Korean Journal of Obstetrics and Gynecology Vol. 52 No. 12 December 2009 조사보고서한국보조생식술의현황 : 2006년 대한산부인과학회 보조생식술소위원회 Current status of assisted reproductive technology in Korea, 2006 접수일 :2009. 8. 14. 교신저자 : 최영민 E-mail:ymchoi@snu.ac.kr 제 1 장서론 1986 년국내에서체외수정시술에의한첫시험관아기가탄생한이래불임환자치료를위한보조생식술은날로그시술기관과시행수가증가되고있을뿐만아니라, 치료성적도괄목할만큼개선되는등불임증진단과치료에많은발전이있어왔다. 불임을치료하기위해보조생식술을시행하고있는의료기관으로부터의자료는성공적인보조생식술, 즉생아의출산을가능하게하는여러가지요소들에대한풍부하고귀중한자료가될수있다. 각의료기관별의치료성적은그자체로도의미가있지만성공률과성공에영향을주는요소에대한통합적인분석을위해서는국내의여러의료기관으로부터의자료를취합하여국내통계를구해보는것이의미가있을것이며, 이러한조사는국내불임환자및보조생식술시술기관의실태파악에도움을주는것은물론궁극적으로국내보조생식술에관한전체적이고일관성있는자료를장기적으로처리분석하여불임증치료의방향까지제시할수있을것으로기대된다. 1993 년 5월제정된인공수태윤리에관한선언에의하 면, 인준된인공수태시술의료기관은그시술내용을연 1회이상대한의사협회 ( 또는동협회가지정한관련학회 ) 에보고하도록되어있으며, 1994 년본학회내에인공수태시술의료기관심사소위원회가설치되었다. 그리고 2005 년부터는 생명윤리및안전에관한법률 이시행되어모든배아생성의료기관은보건복지부의인준을받도록되어있으며, 2009 년 7월현재 139 개기관이인준되어있다. 대한산부인과학회에서는 1992 년부터국내보조생식술의현황을조사하여보고하여오고있으며, 이러한조사사업의일환으로 2006 년도보조생식술현황도조사하여이에보고하게되었다. 본조사에의해얻어진국내보조생식술에대한자료는불임환자및보조생식술시술기관의실태파악에도움을주는것은물론더나아가서는시술방법의계속적인개선과발전, 부작용의감소와임신성공률의향상을도모하는데유용한자료로활용될것이다. 본조사연구는대한산부인과학회의재정지원하에수행되었으며, 실무에서많은노력을기울인대한산부인과학회의직원여러분들과서울대학교병원의전성욱, 김재원선생님, 자료정리에애써주신서울대학교병원전공의및전임의선생님들, 그리고본조사에협조하여주신국내각배아생성의료기관의여러분들께본위원회에서는깊은감사의말을전하고자한다. - 1212 -
최영민. 한국보조생식술의현황 : 2006 년 2009년 8월대한산부인과학회보조생식술소위원회위원장최영민 ( 서울의대 ) 간사이원돈 ( 마리아병원 ) 위원강인수 ( 관동의대 ) 권혁찬 ( 미래와희망산부인과 ) 김기철 ( 함춘여성의원 ) 김선행 ( 고려의대 ) 노성일 ( 미즈메디병원 ) 문신용 ( 서울의대 ) 문화숙 ( 문화병원 ) 민응기 ( 동국의대 ) 윤태기 ( 포천중문의대 ) 이규섭 ( 부산의대 ) 이상훈 ( 중앙의대 ) 이여일 ( 전남의대 ) 이정호 ( 계명의대 ) 전상식 ( 경북의대 ) 한혁동 ( 연세의대 ) 황경주 ( 아주의대 ) 황정혜 ( 한양의대 ) ( 이상가나다순 ) 1. 가야자모병원, 진주 2. 강릉미즈산부인과의원, * 강릉 3. 경북대학교병원, * 대구 4. 경상대학교병원, * 진주 5. 계명대학교동산병원, * 대구 6. 광주기독병원, * 광주 7. 광주미래와희망산부인과의원, * 광주 8. 동국대학교경주병원, * 경주 9. 동국대학교일산병원, * 고양 10. 동아대학교병원, * 부산 11. 동원산부인과의원, * 고양 12. 마리나산부인과의원, 이천 13. 마마파파 & 베이비산부인과의원, * 울산 14. 미래여성병원, * 대구 15. 미래여성병원, * 대전 16. 미래와희망산부인과의원, * 서울 17. 미즈메디병원 ( 강남 ), * 서울 18. 미즈메디병원 ( 강서 ), * 서울 제 2 장조사대상및방법 1. 조사대상 본연구의목적은 2006 년 1월 1일부터 2006 년 12월 31 일까지국내에서시술된보조생식술의현황및시술성적을파악하고자하는것이다. 조사시점인 2008 년 10월당시보건복지부에배아생성의료기관으로인준되어있는 144 개의의료기관을대상으로설문지를발송하였으며 (Fig. 1), 이들기관중시술성적을보고한 83개의의료기관중시술예가있는 81개기관의결과를종합하여분석하였다. 본연구조사결과분석에포함된의료기관은다음과같으며 (* 는시술예가있었던기관 ) 1년간시행하는총치료주기의수에따라의료기관을분류해보면 Table 1과같다. Fig. 1. Location of certified ART clinics in Korea, 2006. - 1213 -
대한산부회지제 52 권제 11 호, 2009 Table 1. Number of IVF centers according to size (total number of treatment in the year) Number of treatment started in year* Number of IVF centers 1,000 or more 5 500~999 9 200~499 12 100~199 8 Less than 100 47 0 2 Number of IVF centers providing data for this report 83 Total number of IVF centers 144 19. 미즈여성병원, * 대전 20. 민병열산부인과의원, * 청주 21. 부산대학교병원, * 부산 22. 분당서울대학교병원, * 성남 23. 분당제일여성병원, * 성남 24. 사회복지법인삼성병원공익재단삼성서울병원, * 서울 25. 삼성미래산부인과, * 부천 26. 삼성산부인과병원, * 수원 27. 서울대학교병원, * 서울 28. 세브란스산부인과의원, * 대전 29. 세화병원, * 부산 30. 시엘병원, * 광주 31. 신여성병원, * 의정부 32. 아름병원, * 부산 33. 양정분산부인과의원, * 이천 34. 에덴산부인과의원, * 익산 35. 엘르메디산부인과의원, * 창원 36. 여성아이병원, * 포항 37. 연세대학교의과대학신촌세브란스병원, * 서울 38. 연세대학교원주의과대학원주기독병원, * 원주 39. 연세앙즈로산부인과의원, * 천안 40. 예일마리여성의원, * 울산 41. 은병원, * 광주 42. 을지대학병원, * 대전 43. 을지병원, * 서울 44. ( 의 ) 정우의료재단프라우메디병원, * 울산 45. 의료법인계산재단문병원, * 전주 46. 의료법인동하의료재단한마음병원, * 창원 47. 의료법인마리아의료재단마리아병원, * 서울 48. 의료법인마리아의료재단마리아의원, * 고양 49. 의료법인마리아의료재단마리아의원, * 평촌 50. 의료법인마리아의료재단마리아의원, * 대구 51. 의료법인마리아의료재단마리아의원, * 부산 52. 의료법인마리아의료재단마리아의원, * 대전 53. 의료법인명지의료재단명지병원, * 고양 54. 이도근산부인과의원, * 진주 55. 이화산부인과의원, * 청주 56. 이화의대부속목동병원, * 서울 57. 인정병원, * 서울 58. 인하대학교의과대학부속병원, * 인천 59. 일산제일병원, * 고양 60. 장스여성병원, * 서울 61. 재단법인아산사회복지재단서울아산병원, * 서울 62. ( 재 ) 한. 호기독교선교회일신기독병원, * 부산 63. 전남대학교병원, * 광주 64. 제일산부인과의원, * 익산 65. 제일의료재단제일병원, * 서울 66. 조선대학교병원, * 광주 67. 좋은문화병원, * 부산 68. 차산부인과의원, * 제주 69. 충남대학교병원, * 대전 70. 포천중문의과대학구미차병원, * 구미 71. 포천중문의과대학분당차병원, * 성남 72. 포천중문의과대학차병원, * 서울 73. 프레메디산부인과의원, * 광주 74. 프리모산부인과의원, * 청주 75. 학교법인고려중앙학원고려대학교의과대학부속병원, * 서울 76. 학교법인인제대학부속부산백병원, * 부산 77. 한나산부인과의원, * 서울 78. 한나여성병원, * 부산 - 1214 -
