목적: 자궁내막증이 체외수정시술에 미치는 영향을 파악하고 시술의 결과를 향상시킬 수 있는 방법을 알아보고자 하였다. 연구방법: 1995년 1월 부터 1996년 12월간에 삼성제일병원 산부인과 불임클리닉을 방문하여 체외수정시술을 받은 불임환자중 자궁내막증만을 갖는 환자 94주기 [단기과배란유도 42명 71주기, 장기과배란유도 19명 23주기]와 난관요인만을 갖는 환자 254주기 [단기과배란유도 172명]에서 소요된 성선자극호르몬의 양, 획득난자수, 양질의 난자수, 전체 배아수, 양질의 배아수, 배아이식당 임상적 임신율 등을 비교 분석하였으며 p<0.05 인 경우 통계적으로 의의있다고 판정하였다. 결과: 환자의 평균 나이는 자궁내막증환자에서 31.7±0.3 세 [평균±표준오차], 난관요인 불임환자에서 31.3±0.2 세였고 과배란유도에 소요된 성선자극호르몬의 양은 자궁내막증에서 더 많은 성선자극호르몬이 필요하였으며 [27.7±1.2 대 24.0±0.6, p=0.004, t-검정], 자궁내막증이 있는 경우 더 적은수의 배아가 얻어졌다 [7.0±0.5 대 9.0±0.4, p=0.0014, t-검정]. 자궁내막증이 있는 경우 단기과배란유도와 장기 과배란유도후 배아이식당 임신율은 각각 21.4 % [15/70], 13.0 % [3/23]로 두군간에 통계적으로 유의한 차이는 없었으나 소요된 성선자극호르몬의 양은 각각 27.7±1.2 앰플, 36.1±2.2 앰플로 단기과배란유도시 유의하게 적은 양의 성선자극호르몬이 소요되었다 [p=0.001, t-검정]. 체외수정시술전 치료를 전혀 하지 않았던 경우 임신율은 21.1 % [4/19], 자궁내막종이 있어서 골반경수술로 이를 제거만 한 경우 0.0 % [0/9], 내과적 약물치료만을 하였던 경우 14.6 % [7/45], 골반경수술과 약물치료를 병행하였던 경우 28.6 % [6/212]였으며, 시술전 치료를 한 경우 골반경수술과 약물치료를 병행한 그룹에서 임신율이 약간 높았으나 통계적으로 유의한 차이에는 도달하지 못하였다. 결론: 자궁내막증은 난자의 성숙, 수정에 영향을 미치며 장기과배란유도 보다는 단기과배란유도가 임상적으로 더 유익하리라고 사료되며 체외수정시술전 내과적, 외과적 치료를 시행하는 데에 있어서는 더 많은 연구가 있어야 할 것이다.

Objective: The aim of this study was to evaluate the clinical impact of endometriosis on the outcome of controlled ovarian hyperstimulation [COH] in IVF-ET cycle. Methods: Ninety-four IVF-ET cycles [71 by short protocol in 42 women, 23 by long protocol in 19 women] in patients with endometriosis only and 254 cycles [all by short protocol in 172 women] in infertile patients with tubal factor only were included in this study. The patients with endometriosis were divided into two groups according to the disease stage: group I [ endometriosis stage I, II], group II [endometriosis stage III, IV]. Results: The mean [31.7±0.3; SEM] age of the patients with endometriosis was not significantly different from that [31.3±0.2] of the patients with tubal factor only. More gonadotropin ampules were used in the patients with endometriosis than in the patient with tubal factor only [ 27.7±1.2 vs. 24.0±0.6; p=0.004, Student`s t-test]. The mean number of cleaved embryos was significantly less [p=0.0014, t-test] in the patients with endometriosis than that of tubal factor group [ 7.0±0.5 vs. 9.0±0.4]. The clinical pregnancy rate per transfer in the patients with endometriosis were 21.4 % [15/70] in short protocol, 13.0 % [3/23] in long protocol, but it did not reach statistically significant level [p=0.68, Chi-square test]. But significantly less gonadotropin ampules were used in short protocol than in long protocol [27.7±1.2 vs.36.1±2.2; p=0.001]. The clinical pregnancy rate per transfer were 15.8 % [9/57] in group I, 22.2 % [8/36] in group II, respectively and there was no statistical significance [p=0.58, Chi-square test]. The clinical pregnancy rates per embryo transfer of the patients with endometriosis was 21.1 % [4/19] in the patients with no treatment before IVF-ET, 0.0 % [0/9] in the patients undergone laparoscopic surgery, 14.6 % [7/45] in the patients of having medication and 28.6 % [6/21] in the patients of having combined therapy [laparoscopic surgery plus medication] respectively, even though the clinical pregnancy rate was higher in the patients undergone combined therapy, there was no statistical significance [p=0.41, Chi-square test] among the different treatment modalities. Conclusion: We conclude that endometriosis may affect COH adversely, in terms of number of retrieved good quality oocytes and cleaved embryos and short prtotol could be more useful clinically. Even though there was no significant difference in the clinical pregnancy rate and some limitation with relatively small sample size, combined therapy before IVF-ET would be more helpful for the improvement of the reproductive outcome in the patient with endometriosis but further study would be needed.