불임여성에서 생화학적 임신이 향후 성공적 임신을 예측할 수 있는 인자로서의 유용성에 관 한 연구 = Is Biochemical Pregnancy a Good Prognostic Indicator in Subfertile Women?

다국어 초록 (Multilingual Abstract)

The objective of this study is to test the hypothesis that the occurrence of biochemical pregnancy is a good prognostic indicator in the future pregnancy performance in subfertile women. A total 174 cycles of conservative treatment in 50 patients infertile for more than one year were included in the analysis. Patients with tubal factor, severe male factor, moderate to severe peritoneal adhesions or patients having assisted reproductive technology were excluded. Serum level of hCG on postovulation day 12 or 13 was measured by immunoradiometric assay using duplicates with sensitivity of 3 mIU/ml and serial measurements were done if hCG>3 mIU/ml. Biochemical pregnancy was defined as serum hCG>3 mIU/ml without gestational sac monitored by vaginal ultrasonography. No-Biochem group was defined as patients having at least three cycles of hCG less than 3 mIU/ml and Biochem group as patients having at least one cycle of biochemical pregnancy. In survival analysis, Kaplan-Meier method was used. The occurrence of viable pregnancy, defined as pregnancy maintaining beyond 20 weeks, was regarded as a terminal event. The patients who were lost to follow up or remaining not experiencing viable pregnancy were regarded as censored. Log rank test was done to determine the difference of cumulative pregnancy rates between the two groups. In this setting, the incidence of biochemical pregnant cycle in infertile women was 10%. There was no significant difference between No-Biochem and Bio- chem group in age, duration of infertility and duration of observation. The 40-month cumulative viable pregnancy rate in No-Biochem was similar to that of Biochem group. By survival analysis, there was no significant difference between the two groups in the cumulative viable pregnancy rate. From these data, the occurrence of biochemical pregnancy dose not appear to be a good prognostic indicator for developing a viable pregnancy via conservative treatment in subfertile patients. Biochemical pregnancy may have two different aspects, one is a success of initiating pregnancy, and the other is a failure of maintaing pregnancy. Thus, it is speculated that in subfertile women, the potential merit of biochemical pregnancy may be counter-balanced by the intrinsic factor(s) which may prevent a viable pregnancy. Further studies are needed to delineate these two different aspects using specific subgroup of patients.