최영민. 한국보조생식술의현황 : 2006 년 79. 한양대학교병원, * 서울 80. 함춘여성의원, * 서울 81. 허유재병원, * 고양 82. 현대병원, * 순천 83. 호산산부인과병원, * 서울 ( 가나다순 ) 2. 조사방법조사설문지를대상기관에 e-mail 로발송하였으며, e-mail 로설문지를회수하였다. 발송된설문지는다음과같다. - 1215 -
대한산부회지제 52 권제 11 호, 2009 2006 년도보조생식술시술결과보고서 REGISTRATION FORM OF ASSISTED REPRODUCTION: 2006 PLEASE READ INSTRUCTIONS AND FOOTNOTES CAREFULLY BEFORE COMPLETING THE FORMS Name of IVF Center ( 한글 ) Name of IVF Center ( 영문 ) Contact Person Name ( 한글 ) Tel Fax E-mail Address ( 한글 ) World report 에각기관의영문명이첨부됩니다. 정확한영문기관이름을적어주십시오. All data relate to treatment that were started during the calendar year, 2006, and to any clinical resulting from those treatment. Please complete as many data items as possible (n=number). If data are not available for some items, write NA. Gestational age (duration of pregnancy) should be calculated by adding 14 days (2 weeks) to the number of completed weeks between the date of fertilization (conception) and the date of completion of the pregnancy In the following tables : Standard IVF (IVF without ICSI) includes those treatment and in which fertilization occurred, or was intended to occur, in the laboratory and fresh embryos were transferred to the uterus or fallopian tubes. This heading excludes : (1) frozen/thawed embryo transfer ; and (2) microinsemination techniques. ICSI includes those treatment and that follow transfer of fresh embryos after intracytoplasmic sperm injection. after both ICSI and embryo freezing are recorded separately. GIFT includes only those and in which gametes (oocytes and sperm) were transferred to the fallopian tubes (excluding combined IVF and GIFT in the same cycle, which should be recorded in IVF category). 주의 : 본보고서에서 ART procedure 를 1) Standard IVF (IVF without ICSI), 2) ICSI, 3) ZIFT 4) GIFT, 5) FET (Frozen Embryo ) after standard IVF, 6) FET after ICSI, 7) Oocyte donation의 7가지로구분하고있습니다. 그리고이항목들의대상은상호중첩되지않으니숫자기입시유의하시기바랍니다. If you did not perform ART practice in 2006, check here Not done If you performed ART practice in 2005, please fill out tables below. - 1216 -
최영민. 한국보조생식술의현황 : 2006 년 ART Report Forms, Korea 2006 Module Ia Pregnancy Outcomes in relation to Treatment Table 1a-1. Pregnancy outcomes : IVF, ICSI, ZIFT, GIFT IVF without ICSI IVF with ICSI ZIFT GIFT Initiated Cycles with oocyte retrieval attempted (aspiration) s 1 embryo (oocyte 1 ) 2 embryos (oocytes) 3 embryos (oocytes) 4 embryos (oocytes) 5 embryos (oocytes) 6 embryos (oocytes) All 2 (intrauterine) Pregnancy losses 3 Pregnancies with one or more live births follow-up 4 * This table excludes in which frozen/thawed embryos were transferred. ( 이테이블에는 frozen/thawed embryo 를사용한 cycle 은포함하지않습니다.) 1 : in case of GIFT 2 : pregnancy: Presence of an intrauterine gestational sac on ultrasound examination ( pregnancy 는초음파에서자궁내태낭을확인한경우로제한됩니다.) 3 : pregnancy (intrauterine) 가확인되었으나임신 20 주이전 abortion 된경우 4 : pregnancy (intrauterine) 가확인되었으나 Pregnancy outcome (abortion or delivery) 을확인하지못한임신의수 - 1217 -
대한산부회지제 52 권제 11 호, 2009 Table 1a-2. Pregnancy outcomes after transfer of frozen/thawed embryos FET 1 : embryos obtained after IVF without ICSI Thawing s 1 embryo 2 embryos 3 embryos 4 embryos 5 embryos 6 embryos All (intrauterine) Pregnancy losses 2 Pregnancies with one or more live births follow-up 3 FET: embryos obtained after IVF with ICSI 1 : FET (Frozen Embryos ) 2 : pregnancy (intrauterine) 가확인되었으나임신 20 주이전 abortion 된경우 3 : pregnancy (intrauterine) 가확인되었으나 Pregnancy outcome (abortion or delivery) 을확인하지못한임신의수 Table 1a-3. Pregnancy outcomes after oocyte donation Cycle Donation s 1 embryo 2 embryos 3 embryos 4 embryos 5 embryos 6 embryos All (intrauterine) Pregnancy losses 1 Pregnancies with one or more live births - 1218 -
