patients during IVF-ET program. Moreover even in stage I endometriosis, IVF-ET may be an more effective treatment modality than COH/IUI.
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