Messinis I E, Milingos S D
Department of Obstetrics and Gynaecology, Medical School, University of Thessalia, Larissa, Greece.
Hum Reprod Update. 1997 May-Jun;3(3):235-53. doi: 10.1093/humupd/3.3.235.
Great progress had been achieved during the last 20 years in the field of ovulation induction in patients with polycystic ovary syndrome (PCOS). Clomiphene citrate remains the first line of treatment for all anovulatory women with PCOS, since in properly selected patients the cumulative pregnancy rate approaches that in normal women. Human urinary gonadotrophins have been used extensively for ovulation induction, but the development of low-dose regimens has opened a new era in the management of anovulation related to PCOS. This article discusses the main advantages and disadvantages of the principal methods and regimens currently used for ovulation induction in patients with PCOS including clomiphene citrate, gonadotrophins, pulsatile gonadotrophin-releasing hormone (GnRH) and GnRH agonists. It also discusses new drugs discovered recently, particularly recombinant gonadotrophins and GnRH antagonists, and provides some thoughts regarding their use in future protocols. Finally, based on the discovery of new ovarian substances which specifically control luteinizing hormone (LH) secretion, this article develops assumptions on possible implications of these substances in the pathophysiology of PCOS and their potential use in the management of the syndrome.
在过去20年里，多囊卵巢综合征（PCOS）患者的促排卵领域取得了巨大进展。枸橼酸氯米芬仍然是所有无排卵PCOS女性的一线治疗药物，因为在适当选择的患者中，累积妊娠率接近正常女性。人尿促性腺激素已被广泛用于促排卵，但低剂量方案的发展为PCOS相关无排卵的治疗开创了一个新时代。本文讨论了目前用于PCOS患者促排卵的主要方法和方案（包括枸橼酸氯米芬、促性腺激素、脉冲式促性腺激素释放激素（GnRH）和GnRH激动剂）的主要优缺点。还讨论了最近发现的新药，特别是重组促性腺激素和GnRH拮抗剂，并对它们在未来方案中的应用提出了一些想法。最后，基于对特异性控制黄体生成素（LH）分泌的新卵巢物质的发现，本文对这些物质在PCOS病理生理学中的可能影响及其在该综合征治疗中的潜在应用提出了假设。