최영민. 한국보조생식술의현황 : 2006 년 ART Report Forms, Korea 2006 Module Ib Complications of Treatment Table 1b. Complications that require admission to hospital Complications Hyperstimulation syndrome Complications of oocyte retrieval Bleeding Infection All Maternal deaths related to the ART process Maternal deaths related to the pregnancy itself *If a woman had two occurrences of the same complication, in 2 different, count her twice. *If a woman had two different complications, count her in each of them. - 1219 -
대한산부회지제 52 권제 11 호, 2009 ART Report Forms, Korea 2006 Module 2 Deliveries in relation to Treatment Table 2-1. Standard IVF (IVF without ICSI) Singleton deliveries Twin deliveries Triplet (or higher order) deliveries All deliveries * Deliveries, not babies. Percentage Table 2-2. ICSI (IVF with ICSI) Singleton deliveries Twin deliveries Triplet (or higher order) deliveries All deliveries * Deliveries, not babies. Percentage Table 2-3. Frozen Embryo Singleton deliveries Twin deliveries Triplet (or higher order) deliveries All deliveries * Deliveries, not babies. Percentage Table 2-4. Oocyte Donation Singleton deliveries Twin deliveries Triplet (or higher order) deliveries All deliveries * Deliveries, not babies. Percentage Table 2-5. Induced Abortions (not SFR) Standard IVF ICSI Percentage/All Pregnancies Table 2-6. Induced Reductions (SFR) Standard IVF ICSI Percentage/All Pregnancies - 1220 -
최영민. 한국보조생식술의현황 : 2006 년 ART Report Forms, Korea 2006 Module 3a Perinatal Mortality in relation to Treatment and Multiple Deliveries Table 3a-1. Fresh (total aspiration following IVF and/or ICSI) (Not Deliveries, but Baby No.) Health status in the perinatal period Pregnancy order Number of neonates Total Stillbirths Live births Neonatal deaths Unknown Singleton Twin Triplet Quadruplet or higher Unknown Total This table excludes PGD and OD This table reports number of neonates (2 for twins, 3 for triplets,..). Table 3a-2. FET (total transfer following IVF and/or ICSI) (Not Deliveries, but Baby No.) Health status in the perinatal period Pregnancy order Number of neonates Total Stillbirths Live births Neonatal deaths Unknown Singleton Twin Triplet Quadruplet or higher Unknown Total This table excludes PGD and OD This table reports number of neonates (2 for twins, 3 for triplets,..). Table 3a-3. Oocyte donation (total transfer following IVF and/or ICSI) (Not Deliveries, but Baby No.) Health status in the perinatal period Pregnancy order Number of neonates Total Stillbirths Live births Neonatal deaths Unknown Singleton Twin Triplet Quadruplet or higher Unknown Total This table excludes PGD This table reports number of neonates (2 for twins, 3 for triplets,..). - Live births : 20 weeks - Stillbirths : 20 weeks - Neonatal deaths are all the deaths occurring after birth, up to 7 completed days of life. - Stillborn include deaths occurring during the delivery process. - 1221 -
대한산부회지제 52 권제 11 호, 2009 ART Report Forms, Korea 2006 Module 3b Malformations in relation to Treatment (includes chromosomal abnormalities) Table 3b-1. Standard IVF (IVF without ICSI) number of neonates/fetuses with congenital anomalies* Technique Abortion Total Delivered** Spontaneous Induced Total IVF fresh cycle ICSI fresh cycle FET (IVF and/or ICSI) Oocyte donation PGD GIFT TOTAL *: malformations and genetic abnormalities **: including stillbirths and those with unknown health status at birth Delivery 20 weeks, abortion <20 weeks Table 3b-2. ICSI (IVF with ICSI) number of neonates/fetuses with congenital anomalies* Technique Fetal losses Total Delivered** Spontaneous Induced Total IVF fresh cycle ICSI fresh cycle FET (IVF and/or ICSI) Oocyte donation PGD GIFT TOTAL *: malformations and genetic abnormalities **: including stillbirths and those with unknown health status at birth Delivery 20 weeks, abortion <20 weeks - 1222 -
