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대한생식의학회지 제24권 제1호 2010년

미수정 및 저수정율의 기왕력을 지닌 체외수정시술 환자에서의 난자 세포질내 정자 주입술을 이용한 미세보조 수정술에 관한 연구

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;서울대학교 의과대학 산부인과학교실;서울대학교 의과대학 산부인과학교실;

문신용;김석현;채희동;김광례;이재훈;김희선;류범용;오선경;서창석;최영민;김정구;이진용;,

Microassisted Fertilization of Human Oocytes with Intracytoplasmic Sperm Injection in IVF-ET Patients with History of Failure in Fertilization or Extremely Low Fertilization Rate in Previous Cycles

Moon, Shin-Yong;Kim, Seok-Hyun;Chae, Hee-Dong;Kim, Kwang-Rye;Lee, Jae-Hoon;Kim, Hee-Sun;Ryu, Buom-Yong;Oh, Sun-Kyung;Suh, Chang-Suk;Choi, Young-Min;Kim, Jung-Gu;Lee, Jin-Yong;

Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;Department of Obstetrics and Gynecology, College of Medicine, Seoul National University;

Although IVF-ET is widely applied in the treatment of couples with male factor infertility, it may fail in many infertile couples with normal semen parameters, and certain couples cannot be accepted for standard IVF-ET due to unfertilization or extremely low fertilization rate of oocytes. Recently, several procedures of microassisted fertilization (MAF) using micromanipulation have been introduced, and pregnancies and births have been obtained after partial zona dissection (PZD), subzonal insertion (SUZI), and intracytoplasmic sperm injection (ICSI). This clinical study was performed to develop and establish ICSI as an effective procedure of MAF in infertile couples who could not undergo standard IVF-ET repetitively because of failure in fertilization or extremely low fertilization rate of oocytes with the conventional fertilization technique in the previous IVF-ET cycles. From March, 1995 to May, 1996, 27 cycles of IVF-ET with ICSI in 19 infertile patients were included in study group, and the outcomes of ICSI were analyzed according to fertilization rate, cumulative embryo score (CES), and pregnancy rate. The number of oocytes retrieved after controlled ovarian hyperstimulation (COH) was $10.50{\pm}6.13$ in 30 previous cycles, and $10.57{\pm}5.53$ in 27 ICSI cycles. In ICSI cycles, the number of oocytes optimal for ICSI procedure was $7.89{\pm}4.30$, and the fertilization rate of $67.9{\pm}20.2%$ could be obtained after ICSI. The number of embryos transferred was $1.43{\pm}2.40$ in previous cycles, and $4.36{\pm}1.77$ with the mean CES of $41.8{\pm}27.4$ in ICSI cycles. In ICSI cycles, the overall pregnancy rate was 29.6% (8/27) per cycle and 42.1% (8/19) per patient with the clinical pregnancy rate of 22.2% (6/27) per cycle and 31.6% (6/19) per patient. In conclusion, MAF of human oocytes with ICSI is a promising fertilization method for IVF-ET patients, especially with the past history of failure in fertilization or low fertilization rate of oocytes in the previous IVF-ET cycles, and ICSI using micromanipulation procedures applied to human oocytes will provide a range of novel techniques which may dramatically improve the pregnancy rate in IVF-ET program and contribute much to effective management of infertile couples.

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