Pepperell R J
Fertil Steril. 1983 Jul;40(1):1-14. doi: 10.1016/s0015-0282(16)47169-4.
Appropriate investigation has led to the recognition of five major endocrinologic categories of anovulatory patients. The clinician is able to follow a definitive therapeutic program for each of these; and except where the FSH levels are elevated, pregnancy rates should approach values observed for normally ovulating women. Although clomiphene citrate is likely to remain the most common drug prescribed to anovulatory women, treatment programs with clomiphene have recently been modified with much improved success rates resulting. Bromocriptine, the drug of choice for women with hyperprolactinemia, restores ovulatory cycles in most women treated. It not only restores fertility, however, but also reduces tumor growth in patients with pituitary adenomas, making surgical removal often unnecessary. Exogenous gonadotropin therapy should be reserved for patients who do not respond to treatment with clomiphene and/or bromocriptine. With adequate monitoring, the multiple pregnancy rate should be able to kept below 20% and high-multiple pregnancies avoided. Pulsatile GnRH therapy is likely to replace gonadotropin therapy for most patients, because this therapy has distinct advantages in terms of cost, patient convenience, and a lowering of multiple pregnancy rates.
适当的检查已使人们认识到无排卵患者的五大内分泌学类别。临床医生能够针对其中每一类制定明确的治疗方案；并且除了促卵泡生成素（FSH）水平升高的情况外，妊娠率应接近正常排卵女性的观察值。尽管枸橼酸氯米芬可能仍然是最常用于无排卵女性的药物，但最近对氯米芬治疗方案进行了修改，成功率有了很大提高。溴隐亭是高泌乳素血症女性的首选药物，在大多数接受治疗的女性中可恢复排卵周期。然而，它不仅能恢复生育能力，还能使垂体腺瘤患者的肿瘤缩小，常常使手术切除变得不必要。外源性促性腺激素治疗应保留给对氯米芬和/或溴隐亭治疗无反应的患者。通过充分监测，多胎妊娠率应能够保持在20%以下，并避免高序多胎妊娠。脉冲式促性腺激素释放激素（GnRH）治疗可能会取代大多数患者的促性腺激素治疗，因为这种治疗在成本、患者便利性以及降低多胎妊娠率方面具有明显优势。
