Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds LS14 6UH, UK.
Mol Cell Endocrinol. 2013 Jul 5;373(1-2):77-82. doi: 10.1016/j.mce.2012.10.008. Epub 2012 Oct 17.
The aim of this brief review is to describe the management of anovulatory infertility in the polycystic ovary syndrome (PCOS). This has traditionally involved the use of clomiphene citrate (CC), and then gonadotropin therapy or laparoscopic ovarian surgery, in those who are clomiphene resistant (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). Recently developed therapeutic approaches include aromatase inhibitors and the potential use of in vitro maturation (IVM) of oocytes collected from unstimulated (or minimally stimulated) polycystic ovaries. Unfortunately the early promise of the insulin sensitizing drugs has not been translated into significant improvement in outcomes and therefore are not prescribed unless the patient has an impairment of glucose tolerance (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). There has been an unfortunate shift away from Mono-follicular ovulation induction remains the first line approach for the management of anovulatory PCOS, and in vitro fertilization treatment (IVF) should be reserved for those who fail to respond or who have additional infertility factors (The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, 2008). Superovulation for IVF presents significant risks for women with polycystic ovaries, namely the potentially life-threatening complication of ovarian hyperstimulation syndrome (OHSS). Carefully conducted and monitored ovulation induction can achieve good cumulative conception rates and furthermore, multiple pregnancy rates can be minimized with strict adherence to criteria that limit the number of follicles that are permitted to ovulate.
本文旨在描述多囊卵巢综合征(PCOS)患者无排卵性不孕的治疗方法。传统上,对于氯米酚抵抗的患者(Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group,2008),通常采用氯米酚治疗,随后采用促性腺激素治疗或腹腔镜卵巢手术。最近,开发了一些新的治疗方法,包括芳香化酶抑制剂和体外成熟(IVM)的应用,即从未刺激(或轻微刺激)的多囊卵巢中采集卵子。不幸的是,胰岛素增敏药物的早期承诺并未转化为结局的显著改善,因此,除非患者的葡萄糖耐量受损(Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group,2008),否则不会开此类药物。不幸的是,人们已经不再关注单卵泡排卵诱导,它仍然是治疗无排卵性 PCOS 的一线方法,体外受精(IVF)治疗应保留给那些对治疗无反应或有其他不孕因素的患者(Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group,2008)。对于多囊卵巢的妇女,超排卵进行 IVF 会带来显著的风险,即卵巢过度刺激综合征(OHSS)这一潜在危及生命的并发症。通过仔细进行和监测排卵诱导,可以实现良好的累积妊娠率,此外,通过严格遵守限制允许排卵的卵泡数量的标准,可以最大限度地减少多胎妊娠率。