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대한생식의학회지 제32권 제3호 2010년
37세 이상의 환자에서 체외수정시술시 GnRH Agonist 주기와 GnRH Antagonist 주기의 비교 연구
성균관대학교 의과대학 삼성제일병원 산부인과
박찬우, ,차선화,김해숙,김혜옥,양광문,김진영,송인옥,유근재,강인수,궁미경
The Comparion of Pregnancy Outcomes between GnRH Agonist and GnRH Antagonist Cycles in Women with Advanced Age
Chan Woo Park, Sun Wha Cha, Hae Suk Kim, Hye Ok Kim, Kwang Moon Yang, Jin Young Kim, In Ok Song, Keun Jae Yoo, Inn Soo Kang, Mi Kyoung Koong
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Samsung Cheil Hospital and Women's Healthcare Center, Sungkyunkwan University School of Medicine, Seoul, Korea
.
Objective: To compare the clinical results and pregnancy outcomes of in vitro fertilization (IVF) between GnRH antagonist cycles and GnRH agonist (GnRH-a) cycles including flare-up and long protocol in women with advanced age.
Materials and Methods: Retrospective clinical study. From January 2001 to September 2003, IVF cycles of female patient 37 years over were included in this study. GnRH-a long protocol (62 cycles, 61 patients) and GnRH antagonist multi-dose flexible protocol (66 cycles, 51 patients) were compared with the control group of GnRH-a flare-up protocol (151 cycles, 138 patients). IVF cycles for non-obstructive azoospermia (NOA), endometriosis III, IV and polycystic ovarian syndrome (PCOS) were excluded in this study. Clinical results such as total gonadotropin dose, serum E2 on hCG administration, the number of retrieved oocytes and the pregnancy outcomes - clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) per embryo transfer - were compared.
results: There were significant differences in the total dose of gonadotropin (GnRH-a flare-up vs. GnRH-a long vs. GnRH-antagonist; 41.8 vs. 54.7 vs. 24.8), serum E2 on hCG administration (1787.2 vs. 1881.6 vs. 788.0), the numbers of retrieved oocytes (8.1 vs. 11.1 vs. 4.5) and endometrial thickness (9.1 vs. 10.4 vs. 8.0) which were significantly lower in GnRH-antagonist cycles. But pregnancy outcomes shows no significant differenced in CPR (25.0% vs. 35.8% vs. 24.5%), IR (11.7% vs. 12.3% vs. 10.1%) and LBR (15.8% vs. 28.3% vs. 15.1%)
Conclusion: In women with advanced age, GnRH-antagonist cycles can result in comparable pregnancy outcomes to GnRH-a cycles including flare-up and long protocol. GnRH-a long protocol show higher CPR, IR and LBR than GnRH antagonist multi-dose flexible protocol and flare-up protocol without significant differences.
키워드 : COH, GnRH antagonist, GnRH agonist, Old age
교신저자 : novak21c@yahoo.co.kr
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