최영민. 한국보조생식술의현황 : 2006 년 Table 3b-3. FET (Frozen Embryo with/without ICSI) number of neonates/fetuses with congenital anomalies* Technique Fetal losses Total Delivered** Spontaneous Induced Total IVF fresh cycle ICSI fresh cycle FET (IVF and/or ICSI) Oocyte donation PGD GIFT TOTAL *: malformations and genetic abnormalities **: including stillbirths and those with unknown health status at birth Delivery 20 weeks, abortion <20 weeks Table 3b-4. Oocyte Donation number of neonates/fetuses with congenital anomalies* Technique Fetal losses Total Delivered** Spontaneous Induced Total IVF fresh cycle ICSI fresh cycle FET (IVF and/or ICSI) Oocyte donation PGD GIFT TOTAL *: malformations and genetic abnormalities **: including stillbirths and those with unknown health status at birth Delivery 20 weeks, abortion <20 weeks - 1223 -
대한산부회지제 52 권제 11 호, 2009 Please list malformations which were reported, if available: Table 3c. List of congenital anomalies (Malformations and genetic abnormalities) Baby 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Congenital anomalies (Describe all anomalies found in each baby) Woman s Age* Technique* ART Semen/ sperm* Gestational age at birth/ abortion* Status* - 1224 -
최영민. 한국보조생식술의현황 : 2006 년 ART Report Forms, Korea 2006 Module 4 Outcomes by Maternal Age, Cause of Infertility Table 4-1. Number of oocyte retrieval and clinical by maternal age, 2006 Standard IVF (IVF without ICSI) Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Initiated Cycles with oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Initiated Cycles with oocyte retrieval attempted IVF with ICSI Pregnancy losses 1 Pregnancies with one or more live births Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Thawing Cycles with embryo transfer Frozen embryo transfers after IVF without ICSI Pregnancy losses 1 Pregnancies with one or more live births - 1225 -
대한산부회지제 52 권제 11 호, 2009 Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Thawing Cycles with embryo transfer Frozen embryo transfers after IVF with ICSI Pregnancy losses 1 Pregnancies with one or more live births Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Initiated Cycles with oocyte retrieval attempted ZIFT Pregnancy losses 1 Pregnancies with one or more live births Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Initiated Cycles with oocyte retrieval attempted GIFT Pregnancy losses 1 Pregnancies with one or more live births Women s age at start of treatment <25 yrs 25-29 30-34 35-39 40 Initiated Cycles with oocyte retrieval attempted Oocyte Donation Pregnancy losses 1 Pregnancies with one or more live births - 1226 -
최영민. 한국보조생식술의현황 : 2006 년 Table 4-2. Number of oocyte retrieval and clinical by cause (s) of infertility, 2006 Standard IVF (IVF without ICSI) Cause (s) of infertility Initiated Cycles with oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Female only Male factor only Mixed male and female Unexplained Other factors -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Cause (s) of infertility Initiated Cycles with oocyte retrieval attempted IVF with ICSI Pregnancy losses 1 Pregnancies with one or more live births Female only Male factor only Mixed male and female Unexplained Other factors -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Cause (s) of infertility Female only Male factor only Mixed male and female Unexplained Other factors Initiated Cycles with oocyte retrieval attempted ZIFT Pregnancy losses 1 Pregnancies with one or more live births -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. - 1227 -
