Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Effects of Y Chromosome Microdeletion on the Outcome of in vitro Fertilization

남성 불임 환자에서 Y 염색체 미세 결손이 체외 수정 결과에 미치는 영향

  • Choi, Noh-Mi (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Yang, Kwang-Moon (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Kang, Inn-Soo (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Seo, Ju-Tae (Department of Urology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Song, In-Ok (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Park, Chan-Woo (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Lee, Hyoung-Song (Laboratory of Reprodudive Biology & Infertility, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Lee, Hyun-Joo (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Ahn, Ka-Young (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Hahn, Ho-Suap (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Lee, Hee-Jung (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Kim, Na-Young (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine) ;
  • Yu, Seung-Youn (Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine)
  • 최노미 (관동대학교 의과대학 제일병원 산부인과) ;
  • 양광문 (관동대학교 의과대학 제일병원 산부인과) ;
  • 강인수 (관동대학교 의과대학 제일병원 산부인과) ;
  • 서주태 (관동대학교 의과대학 제일병원 비뇨기과) ;
  • 송인옥 (관동대학교 의과대학 제일병원 산부인과) ;
  • 박찬우 (관동대학교 의과대학 제일병원 산부인과) ;
  • 이형송 (관동대학교 의과대학 제일병원 생식생물학 및 불임연구실) ;
  • 이현주 (관동대학교 의과대학 제일병원 산부인과) ;
  • 안가영 (관동대학교 의과대학 제일병원 산부인과) ;
  • 한호섭 (관동대학교 의과대학 제일병원 산부인과) ;
  • 이희정 (관동대학교 의과대학 제일병원 산부인과) ;
  • 김나영 (관동대학교 의과대학 제일병원 산부인과) ;
  • 유승연 (관동대학교 의과대학 제일병원 산부인과)
  • Published : 2007.03.31
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Abstract

Objective: To determine whether the presence of Y-chromosome microdeletion affects the outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) program. Methods: Fourteen couples with microdeletion in azoospermic factor (AZF)c region who attempted IVF/ICSI or cryopreserved and thawed embryo transfer cycles were enrolled. All of the men showed severe oligoasthenoteratoazoospermia (OATS) or azoospermia. As a control, 12 couples with OATS or azoospermia and having normal Y-chromosome were included. Both groups were divided into two subgroups by sperm source used in ICSI such as those who underwent testicular sperm extraction (TESE) and those used ejaculate sperm. We retrospectively analyzed our database in respect to the IVF outcomes. The outcome measures were mean number of good quality embryos, fertilization rates, implantation rates, $\beta$-hCG positive rates, early pregnancy loss and live birth rates. Results: Mean number of good quality embryos, implantation rates, $\beta$-hCG positive rates, early pregnancy loss rates and live birth rates were not significantly different between Y-chromosome microdeletion and control groups. But, fertilization rates in the Y-chromosome microdeletion group (61.1%) was significantly lower than that of control group (79.8%, p=0.003). Also, the subgroup underwent TESE and having AZFc microdeletion showed significantly lower fertilization rates (52.9%) than the subgroup underwent TESE and having normal Y-chromosome (79.5%, p=0.008). Otherwise, in the subgroups used ejaculate sperm, fertilization rates were showed tendency toward lower in couples having Y-chromosome microdeletion than couples with normal Y-chromosome. (65.5% versus 79.9%, p=0.082). But, there was no significance statistically. Conclusions: In IVF/ICSI cycles using TESE sperm, presence of V-chromosome microdeletion may adversely affect to fertilization ability of injected sperm. But, in cases of ejaculate sperm available for ICSI, IVF outcome was not affected by presence of Y-chromosome AZFc microdeletion. However, more larger scaled prospective study was needed to support our results.

목 적: 무정자증이나 심한 희소정자증이 있는 남성 불임 환자에서 Y 염색체 미세 결손을 동반하는 경우 체외 수정 및 세포질내 정자 주입술과 배아 이식의 결과에 미치는 영향을 알아보고자 하였다. 연구방법: 후향적 실험군 -대조군 연구로, Y 염색체 미세 결손이 동반된 무정자증이나 심한 희소정자증이 있는 남성 불임 부부 14 쌍을 실험군으로 하였고 대조군으로는 남성 배우자가 무정자증이나 심한 희소정자증이 있지만 Y 염색체는 정상인 12 쌍의 불임 부부를 대상으로 하였으며, 이 두 군을 다시 정자 채취 방법에 따라 사정된 정자를 이용한 군과 고환 내 정자 추출술을 통해 정자를 채취한 군으로 분류하였다. 연구 결과로는 수정률, 등급이 우수한 배아 수, 착상률, 융모막성 성선자극호르몬 양성률, 초기 임신 소실률, 출생률을 비교하였다. 결 과: 등급이 우수한 배아 수, 착상률, 융모막성 성선자극호르몬 양성률, 초기 임신 소실률, 출생률은 Y 염색체 미세 결손이 있는 군과 정상 Y 염색체를 갖는 군 간에 차이가 없었으나, 수정률은 Y 염색체 미세 결손이 있는 불임 부부 (61.1%) 에서 정상 Y 염색체를 갖는 불임 부부 (79.8%, p=0.003) 보다 낮았다. 정자 채취의 방법에 따라 비교하였을 때, 고환 내 정자 추출술을 통해 정자를 채취한 경우 실험군 (52.9%) 에서 대조군 (79.5%, p=0.008) 보다 유의하게 수정률이 낮게 나타났으나 사정된 정자를 이용한 경우에는 실험군에서 대조군 보다 수정률이 더 낮은 경향을 보였으나 유의한 차이는 없었고, 나머지 결과들은 두 군 간에 차이가 없었다. 결 론: Y 염색체 미세 결손이 동반된 무정자증이나 심한 희소정자증이 있는 불임 부부에서 고환 내 정자 추출술을 통해 정자를 채취할 경우 체외 수정 및 세포질내 정자 주입술 결과 정상 Y 염색체를 갖는 불임 부부에서 보다 수정률이 더 낮게 나타났으나, 사정된 정자를 이용하는 경우나 고환 내 정자 추출술을 통해 정자를 채취하여 수정이 된 후에는 Y 염색체의 미세 결손이 체외 수정 및 세포질내 정자 주입술과 배아 이식의 결과에 영향을 주지 않는 것으로 보인다. 그러나 향후 대규모의 전향적 연구가 더 필요할 것으로 사료된다.

Keywords

References

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