Nader S
Department of Obstetrics and Gynecology, University of Texas Medical School, Houston, TX 77030, USA.
Minerva Ginecol. 2008 Feb;60(1):53-61.
Management of polycystic ovary syndrome (PCOS) usually spans a woman's reproductive years. While treatment of androgenic symptoms is often a primary concern, periodically, the regimen has to be modified because of a desire for pregnancy. As these women are usually anovulatory, ovulation induction is generally required. The premise on which ovulation induction in PCOS is based is two-fold: increasing ovarian exposure to follicle stimulating hormone (FSH) and/or correcting hormonal derangements. Potential differences in pathogenesis, evidenced clinically by phenotypic diversity, suggest that treatment should be individualized. This paper is an overview of treatments available and also provides a critical appraisal of management options. These options include the use of clomiphene citrate, insulin sensitizers, and the combination. Protocols for ovulation induction with FSH injections are outlined and the relative risks of multiple gestation and severe ovarian hyperstimulation syndrome of these various protocols discussed. The use of aromatase inhibitors and the occasional use of glucocorticoids are briefly reviewed. Finally, the role of laparoscopic ovarian diathermy in the management of anovulatory infertility in PCOS is outlined.
多囊卵巢综合征（PCOS）的管理通常贯穿女性的生育期。虽然雄激素症状的治疗往往是主要关注点，但由于有怀孕的需求，治疗方案有时需要定期调整。由于这些女性通常无排卵，一般需要进行促排卵治疗。PCOS促排卵治疗的依据有两个方面：增加卵巢对促卵泡激素（FSH）的暴露和/或纠正激素紊乱。临床表型多样性所证明的发病机制潜在差异表明，治疗应个体化。本文概述了可用的治疗方法，并对管理方案进行了批判性评估。这些方案包括使用枸橼酸氯米芬、胰岛素增敏剂及其联合使用。概述了使用FSH注射进行促排卵的方案，并讨论了这些不同方案发生多胎妊娠和严重卵巢过度刺激综合征的相对风险。简要回顾了芳香化酶抑制剂的使用以及糖皮质激素的偶尔使用。最后，概述了腹腔镜卵巢电灼术在PCOS无排卵性不孕管理中的作用。