대한산부회지제 52 권제 11 호, 2009 GIFT Cause (s) of infertility Initiated Cycles with oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Female only Male factor only Mixed male and female Unexplained Other factors -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. Frozen embryo transfers after IVF without ICSI Cause (s) of infertility Thawing Cycles with oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Female only Male factor only Mixed male and female Unexplained Other factors -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. Frozen embryo transfers after ICSI Cause (s) of infertility Thawing Cycles with oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Female only Male factor only Mixed male and female Unexplained Other factors -The groups in the sections on cause of infertility are mutually exclusive so each treatment cycle or pregnancy should be included in only one group. - 1228 -
최영민. 한국보조생식술의현황 : 2006 년 Table 4-3. Number of oocyte retrieval and clinical by number of embryos or oocytes transferred, 2006 Standard IVF Number of embryos transferred Pregnancy losses 1 Pregnancies with one or more live births Singleton Twin Triplet or more One Two Three Four Five Six or more 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Number of embryos transferred Pregnancy losses 1 Pregnancies with one or more live births IVF with ICSI Singleton Twin Triplet or more One Two Three Four Five Six or more 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Number of embryos transferred One Two Three Four Five Six or more Frozen embryo transfers after IVF without ICSI Pregnancy losses 1 Pregnancies with one or more live births Singleton Twin Triplet or more - 1229 -
대한산부회지제 52 권제 11 호, 2009 Number of embryos transferred Pregnancy losses 1 Frozen embryo transfers after ICSI Pregnancies with one or more live births Singleton Twin Triplet or more One Two Three Four Five Six or more 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Number of embryos transferred Pregnancy losses 1 Pregnancies with one or more live births ZIFT Singleton Twin Triplet or more One Two Three Four Five Six or more 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 Number of oocytes transferred One Two Three Four Five Six or more Pregnancy losses 1 Pregnancies with one or more live births GIFT Singleton Twin Triplet or more - 1230 -
최영민. 한국보조생식술의현황 : 2006 년 ART Report Forms, Korea 2006 Module 5 Embryo Freezing and Other Special Techniques Table 5-1. Embryo freezing, 2006 Have you ever performed embryo freezing in 2006? Yes ( ), No ( ) Number of oocyte pick-up (OPU) that resulted in embryo freezing in 2006 Number of embryos that were frozen in 2006 Total number of embryos in frozen storage at present Table 5-2. Oocyte retrieval, transfer and using special techniques of sperm collection and/or assisted hatching, 2006 Selected techniques Oocyte retrieval attempted Pregnancy losses 1 Pregnancies with one or more live births Microepididymal sperm aspiration (MESA) Testicular sperm extraction (TESE) Other and unspecified techniques of sperm collection* Assisted hatching 1 : pregnancy (intrauterine) 가확인되었으나임신 20주이전 abortion된경우 *: describe: * 이상입니다. 기입하여주셔서감사드립니다. 작성시의문점이있으신경우나수정또는개선점이있으시면서울의대산부인과최영민교수 ( 전화 : 02-2072-2385, HP: 010-3248-2385, Fax: 02-762-3599, E-mail: ymchoi@snu.ac.kr) 에게연락하여주십시오. - 1231 -
