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대한생식의학회지 제29권 제4호 2010년
골반결핵으로 인한 불임 환자에서 체외수정 시술의 결과
성균관대학교 의과대학 삼성제일병원 산부인과
김진영, 강인수
Outcome of In Vitro Fertilization and Embryo Transfer in Infertile Women with Pelvic Tuberculosis
Kim JY
Department of Obstetrics and Gynecology, Samsung Cheil Hospital,Sungkyunkwan University School of Medicine
Objectives: Pelvic tuberculosis (TB) causes infertility despite of anti-TB chemotherapy and IVF-ET is effective treatment to achieve pregnancy. The aim of this study is to assess the outcomes of IVF-ET in pelvic TB, especially according to main Tb lesion, and to investigate the factors affecting the successful outcome. Methods: A total of 135 IVF-ET cycles were performed in 54 patients with pelvic TB and the outcome was compared with that of control group with tubal factor not associated with TB in 301 cycles, 227 patients. Anti-TB chemotherapy was performed in the patients with pelvic TB. Pregnancy rate was compared according to main TB lesion as salpingitis, peritonitis, and endometritis. In the patients with endometrial TB, when complicated with uterine synechia, hysteroscopic lysis was done before IVF-ET and pregnancy rate was compared according to the presence of uterine synechia. Results: There was no significant difference in peak E2 (2,790¡¾280.1 vs 2,554¡¾101.2, p>0.05), the number of retrieved oocytes (13.5¡¾0.7 vs 12.5¡¾0.4, p>0.05) and fertilized oocytes (7.7¡¾0.5 vs 7.8¡¾0.3, p>0.05) between patient and control group. Clinical pregnancy rate per transfer in pelvic TB group was 22.9% and showed no difference from that of control group (24.3%, p>0.05). Although it was not statistically significant, pregnancy rate in the endometrial Tb (18%) was lower than that in the salpingitis (28.5%) or peritonitis (26.5%) (p>0.05). In the endometrial TB with uterine synechia, pregnancy rate was significantly lower than that of the patients without synechia even after hysteroscopic lysis (9.7% vs 31.6%, p<0.05). Conclusion: IVF-ET after anti-TB chemotherapy is the most effective treatment to achieve pregnancy in infertile patients with pelvic TB. Because the presence of endometrial TB and resulting uterine synechia affects the outcome of IVF-ET, thorough evaluation for endometrium with endometrial biopsy and hysteroscopy is important to predict the prognosis of IVF-ET treatment.
키워드 : Pelvic tuberculosis, Infertility, IVF-ET, Endometrial tuberculosis
교신저자 : ikang6@users.unitel.co.kr
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