Kousta E, White D M, Franks S
Department of Obstetrics and Gynaecology, Imperial College School of Medicine at St. Mary's, London, UK.
Hum Reprod Update. 1997 Jul-Aug;3(4):359-65. doi: 10.1093/humupd/3.4.359.
Clomiphene citrate is the treatment of first choice in the management of infertility in normally oestrogenized, anovulatory women (WHO group II). The majority of women with 'pure' anovulatory infertility respond to treatment with clomiphene citrate. The rates of pregnancy and miscarriage are close to those expected in a normal fertile population. Basal hormone concentrations do not predict outcome. An increased body mass index is the only factor which is consistently associated with a decreased response to clomiphene citrate; it follows therefore, that weight reduction should be an important part of therapy in anovulatory women. According to our data, only an increased luteinizing hormone value immediately post clomiphene citrate predicted an adverse pregnancy outcome in women who conceived. Clomiphene citrate, along with other ovulation induction therapies, can cause multiple follicular development, with a risk of ovarian hyperstimulation and multiple pregnancy. Ultrasound monitoring of treatment is important in order to choose the appropriate dose of clomiphene citrate in subsequent cycles and to minimize the risks of hyperstimulation and multiple pregnancy. When couples with other factors contributing to subfertility are excluded, the cumulative conception rate continues to rise after 6 months of treatment with clomiphene citrate, reaches a plateau by treatment cycle 12 and approaches that of the normal population. It has been reported that prolonged use of clomiphene citrate may be associated with an increased risk of a borderline or invasive ovarian tumour. Taking into consideration these observations, we recommend that anovulatory women responsive to clomiphene citrate should be treated for at least 6 cycles before considering more complex or invasive methods of ovulation induction, and that treatment should probably be limited to a maximum of 12 cycles.
枸橼酸氯米芬是雌激素水平正常的无排卵女性（世界卫生组织II组）不孕症治疗的首选药物。大多数“单纯”无排卵性不孕症女性对枸橼酸氯米芬治疗有反应。妊娠率和流产率接近正常可育人群的预期水平。基础激素浓度无法预测治疗结果。体重指数增加是唯一始终与枸橼酸氯米芬反应降低相关的因素；因此，体重减轻应成为无排卵女性治疗的重要组成部分。根据我们的数据，仅枸橼酸氯米芬治疗后立即升高的促黄体生成素值可预测受孕女性的不良妊娠结局。枸橼酸氯米芬与其他促排卵疗法一样，可导致多个卵泡发育，存在卵巢过度刺激和多胎妊娠的风险。治疗期间进行超声监测很重要，以便在后续周期中选择合适剂量的枸橼酸氯米芬，并将过度刺激和多胎妊娠的风险降至最低。当排除存在其他导致生育力低下因素的夫妇后，枸橼酸氯米芬治疗6个月后累积受孕率持续上升，在第12个治疗周期达到平台期，并接近正常人群水平。据报道，长期使用枸橼酸氯米芬可能会增加交界性或浸润性卵巢肿瘤的风险。考虑到这些观察结果，我们建议对枸橼酸氯米芬有反应的无排卵女性在考虑更复杂或侵入性的促排卵方法之前应至少治疗6个周期，并且治疗可能应限制在最多12个周期。