대한산부회지제 52 권제 11 호, 2009 Table 2. pregnancy in relation to treatment Treatment / IVF ICSI ZIFT GIFT FER * after FER after Oocyte IVF ICSI donation Cycles initiated (started) 11,776 13,420 24 1 2,150 2,160 Cycles with oocyte retrieval 10,935 12,786 24 1 202 Cycles with embryo transfer 10,033 11,757 22 1 2,145 2,137 193 1 embryo (oocyte) 479 1,441 0 0 195 158 10 2 embryo (oocytes) 1,273 1,698 0 0 488 457 27 3 embryo (oocytes) 2,301 2,602 2 0 679 705 40 4 embryo (oocytes) 3,240 3,336 18 0 438 540 71 5 embryo (oocytes) 2,232 2,013 2 1 254 203 35 6 embryo (oocytes) 508 667 0 0 91 74 10 3,433 3,538 10 1 695 738 75 (CP per retrieval, %) 31.4% 27.7% 41.7% 100.0% (CP per transfer, %) 34.2% 30.1% 45.5% 100.0% 32.4% 34.5% 38.9% Live births 2,819 2,711 8 1 570 591 62 (Live births per retrieval, %) 25.8% 21.2% 33.3% 100.0% - (Live births per transfer, %) 28.1% 23.1% 36.4% 100.0% 26.6% 27.7% 32.1% *frozen embryos replacement, a: thawing, b: cycle donation, estimated. 본조사에서는체외수정및자궁내배아이식술 (in vitro fertilization and embryo transfer: IVF-ET) 중난자세포질내정자주입술 (intracytoplasmic sperm injection: ICSI) 을시행한경우를분리하여조사하였으며마찬가지로냉동보존배아를이용한 IVF-ET 의경우에도 ICSI 를시행한군과시행하지않은군으로나누어조사하였다. 모든자료들은 2006 년에시작된치료주기에관련된것이고따라서 2006 년에시작된주기의결과로발생한임상적임신은모두분석에포함하였다. 임상적임신은초음파에의한태낭의확인또는소파술로얻어진임신산물등의임신의임상적증후가있는경우만을포함하고단순히혈중 β-hcg 만의상승이있었던생화학적임신은제외하였다. 임신주수는수정으로부터임신이종결된시점간의기간에 14일 (2주 ) 을더하여 completed weeks 의수로나타내었다. 그리고취합된자료들은 Microsoft 사의 Excel 프로그램과 Window 용 SPSS (version 12.0) 프로그램을이용하여분석하였다. 제3장결과분석및고찰 1. 2006 년도한국보조생식술시술개요 2006 년의시술예를보고해온국내의 81개의보조생식술시술기관에서총 29,733 예의보조생식술을시행하였다 (Table 2). 2000 년에는 58개의시술기관에서 15,619 예, 2001 년 53개의시술기관에서총 14,667 예, 2002 년 69개시술기관에서 18,310 예, 2003 년에는 48개시술기관에서 14,667 예그리고 2004 년에는 65개시술기관에서 17,802 예, 2005 년에는 76개시술기관에서 19,149 예를보고한바있다. 1 보조생식술의시술방법별분포를보면, 총 29,733 예의주기중 IVF (ICSI 를병행한경우는제외 ) 11,776 예 (39.6%), ICSI 13,420 예 (45.1%) 로 IVF와 ICSI 시술의합이총 25,196 예 (84.7%) 로대부분의보조생식술이신선배아를이용하는것으로이루어지고있음을알수있다. 냉동보존배아이식 (frozen embryo replacement: FER) 은 4,310 예 (14.5%) 가시행되었으며, 난자공여시술 (oocyte donation) 은 202 예 (0.7%), 생식세포난관내이식술 (gamete - 1232 -
최영민. 한국보조생식술의현황 : 2006 년 intrafallopian transfer: GIFT) 은 1예 (0.003%), 접합자난관내이식술 (zygote intrafallopian transfer: ZIFT) 은 24예 (0.08%) 였다 (Table 2, Fig. 2). 2. IVF 와 ICSI 1) 임상적임신율및생아출생률 IVF 와 ICSI 를시행받은대상환자중총 5,578 명 ( 난자채취주기당 23.5%, 배아이식주기당 31.8%) 이임상적으로임신을확인할수있었으며, 추정하여 4,581 명 ( 난자채취주기당 19.3.%, 배아이식주기당 26.1%) 이생아를출산하였다 (Table 2). Fig. 2. Types of ART procedures. 2) 대상환자의연령분포및이에따른임신율 IVF 와 ICSI 를시행받은대상환자의연령분포를보면 25세미만이 0.5%, 25~29 세가 10.8%, 30~34 세가 45.2%, 35~39 세가 31.4%, 40세이상이 12.1% 로 30~39 세가전체의 76.6% 로대부분을차지하였다 (Table 3-1, Fig. 3). 난자채취주기당임상적임신율은 25세미만이 44.8%, 25~29 세가 39.1%, 30~34세가 36.0%, 35~39세가 28.1%, 40세이상은 10.8% 로연령별로유의한차이가있었다 (P< 0.001) (Table 3-1, Fig. 4). 3) 불임원인및이에따른임신율 IVF 와 ICSI 를시행받은대상환자의적응증, 즉불임증의원인인자별분포는여성인자 (female only) 만있는경우가 41.6%, 남성인자 (male factors only) 만있는경우가 18.9%, 여성인자와남성인자가공존하는경우 (mixed male and female) 가 11.9%, 원인불명의불임증 (unexplained) 이 24.8%, 기타다른인자가 2.8% 였다 (Table 4, Fig. 5). 난자채취주기당임상적임신율은여성인자만있는경우는 28.4%, 남성인자만있는경우는 34.9%, 여성인자와남성인자가공존하는경우는 27.0%, 원인불명의불임증은 33.0%, 기타다른인자의경우 26.6% 로원인별로유 Table 3-1. Number of oocyte retrieval and clinical by maternal age Maternal age at IVF ICSI Total start of treatment OR CP (%) OR CP (%) OR CP (%) <25 25~29 30~34 35~39 40 55 1,152 5,011 3,295 969 22 (40.0%) 484 (42.0%) 1,907 (38.1%) 1,087 (33.0%) 119 (12.3%) 61 1,372 5,596 4,067 1,876 30 (49.2%) 504 (36.7%) 1,908 (34.1%) 985 (24.2%) 187 (10.0%) 116 2,524 10,607 7,362 2,845 52 (44.8%) 988 (39.1%) 3,815 (36.0%) 2,072 (28.1%) 306 (10.8%) Total 10,482 3,619 (34.5%) 12,972 3,614 (27.9%) 23,454 7,233 (30.8%) Table 3-2. Number of frozen embryo replacement and clinical by maternal age Maternal age at FER without ICSI FER with ICSI Total start of treatment CP (%) CP (%) CP (%) <25 25~29 30~34 35~39 40 12 272 1,020 610 122 6 (50.0%) 102 (37.5%) 369 (36.2%) 185 (30.3%) 26 (21.3%) 9 230 1,053 662 132 3 (33.3%) 92 (40.0%) 397 (37.7%) 202 (30.5%) 31 (23.5%) 21 502 2,073 1,272 254 9 (42.9%) 194 (38.6%) 766 (37.0%) 387 (30.4%) 57 (22.4%) Total 2,036 688 (33.8%) 2,086 725 (34.8%) 4,122 1,413 (34.3%) - 1233 -
