多囊卵巢综合征控制性卵巢刺激的有效运用

Ovulation Induction Strategy in Polycystic Ovary Syndrome

多囊卵巢综合征（PCOS）患病率在4%~12%,是育龄期妇女常见的涉及多系统的生殖内分泌疾病。临床表现为高雄激素、月经紊乱和不孕,代谢性障碍可表现为胰岛素抵抗、高脂血症和肥胖等。PCOS的代谢紊乱与下丘脑-垂体-卵巢-肾上腺的功能障碍有关,这些紊乱可引起长期并发症,如高血压、糖尿病和心血管疾病等,临床医生需密切监测并积极预防。PCOS促排卵治疗中,首先应使肥胖患者减轻体质量,降低体内胰岛素水平,恢复自发排卵。氯米芬为促排卵治疗的一线药物,可结合口服避孕药、二甲双胍或糖皮质激素降低体内雄激素水平以增加对氯米芬的敏感性;芳香化酶抑制剂也可用于促排卵治疗,尤其适用于既往有雌激素依赖性肿瘤的患者;促性腺激素与卵巢打孔手术可达到相同的妊娠率,临床选择时应充分考虑患者的条件及手术可能引起的并发症。体外受精中,可选择使用促性腺激素释放激素拮抗剂及激动剂诱发排卵以减少卵巢过度刺激综合征的发生,也可使用卵子体外培养以获得成功妊娠。

PCOS,with the prevalence rate 4% to 12%,is one of the most common disorder of reproductive and endocrine systems in fertile women.The principal clinical manifestations are hyperandrogenism,irregular menstruation and infertility.The metabolic dysfunction includes insulin resistance,dyslipidemia and obesity.Those metabolic disorders are involved with the dysfunction of hypothalamic pituitary ovary axis and adrenal gland.All of these disorders may contribute to the chronic complication,such as hypertension,DM,CVD.So,doctors should closely monitoring and positively prevent those metabolic disorders.Anovulation in obese women with PCOS could be successfully treated with weight loss.Clomiphene,clomiphene plus glucocorticoid,clomiphene and estrogen-progestin pretreatment,clomiphene and metformin,aromatase inhibitors,gonadotropin and ovarian surgery could be used for induction of ovulation in PCOS.GnRH antagonist and GnRH agonist could be used for PCOS during IVF to prevent OHSS.In vitro maturation of oocytes also is plausible.