Giarola A
Minerva Med. 1983 May 7;74(19):1097-126.
Female dysendocrine sterility has displayed a statistical incidence of 3.4% since 1967 in Milan's fertility and sterility centres. It is always marked by clear-cut clinical situations. Of these, particular interest is attached to anovulation (62.4% of cases), both with the cycle and with anovularity, ovarian micropolycystosis (2.7%), both as Stein ovary and as micropolycystic ovary, disturbances of ovary endocrine secretion: lutein deficiencies (21.2%) in the form of both brief and inadequate luteal phase. Treatment is aimed at possibly discontinuous reinstatement of ovulation. Clinical and pharmacological experiments over the last twenty years have put forward many "inducers". Mention is made of four personal approaches: --clinical employment of homologous gonadotropins (hMG + hCG), sequentially rather than paired, when poor gonadotropin secretion accompanied by insufficient endogenous oestrogenic activity is the main feature. Investigation from June 1964 to December 1981, coupled with monitorisation and personalisation of the treatment, initially through daily checks of total and fractionated oestrogenuria, and in recent years preferably through plasma 17-beta oestradiol or urinary enzyme determinations, has given a different slant to the reported disadvantages of gonadotropic management: hyperstimulation frequent multiple pregnancies, frequent multiple miscarriages; --employment of GnRH or its analogues (indications virtually those for paired gonadotropins). Some uncertainties however, exist with regard to the contraceptive action displayed by the agonist and antagonist analogues at certain doses, and with regard to the antigonadic action GnRH appears to have, both in the depression of oestrogen and progesterone production and in the arrest of follicular maturation an ovulation; --a preference for clomiphene among the antioestrogens in cases of primarily hypothalamic dysfunction and in ovarian micropolycystosis, provided endogenous oestrogenic activity is within normal limits; --a preference for hypoprolactinaemic drugs (bromoergocriptine, lysuride) in PRL-dependency, marked solely by an appreciable increase in serum LTH, screened as functional by means of selective tests; --experimentation of epimestrol, mainly in cases of sterility due to lutein deficiency.
自1967年以来，女性内分泌失调性不育在米兰的生育与不育中心的统计发病率为3.4%。它总是以明确的临床情况为特征。其中，无排卵（占病例的62.4%），包括月经周期紊乱和无排卵，以及卵巢微多囊症（2.7%），包括斯坦因卵巢型和微多囊卵巢型，卵巢内分泌分泌紊乱：黄体功能不足（21.2%），表现为黄体期短暂和不足，特别值得关注。治疗旨在尽可能间断性地恢复排卵。在过去二十年中，临床和药理学实验提出了许多“诱导剂”。这里提及四种个人治疗方法：——当以促性腺激素分泌不足伴内源性雌激素活性不足为主要特征时，临床上使用同源促性腺激素（hMG + hCG），采用序贯给药而非联合给药。1964年6月至1981年12月的研究，以及治疗的监测和个体化，最初通过每日检查总雌激素尿和分段雌激素尿，近年来则优选通过血浆17-β雌二醇或尿酶测定，使促性腺激素治疗的报告缺点呈现出不同的倾向：过度刺激、频繁多胎妊娠、频繁多次流产；——使用GnRH或其类似物（适应证与联合促性腺激素基本相同）。然而，关于激动剂和拮抗剂类似物在某些剂量下显示的避孕作用，以及GnRH似乎具有的抗性腺作用，即在抑制雌激素和孕酮产生以及阻止卵泡成熟和排卵方面，存在一些不确定性；——对于原发性下丘脑功能障碍和卵巢微多囊症病例，在内源性雌激素活性在正常范围内时，在抗雌激素中优先选择克罗米芬；——对于仅以血清催乳素明显升高为特征的泌乳素依赖性不育（通过选择性试验筛选为功能性），优先选择降泌乳素药物（溴隐亭、利舒脲）；——主要在黄体功能不足导致的不育病例中试验依普美罗。