대한산부회지제 52 권제 11 호, 2009 Fig. 3. Percentage of ART users by ages: IVF & ICSI. Fig. 4. pregnancy rates by ages of women, IVF & ICSI. Table 4. Number of oocyte retrieval by cause of infertility Cause of infertility Female only Male factor only Mixed male and female Unexplained Other factors IVF ICSI Total OR CP (%) OR CP (%) OR CP (%) 5,342 530 828 3,318 177 1,702 (31.9%) 197 (37.2%) 260 (31.4%) 1,232 (37.1%) 61 (34.5%) 4,250 3,817 1,927 2,396 474 1,020 (24.0%) 1,322 (34.6%) 484 (25.1%) 651 (27.2%) 112 (23.6%) 9,592 4,347 2,755 5,714 651 2,722 (28.4%) 1,519 (34.9%) 744 (27.0%) 1,883 (33.0%) 173 (26.6%) Total 10,195 3,452 (33.9%) 12,864 3,589 (27.9%) 23,059 7,041 (30.5%) 의하게차이가있었다 (P<0.001) (Table 4, Fig. 6). 4) 이식배아수및이에따른임신율 IVF 와 ICSI 시행주기에서이식한배아의수는 1개의경우가 8.7%, 2개인경우 13.7%, 3개인경우 22.6%, 4개인경우 30.3%, 5개인경우 19.9%, 6개이상인경우 4.8% 였다 (Table 5-1). 이식주기당임상적임신율은 1개의경우가 14.3%, 2개인경우 26.6%, 3개인경우 33.3%, 4개인경우 38.1%, 5개인경우 40.8%, 6개이상인경우 51.9% 로배아이식수에따라유의하게다른임신율을보였다 (P<0.001) (Table 5-1). 5) 다태아출생비율 IVF 와 ICSI 시행주기에서출생한총생아 (live birth) 중단태아의비율은 66.2% 였으며쌍태아는 33.2%, 삼태아는 0.6% 였으며사태아이상은없었다. 전체적으로쌍태아이상의다태임신의빈도가일반인구에서의쌍태아빈도가 3% 인것과 2 비교하면매우높은빈도이다 (Table 6, Fig 7). 3. 난자공여시술 (oocyte donation) 총 202 예의난자공여시술이있었으며, 193 예에서배아이식을시행하였다. 배아이식당임상적임신율은 38.9%, 생아출산율은 32.1% 였다 (Table 2). 4. 생식세포난관내이식술총 1예에서생식세포난관내이식술을시행하였다 (Table 2). 이는 2001 년의총 63예에서생식세포난관내이식술을시행한것에비하면많이감소한수치로 2005 년에는 1예시행하였다. 1 접합자난관내이식 (ZIFT) 은총 24예가시행되었으며이식주기당임신율은 45.5%, 생아출산율은모두 36.4% 였다 (Table 2). - 1234 -
최영민. 한국보조생식술의현황 : 2006 년 Fig. 5. Primary diagnosis for ART procedures, IVF & ICSI. Fig. 6. pregnancy rates by cause of infertility, IVF & ICSI. Table 5-1. by number of embryos transferred Number of embryos transferred Standard IVF IVF with ICSI Total (%) (%) (%) One 401 120 (29.9%) 1,455 145 (10.0%) 1,856 265 (14.3%) Two 1,191 404 (33.9%) 1,720 370 (21.5%) 2,911 774 (26.6%) Three 2,210 681 (30.8%) 2,594 918 (35.4%) 4,804 1,599 (33.3%) Four 3,114 1,187 (38.1%) 3,311 1,260 (38.1%) 6,425 2,447 (38.1%) Five 2,234 957 (42.8%) 1,989 765 (38.5%) 4,223 1,722 (40.8%) Six or more 394 227 (57.6%) 622 300 (48.2%) 1,016 527 (51.9%) Total 9,544 3,576 (37.5%) 11,691 3,758 (32.1%) 21,235 7334 (34.5%) Table 5-2. by number of frozen embryos transferred (FER) Number of embryos transferred Standard IVF IVF with ICSI Total (%) (%) (%) One 186 43 (23.1%) 150 32 (21.3%) 336 75 (22.3%) Two 474 132 (27.8%) 452 144 (31.9%) 926 276 (29.8%) Three 661 248 (37.5%) 703 274 (39.0%) 1,364 522 (38.3%) Four 418 165 (39.5%) 535 204 (38.1%) 953 369 (38.7%) Five 256 94 (36.7%) 200 65 (32.5%) 456 159 (34.9%) Six or more 95 24 (25.3%) 69 26 (27.0%) 164 50 (30.5%) Total 2,090 706 (33.8%) 2,109 745 (35.3%) 4,199 1,451 (34.6%) 5. 냉동보존배아이식 (frozen embryo replacement) 2006 년에총 4,310 예의냉동보존배아이식시도가있었으며, 이중총 4,282 예에서냉동보존배아이식을시행하였다. 배아이식주기당임상적임신율은 33.5% 생아출산율은 27.1% 였다 (Table 2). 2005 년에는총 3,220 예의냉동 보존배아이식시도가있었으며, 이중총 3,051 예에서냉동보존배아이식을시행하여배아이식주기당임상적임신율은 32.9%, 생아출산율은 28.3% 를보였다. 2006 년도의배아이식주기당임상적임신율및생아출산율은 2005 년도와통계적으로유의한차이가없었다 (P=0.633 and P=0.289, respectively). 2005 년도의배아이식주기당임 - 1235 -
대한산부회지제 52 권제 11 호, 2009 상적임신율및생아출산율은 2004 년도 (35.0% 및 27.0%) 와유의한차이가없었음을보고한바있다 (P= 0.107 and P=0.309, respectively). 1 냉동보존배아이식시도를시행한환자의연령분포를보 Fig. 7. Pluralities among live births: IVF & ICSI. 면 25세미만이 0.5%, 25~29 세가 12.2%, 30~34 세가 50.3%, 35~39 세가 30.9%, 40세이상이 6.2% 로 30~39 세가전체의 81.2% 로대부분을차지하였다 (Table 3-2). 이식주기당임상적임신율은 25세미만이 42.9%, 25~29 세가 38.6%, 30~34세가 37.0%, 35~39세가 30.4%, 40세이상은 22.4% 로연령별로유의한차이가있었다 (P<0.001, Table 3-2). 이식한배아의수는 1개의경우가 8.0%, 2개인경우 22.1%, 3개인경우 32.5%, 4개인경우 22.7%, 5개인경우 10.9%, 6개이상인경우 3.9% 였다 (Table 5-2). 