缓释二甲双胍不能降低多囊卵巢综合征患者诱导排卵所需的枸橼酸氯米芬剂量。
Extended-release metformin does not reduce the clomiphene citrate dose required to induce ovulation in polycystic ovary syndrome.
作者信息
Cataldo Nicholas A, Barnhart Huiman X, Legro Richard S, Myers Evan R, Schlaff William D, Carr Bruce R, Diamond Michael P, Carson Sandra A, Steinkampf Michael P, Coutifaris Christos, McGovern Peter G, Gosman Gabriella, Nestler John E, Giudice Linda C
机构信息
Stanford University School of Medicine, Stanford, CA 94305, USA.
出版信息
J Clin Endocrinol Metab. 2008 Aug;93(8):3124-7. doi: 10.1210/jc.2008-0287. Epub 2008 May 27.
CONTEXT
When used for ovulation induction, higher doses of clomiphene may lead to antiestrogenic side effects that reduce fecundity. It has been suggested that metformin in combination with clomiphene can restore ovulation to some clomiphene-resistant anovulators with polycystic ovary syndrome (PCOS).
OBJECTIVE
Our objective was to determine if cotreatment with extended-release metformin (metformin XR) can lower the threshold dose of clomiphene needed to induce ovulation in women with PCOS.
DESIGN
A secondary analysis of data from the National Institute of Child Health and Human Development Cooperative Multicenter Reproductive Medicine Network prospective, double-blind, placebo-controlled multicenter clinical trial, Pregnancy in Polycystic Ovary Syndrome, was performed.
SETTING
Study volunteers at multiple academic medical centers were included.
PARTICIPANTS
Women with PCOS and elevated serum testosterone who were randomized to clomiphene alone or with metformin (n = 209 in each group) were included in the study.
INTERVENTIONS
Clomiphene citrate, 50 mg daily for 5 d, was increased to 100 and 150 mg in subsequent cycles if ovulation was not achieved; half also received metformin XR, 1000 mg twice daily. Treatment was for up to 30 wk or six cycles, or until first pregnancy.
MAIN OUTCOME MEASURES
Ovulation was confirmed by a serum progesterone more than or equal to 5 ng/ml, drawn prospectively every 1-2 wk.
RESULTS
The overall prevalence of at least one ovulation after clomiphene was 75 and 83% (P = 0.04) for the clomiphene-only and clomiphene plus metformin groups, respectively. Using available data from 314 ovulators, the frequency distribution of the lowest clomiphene dose (50, 100, or 150 mg daily) resulting in ovulation was indistinguishable between the two treatment groups.
CONCLUSION
Metformin XR does not reduce the lowest dose of clomiphene that induces ovulation in women with PCOS.
背景
用于诱导排卵时，较高剂量的克罗米芬可能会导致抗雌激素副作用，从而降低生育能力。有人提出，二甲双胍与克罗米芬联合使用可使一些患有多囊卵巢综合征（PCOS）的克罗米芬抵抗性无排卵者恢复排卵。
目的
我们的目的是确定缓释二甲双胍（二甲双胍XR）联合治疗是否能降低PCOS女性诱导排卵所需的克罗米芬阈值剂量。
设计
对美国国立儿童健康与人类发展研究所合作多中心生殖医学网络进行的前瞻性、双盲、安慰剂对照多中心临床试验“多囊卵巢综合征妊娠”的数据进行了二次分析。
地点
纳入了多个学术医学中心的研究志愿者。
参与者
纳入了患有PCOS且血清睾酮升高、被随机分为单独使用克罗米芬或联合二甲双胍治疗的女性（每组n = 209）。
干预措施
枸橼酸克罗米芬，每日50 mg，连用5天，若未排卵，则在随后的周期中将剂量增加至100 mg和150 mg；其中一半还接受二甲双胍XR，每日两次，每次1000 mg。治疗持续长达30周或六个周期，或直至首次怀孕。
主要观察指标
前瞻性地每1 - 2周检测一次血清孕酮，若血清孕酮大于或等于5 ng/ml，则确认排卵。
结果
单独使用克罗米芬组和克罗米芬加二甲双胍组在使用克罗米芬后至少有一次排卵的总体发生率分别为75%和83%（P = 0.04）。根据314名排卵者的现有数据，两个治疗组中导致排卵的最低克罗米芬剂量（每日50、100或150 mg）的频率分布无差异。
结论
二甲双胍XR不会降低诱导PCOS女性排卵所需的最低克罗米芬剂量。
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