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불임환자에서 체외수정시술시 난소내 기질 동맥 Doppler 초음파검사 및 혈청 Glycodelin 측정의 임신 예측인자로서의 임상적 효용성

Clinical Efficacy of Intraovarian Stromal Artery Doppler Ultrasonography and Serum Glycodelin Assay as Prognostic Factors of Pregnancy in Infertile Patients Undergoing In Vitro Fertilization and Embryo Transfer

대한산부인과학회지 2005년 48권 3호 p.682 ~ 694
김선미/Kim SM
황규리/김진주/문정애/방영주/지병철/구승엽/서창석/최영민/김정구/문신용/Hwang KR/Kim JJ/Moon JA/Bang YJ/Jee BC/Ku SY/Suh CS/Choi YM/Kim JG/Moon SY

Abstract


Objective: To assess the clinical efficacy of intraovarian artery stromal Doppler ultrasonography and serum glycodelin (placental protein 14, PP14) as prognostic factors of pregnancy in in vitro fertilization and embryo transfer (IVF-ET) cycles.

Methods: Fifty seven infertile women undergoing IVF-ET were recruited at SNUH from April, 2003 to March, 2004. All IVF-ET patients received controlled ovarian hyperstimulation (COH) using gonadotropins with either GnRH agonist or GnRH antagonist. Doppler ultrasonographic measurements were performed by Sonoace-8800 (Medison) with 5.5 MHz transvaginal probe. Pulsatility Index (PI) of intraovarian stromal artery was evaluated on the first day of ovarian stimulation and the day of hCG administration. Blood sampling for hormonal assay including PP14 was taken at the time of the first day of ovarian stimulation, hCG administration, oocyte retrieval, and embryo transfer (ET). Serum hormonal profiles, PI, and outcomes of COH and IVF-ET were compared between clinically pregnant (n=12) and nonpregnant (n=45) groups.

Results: Demographic and clinical characteristics of the patients were comparable in both groups except body mass index (BMI). There was no significant correlation between BMI and serum PP14 levels or PI measured in intraovarian stromal artery. Pregnant group had significantly higher fertilization rate and larger number of cryopreserved embryos. The mean serum levels of estradiol, progesterone, LH and FSH were not different between the two groups. When compared with the nonpregnant group, serum PP14 levels were lower in the pregnant group throughout the treatment cycle, but there was no statistical significance. PI of intraovarian stromal artery on hCG day was significantly lower in the pregnant group (1.2 +/- 0.4 vs. 1.8 +/- 0.8). There was no significant correlation between serum PP14 levels and PI.

Conclusion: This study suggests that serum PP14 levels cannot be a prognostic factor in IVF-ET. The development of more sensitive assay method is required. PI of intraovarian stromal artery on hCG day can be clinically more useful in predicting the success of IVF-ET.

키워드

체외수정시술;임신;난소내 기질 동맥;도플러 초음파검사;PI;혈청 PP14;IVF-ET;Pregnancy;Intraovarian stromal artery;Doppler ultrasonography;PI;Serum PP14
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