Kato Mariko, Kikuchi Iwaho, Shimaniki Hiroto, Kobori Hiroyuki, Aida Takuya, Kitade Mari, Kumakiri Jun, Takeuchi Hiroyuki
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
J Obstet Gynaecol Res. 2007 Apr;33(2):174-80. doi: 10.1111/j.1447-0756.2007.00504.x.
It is difficult to induce ovulation in patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC) because of the narrow safety margin of human menopausal gonadotropin preparations. In the present study, patients diagnosed as having PCOS according to the Japanese diagnostic criteria were divided into two groups (Groups H and N). Testosterone level was used as a cut-off value between Groups H and N to examine the usefulness of laparoscopic ovarian drilling (LOD) to induce ovulation.
Thirty-two women with PCOS resistant to CC who underwent LOD were evaluated. The patients were divided into a high and a normal androgen group (Groups H and N with 19 and 13 patients, respectively) based on the level of testosterone measured 1 week before surgery using a cut-off value of 50 ng/dL. LOD was performed with microlaparoscopy under intravenous anesthesia.
After LOD, spontaneous ovulation occurred in 16 (84.2%) and nine (69.2%) patients in Groups H and N, respectively. Additional treatment with CC was given to 12 (63.2%) and 11 (84.6%) patients, respectively. No significant difference was noted with regard to the spontaneous ovulation rate after LOD. Eighteen pregnancies were established in 17 patients (53.1%). The pregnancy rate after LOD was not significantly different between Groups H and N: 42.1% (8 patients) and 76.9% (10 patients), respectively.
Patients with PCOS as diagnosed based on the Japanese diagnostic criteria include those with increased and normal androgen levels. LOD is considered an effective ovulation induction method for both types of patients with PCOS.
由于人绝经期促性腺激素制剂的安全范围较窄，多囊卵巢综合征（PCOS）患者对枸橼酸氯米芬（CC）耐药时很难诱导排卵。在本研究中，根据日本诊断标准诊断为PCOS的患者被分为两组（H组和N组）。以睾酮水平作为H组和N组的分界值，以研究腹腔镜卵巢打孔术（LOD）诱导排卵的有效性。
对32例接受LOD的CC耐药PCOS女性患者进行评估。根据术前1周测得的睾酮水平，以50 ng/dL为分界值，将患者分为高雄激素组和正常雄激素组（H组19例，N组13例）。在静脉麻醉下通过微型腹腔镜进行LOD。
LOD后，H组和N组分别有16例（84.2%）和9例（69.2%）患者发生自发排卵。分别有12例（63.2%）和11例（84.6%）患者接受了CC辅助治疗。LOD后的自发排卵率无显著差异。17例患者（53.1%）共妊娠18次。H组和N组LOD后的妊娠率无显著差异：分别为42.1%（8例）和76.9%（10例）。
根据日本诊断标准诊断的PCOS患者包括雄激素水平升高和正常的患者。LOD被认为是这两种类型PCOS患者有效的排卵诱导方法。
