Ginsburg J, Hardiman P
Department of Endocrinology, Royal Free Hospital and Medical School, London, UK.
Gynecol Endocrinol. 1991 Mar;5(1):57-78. doi: 10.3109/09513599109049942.
The aim of human menopausal gonadotropin treatment (hMG), to simulate normal follicular development by injecting FSH and LH and induce follicular rupture with hCG, is rarely met. Multiple follicular development occurs because hypothalamic-pituitary feedback is bypassed. This, exacerbated by the long half-life of hCG, causes the principal complications of hMG therapy--multiple pregnancy and hyperstimulation. The initial use of hMG in pituitary deficiency has been widened to include failure to respond to clomiphene, polycystic ovaries, 'unexplained infertility' and in vitro fertilization. Reported pregnancy rates, incidence of hyperstimulation and of multiple pregnancy vary widely. We reviewed the results of hMG therapy from 1977 to 1989 in 260 consecutive women with clomiphene-resistant infertility. Conception and live birth rates after six treatment cycles were 45.7% and 43.3%, respectively and were influenced by the cause of infertility, age, weight and sperm parameters. The miscarriage rate was 18.6% and multiple pregnancy rate 19.3%. The conception rate fell during the 12-year period in all groups except those with regular anovulatory cycles. Over this period, age, weight and male subfertility increased in patients referred to us. hMG is an effective and safe treatment for women with clomiphene-resistant infertility and patent tubes.
人绝经期促性腺激素治疗（hMG）的目的是通过注射促卵泡激素（FSH）和促黄体生成素（LH）来模拟正常的卵泡发育，并使用人绒毛膜促性腺激素（hCG）诱导卵泡破裂，但这一目的很少能实现。由于绕过了下丘脑 - 垂体反馈，会出现多个卵泡发育。而hCG的长半衰期加剧了这种情况，导致了hMG治疗的主要并发症——多胎妊娠和卵巢过度刺激综合征。hMG最初用于垂体功能低下，现在其应用范围已扩大到包括对克罗米芬无反应、多囊卵巢、“不明原因不孕”以及体外受精等情况。报道的妊娠率、卵巢过度刺激综合征发生率和多胎妊娠率差异很大。我们回顾了1977年至1989年连续260例对克罗米芬耐药不孕女性的hMG治疗结果。六个治疗周期后的受孕率和活产率分别为45.7%和43.3%，并受不孕原因、年龄、体重和精子参数影响。流产率为18.6%，多胎妊娠率为19.3%。除了有规律的无排卵周期的患者外，所有组的受孕率在这12年期间都有所下降。在此期间，转诊到我们这里的患者年龄、体重增加，男性生育力下降。对于对克罗米芬耐药且输卵管通畅的女性，hMG是一种有效且安全的治疗方法。
