인간 난포액 내의 Prostaglandin E₂, Prostaglandin F₂α 농도와 난자의 수정율과의 연관성에 관한 연구

Abstract

[한글]

난포의 성숙도를 판별하는데는 초음파에 의한 난포의 크기, 수, 형태 측정이 보편적으로 이용되어 왔으나 최근에는 난포액 내의 유기성분중 일부가 그 지표로써 이용될 수 있다는 보고가 계속되어왔다. 즉 난포액 내의 PG E^^2 , PG F^^2a , FSH, LH, estradiol, progesterone 등이 난포의 성숙도를 알 수 있는 지표로써 사용가능하지 않을까 하는 의견이 제시되어 왔으나, 수정율, 임신율과의 연관성에는 논란이 있는 실정이다.

본 연구에서는 1992년 4월부터 1999년 3월까지 연세대학교 의과대학 세브란스병원 산부인과 불임클리닉에 내원하여 체외수정을 시행한 환자 중 42명을 대상으로 연구를 수행하였다. 이들의 연령분포는 20대가 10명, 30대가 26명, 40대가 6명이었으며, 최고령은 46세

, 최소령은 26세였다. 불임의 원인은 배우자의 이상이 19례, 난관의 이상이 18례, 자궁의 이상이 3례, 원인 미상이 3례였고, 1 명은 난관의 이상과 배우자의 이상이 같이 발견되었다. 혈청 Estradiol 농도와 질식 초음파를 이용하여 난포의 크기를 측정하면서 GnRHa와

hMG를 계속 투여하였고, 적절하게 혈청 Estradiol 농도가 증가하고 난포의 크기가 1.7cm 이상 되었을 때 hCG를 주사하고 36시간 후 난자 채취를 시행하였다. 이때 채취한 인간 난포액 내의 PG E^^2 농도, PG F^^2a 농도, PG E^^2 : PG F^^2a 비를 측정하였으며, 이들 측정치와 수정율, 임신율, 최대 난포 직경과의 연관성을 살펴보아 다음과 같은 결과를 얻었다.

1. 총 42례중 수정군이 37례, 비수정군이 12례로 수정율은 71.4 %였고, 수정된 30례 중 임신군이 4례로 임신율은 13.3 %였다. 이는 본원의 평균 임신율 22-25%와 비교하여 저조한 수치이며, 불임의 원인 중 남성 요인이 다수 포함된 때문으로 사료된다.

2. 수정군과 비수정군에 있어 난포액 내의 PG E^^2 농도, PG F^^2a 농도, PG E^^2 : PG F^^2a 비를 비교해 본 결과 두 군간에 있어 통계학적으로 유의한 차이는 없었다.

3. 수정 후 배아 이식을 시행한 30례 중 임신 된 경우와 임신되지 않은 경우에 있어 난포액 내의 PG E^^2 농도, PG F^^2a 농도, PG E^^2 : PG F^^2a , 비를 비교한 결과 두 군간에 있어 통계학적으로 유의한 차이는 없었다.

4. 난자 채취시 질식 초음파를 이용하여 측정한 난포의 크기 중 최대치와 난포액 내의 PG E^^2 농도, PG F^^2a 농도, PG E2^^ : PG F^^2a , 비를 비교해 본 결과, 각각의 변수에 있어 통계학적으로 유의한 상관관계는 나타나지 않았다.

본 연구의 결과에 의하면 난포액 내의 PG E^^2 농도, PG F^^2a 농도와 PG E^^2 : PG F^^2a 비는 체외수정 이후의 수정율, 임신율과 상관성이 없을 것으로 사료되며, 각 변수와 난포의 성숙도 사이에도 상관관계가 없는 것으로 보아 초음파의 보조적인 역할로써 난포

의 성숙도를 예상할 수 있는 지표로 사용하는 것은 재고되어야 할 것으로 사료된다.

Correlation between fertilization rate and human follicular fluid prostaglandin

E^^2, prostaglandin F^^2a, prostaglandin E^^2 : prostaglandin F^^2a ratio

Jung Pil Lee

Department of Medical Science, The Graduate School , Yonsei University

(Directed by Professor Chan Mo Song)

Ultrasonography has been routinely used in determining follicular maturation. But

recently there are reports that a proportion of organic components in the

follicular fluid Hay be employed as parameters. That is, prostaglandin E^^2,

prostaglandin F^^2a , steroid hormones, estradiol, and progesterone in the

follicular fluid has been suggested to be possible parameters for follicular

maturation. However, studies on such organic compounds are still being conducted

with controversy regarding fertilization rate in In Vitro Fertilization and Embryo

Transfer (IVF-ET) and its relationship with pregnancy rate. The authors studied 42

patients from April, 1992 to March, 1993 who underwent IVF-ET at the Infertile its

Clinic, Department of Obstetrics and Gynecology, Yonsei University College of

Medicine. Their age distribution showed 10 in the 20-29 group, 26 in the 30-39

group, 6 over 40, and the minimal and maximal ages were 26 and 46 years,

respectively. Reason for infertility was 19 cases of male factor infertility, 18

cases of tubal abnormalities, 3 cases of uterine abnormalities, 3 cases of unknown

etiology, and 1 case with tubal abnormality accompanied by male factor infertility.

