Dickey R P, Holtkamp D E
Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, New Orleans, USA.
Hum Reprod Update. 1996 Nov-Dec;2(6):483-506. doi: 10.1093/humupd/2.6.483.
This review describes the development and pharmacology of clomiphene and those specific characteristics of both drug and patients which determine its clinical efficacy. The studies reviewed describe clinical observation of patient characteristics (age, additional infertility diagnosis, semen quality), vaginal ultrasound observations of ovaries (number and size of pre-ovulatory follicles) and endometrial lining (thickness, pattern) in 2841 clomiphene cycles in patients who required intrauterine insemination (IUI) because of poor sperm quality or an unsatisfactory postcoital test. They show that (i) conception in clomiphene cycles is related to the number and size of pre-ovulatory follicles, endometrial thickness, patient age, pelvic adhesions, type of anovulatory disorder and semen quality; (ii) pregnancy rates per clomiphene-IUI cycle are constant through at least six cycles; (iii) multiple births cannot be prevented by withholding human chorionic gonadotrophin or advising against coitus when multiple pre-ovulation follicles are present unless all follicles down to 10-12 mm diameter are counted. We also reviewed pregnancy outcome (number of gestational sacs, babies, preclinical and clinical abortion, ectopic pregnancy and birth sex) in 1744 clomiphene pregnancies from our clinic. We found that (i) preclinical and clinical abortions are increased only slightly by clomiphene use, compared to spontaneous pregnancy; (ii) clinical abortions are decreased in patients with polycystic ovaries and luteal insufficiency who use clomiphene; (iii) conception and preclinical abortions are related to endometrial thickness prior to ovulation; (iv) ectopic pregnancies are not increased by clomiphene and (v) the ratio of male births is not altered by clomiphene, except possibly in timed insemination cycles. These studies repudiate many misconceptions regarding clomiphene. They also show that clinical outcome may be improved by pre-ovulation ultrasound monitoring of ovarian and endometrial response.
本综述阐述了克罗米芬的研发及药理学特性，以及决定其临床疗效的药物和患者的特定特征。所综述的研究描述了对2841个克罗米芬治疗周期患者的临床观察（年龄、其他不孕诊断、精液质量）、卵巢的经阴道超声观察（排卵前卵泡的数量和大小）以及子宫内膜（厚度、形态），这些患者因精子质量差或性交后试验结果不理想而需要进行宫腔内人工授精（IUI）。研究表明：（i）克罗米芬治疗周期的受孕与排卵前卵泡的数量和大小、子宫内膜厚度、患者年龄、盆腔粘连、无排卵障碍类型以及精液质量有关；（ii）每个克罗米芬-IUI周期的妊娠率至少在六个周期内保持恒定；（iii）当存在多个排卵前卵泡时，除非对所有直径降至10 - 12毫米的卵泡进行计数，否则无法通过停用人类绒毛膜促性腺激素或建议避免性交来预防多胎妊娠。我们还回顾了本诊所1744例克罗米芬妊娠的妊娠结局（妊娠囊数量、婴儿数量、临床前和临床流产、异位妊娠及出生性别）。我们发现：（i）与自然妊娠相比，使用克罗米芬仅使临床前和临床流产略有增加；（ii）使用克罗米芬的多囊卵巢和黄体功能不全患者的临床流产减少；（iii）受孕和临床前流产与排卵前的子宫内膜厚度有关；（iv）克罗米芬不会增加异位妊娠的发生率；（v）除了在定时授精周期可能有影响外，克罗米芬不会改变男婴出生比例。这些研究驳斥了许多关于克罗米芬的误解。它们还表明，通过排卵前超声监测卵巢和子宫内膜反应可改善临床结局。