이식주기당임상적임신율은이식한배아의수가 1개의경우는 22.3%, 2개인경우 29.8%, 3개인경우 38.3%, 4개인경우 38.7%, 5개인경우 34.9%, 6개이상인경우 30.5% 로배아이식수에따라유의하게다른임신율을보였다 (P<0.001, Table 5-2). Table 6. Deliveries in relation to treatment IVF Number Percentage ICSI Number Percentage FER Number Percentage Oocyte donation Number Percentage Singleton Twin deliveries Triplet deliveries All deliveries 561 (65.3%) 979 (66.7%) 305 (69.0%) 8 (32.0%) 292 (34.0%) 481 (32.8%) 136 (30.8%) 13 (52.0%) 6 (0.7%) 57 (0.5%) 1 (0.2%) 4 (16.0%) 859 1,467 442 25 Table 7. Oocyte retrieval, transfer and using special techniques of sperm collection and/or assisted hatching Selected techniques Oocyte retrieval attempted (% * ) Pregnancies with live births (% * ) Microepididymal sperm 108 106 34 (31.5%) 29 (26.9%) aspiration (MESA) Testicular sperm extraction 805 761 268 (33.3%) 208 (25.8%) (TESE) Other and unspecified techniques 31 30 7 (22.6%) 6 (9.4%) of sperm collection * Assisted hatching 3,988 3,955 1,230 (30.8%) 779 (19.5%) * per oocyte retrieval cycle. - 1236 -
최영민. 한국보조생식술의현황 : 2006 년 Table 8. Comparison with data from international registers Korea, 2006 US, 2006 3 ESHRE, 2005 4 IVF Cycles with oocyte retrieval 10,935 87,799 * 108,769 Cycles with embryo transfer 10,033 80,313 * 96,729 pregnancy (CP) 3,433 34,719 * 29,302 CP per retrieval (%) 31.4% 39.5% * 26.9% CP per transfer (%) 34.2% 43.2% * 30.3% Live birth per retrieval (%) 25.8% 32.4% * ICSI Cycles with oocyte retrieval 12,786 194,156 Cycles with embryo transfer 11,757 179,012 pregnancy (CP) 3,538 55,305 CP per retrieval (%) 27.7% 28.5% CP per transfer (%) 30.1% 30.9% Live birth per retrieval (%) 21.2% FER after IVF Cycles with embryo transfer 4,282 20,057 70,151 with/without ICSI pregnancy 1,433 7,401 13,719 CP per transfer 33.5% 36.9% 19.6% Live birth per transfer 27.7% 28.9% * including ICSI. US: United States, ESHRE: European Society for Human Reproduction and Embryology. 6. 수술적방법에의한정자채취와보조부화술 2006 년도에시행된 MESA (microsurgical epididymal sperm aspiration) 는총 108예이고난자채취주기당임신율은 31.5%, 난자채취주기당생아출생률은 26.9% 였다. TESE (testicular sperm extraction) 는 805예에서시행되었고난자채취주기당임신율은 33.3% 였고난자채취주기당생아출생률은 25.8% 였다. 보조부화술은 3,988 예에서시행되었고난자채취주기당임신율은 30.8%, 난자채취주기당생아출생률은 19.5% 였다 (Table 7). 7. 외국보고서와의비교보고된 2006 년도결과를국제데이터와비교한것은 Table 8과같다. 미국의경우 Centers for Disease Control and Prevention (CDC) 에서보고한 2006년 ART success rates: National summary and fertility clinic report 3 가최근보고이며, ESHRE (European Society for Human Reproduction and Embryology) 의최근보고인 2005 년 보조생식술결과는 4 유럽 30개국의데이터를분석한것이다. ICSI 를포함한신선배아를이용한주기를비교할때, 미국의경우배아이식주기당임상적임신율이 39.5% 로우리나라의 31.4% 에비해유의하게높았으며 (P<0.001), ESHRE 보고의경우배아이식주기당임상적임신율은 30.7% 이었다 (Table 8). 냉동보존배아이식의경우에서는미국의경우배아이식주기당임상적임신율이 36.9% 로우리나라의 33.5% 에비해통계적으로유의하게높았다 (P<0.001). 반면, 우리나라와유럽의결과를비교할때 ESHRE 에서보고한유럽의냉동보존배아이식의경우배아이식주기당임상적임신율이 19.6% 로우리나라의결과에비해통계적으로유의하게낮았다 (P<0.001, Table 8). 각기관의결과는같은해의결과가아닌가장최근보고된결과이다. 제4장맺음말 2006 년도한국의보조생식술현황은기존의 2005 년까지의보고 1 와큰차이는없었다. 외국의경우신선배아를 - 1237 -
대한산부회지제 52 권제 11 호, 2009 이용한경우에비해냉동배아를이용한경우임신율이떨어진반면, 우리나라의경우냉동배아를이용한경우의임상적임신율과신선배아를이용한임신율사이에통계적으로유의한차이가없었다 (P=0.060, Table 2). 2005 년보조생식술현황보고에서는냉동배아를이용한경우의임상적임신율이신선배아를이용한경우보다통계적으로유의하게높았음을보고한바있다 1 (P<0.001). 이러한냉동보 존배아이식의임신율에있어서외국보고와차이가나타나는원인에대해서는추가적인연구가필요할것으로생각된다. 보조생식술의성공에영향을줄수있는중요한요인으로여성의나이, 배아이식수등이포함된다는것은이전결과들과같았다. 1. 대한산부인과학회보조생식술소위원회. 조사보고서한국보조생식술의현황 : 2005 년. 대한산부회지 2008; 51: 1421-47. 2. Cunningham FG, Williams JW. Williams Obstetrics. 22nd ed. New York: McGraw-Hill Professional; 2005. 참고문헌 3. 2006 Assisted reproductive technology success rates. National summary and fertility clinic reports. Centers for Disease Control and Prevention (CDC). 2008; 1-573. 4. Nyboe Anderson AN, Goossens V, Bhattacharya S, Ferraretti AP, Kupka MS, de Mouzon J, et al. Assisted reproductive technology and intrauterine insemination in Europe, 2005. Results generated from European registers by ESHRE : ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2009; 24: 1267-87. - 1238 -