From human follicular fluid obtained from ovaries after superovulation, the

levels of PG E^^2 , PG F^^2a , PG E^^2 : PG F^^2a ratio were measured and their

relationships with fertilization rate, pregnancy rate, and maximal follicular

diameter were analyzed and the tool lowing results were obtained.

1. Among a total of 42 cases, there were 30 fertilizations, and 12

nonfertilizations showing a fertilization rate of 71.4%, and there were 4 cases of

pregnancy among the 30 cases of fertilization, representing a 13.3% pregnancy rate.

2. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , and PG E^^2 : PG

F^^2a ratio between the fertilization and nonfertilization group, there was no

significant difference between the two groups.

3. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , PG E^^2 : PG

F^^2a ratio between the pregnancy and nonpregnancy group from the 30 closes of

embryo transfer, there was no statistically significant difference between the two

groups.

4. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , and PG E^^2 : PG

F^^2a ratio with the maximal follicular diameter obtained by vaginal sonography

during ovum pick up, there was no significant difference between each parameter.

Therefore, this study showed that the levels of PG E^^2, PG F^^2a PG E^^2 : PG

F^^2a ratio in the follicular fluid was not adequate as a Barter for predicting

fertilization rate and pregnancy rate after IVF-ET. Also, there was no correlation

between each parameter and follicular maturation, and consequently it was

considered to be inadequate in replacing ultrasonography in the predicting

follicular maturation.

At the present time, measurements of follicular size which is routinely performed

with ultrasonogrphy and assistant parameters such as serum estradiol etc. is

probably the best method in selecting mature follicles.

[영문]

Ultrasonography has been routinely used in determining follicular maturation. But recently there are reports that a proportion of organic components in the follicular fluid Hay be employed as parameters. That is, prostaglandin E^^2, prostaglandin F^^2a , steroid hormones, estradiol, and progesterone in the follicular fluid has been suggested to be possible parameters for follicular

maturation. However, studies on such organic compounds are still being conducted with controversy regarding fertilization rate in In Vitro Fertilization and Embryo Transfer (IVF-ET) and its relationship with pregnancy rate. The authors studied 42

patients from April, 1992 to March, 1993 who underwent IVF-ET at the Infertile its Clinic, Department of Obstetrics and Gynecology, Yonsei University College of Medicine. Their age distribution showed 10 in the 20-29 group, 26 in the 30-39

group, 6 over 40, and the minimal and maximal ages were 26 and 46 years, respectively. Reason for infertility was 19 cases of male factor infertility, 18 cases of tubal abnormalities, 3 cases of uterine abnormalities, 3 cases of unknown etiology, and 1 case with tubal abnormality accompanied by male factor infertility.

From human follicular fluid obtained from ovaries after superovulation, the levels of PG E^^2 , PG F^^2a , PG E^^2 : PG F^^2a ratio were measured and their relationships with fertilization rate, pregnancy rate, and maximal follicular

diameter were analyzed and the tool lowing results were obtained.

1. Among a total of 42 cases, there were 30 fertilizations, and 12 nonfertilizations showing a fertilization rate of 71.4%, and there were 4 cases of pregnancy among the 30 cases of fertilization, representing a 13.3% pregnancy rate.

2. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , and PG E^^2 : PG F^^2a ratio between the fertilization and nonfertilization group, there was no significant difference between the two groups.

3. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , PG E^^2 : PG F^^2a ratio between the pregnancy and nonpregnancy group from the 30 closes of embryo transfer, there was no statistically significant difference between the two groups.

4. Comparing the follicular fluid levels of PG E^^2 , PG F^^2a , and PG E^^2 : PG F^^2a ratio with the maximal follicular diameter obtained by vaginal sonography during ovum pick up, there was no significant difference between each parameter.

Therefore, this study showed that the levels of PG E^^2, PG F^^2a PG E^^2 : PG F^^2a ratio in the follicular fluid was not adequate as a Barter for predicting fertilization rate and pregnancy rate after IVF-ET. Also, there was no correlation

between each parameter and follicular maturation, and consequently it was considered to be inadequate in replacing ultrasonography in the predicting follicular maturation.

At the present time, measurements of follicular size which is routinely performed with ultrasonogrphy and assistant parameters such as serum estradiol etc. is probably the best method in selecting mature follicles.