多囊卵巢综合征不孕症患者的促排卵治疗  

Ovulation induction for infertile patients with polycystic ovary syndrome

作　　者：孙春艳 陈淼鑫 SUN Chun-yan;CHEN Miao-xin(Center for Reproductive Medicine,Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai 201204,China)

机构地区：[1]同济大学附属第一妇婴保健院辅助生殖医学科,上海201204

出　　处：《世界临床药物》2020年第8期575-580,共6页World Clinical Drug

基　　金：国家自然科学基金委面上项目(81871213,81671468);中华医学会生殖医学青年医师研究与发展项目(18010030732);上海市科委医学引导类(西医)科技支撑项目(19411960500);上海市卫计委计划生育类项目(201640346);国家重点研发计划子课题(SQ2017ZY050118-03)。

摘　　要：多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期女性常见的内分泌及代谢性疾病。PCOS是不孕症女性排卵障碍最常见的原因之一,所以促排卵治疗是目前治疗PCOS不孕症的主要方法。常用的促排卵药物主要有克罗米芬(clomiphene citrate)、来曲唑(letrozole)、促性腺激素(gonadotropins)及二甲双胍(metformin)。克罗米芬和来曲唑是一线促排卵药物。来曲唑较克罗米芬有更高的排卵率、妊娠率和活产率,多胎妊娠的风险较低。促性腺激素是PCOS的二线促排卵药物,促排卵的有效性高,但需采用低剂量递增或递减方案,以防止卵巢过度刺激和多胎妊娠。二甲双胍可改善胰岛素抵抗和排卵,一般与其他药物联用。腹腔镜下卵巢打孔术可以作为克罗米芬抵抗和促排卵失败PCOS患者的二线治疗手段。Polycystic ovary syndrome (PCOS) is one of the most common endocrine and metabolic disorders in reproductive aged women.PCOS is also the most frequent cause of anovulation in infertile women and ovulation induction is the most common treatment.The commonly used ovulation induction agents include clomiphene citrate,letrozole,gonadotropins and metformin.Clomiphene citrate and letrozole are considered first line pharmacological treatment for ovulation induction in women with PCOS.Letrozole has higher ovulation rate,pregnancy rate,live birth rate and lower multiple pregnancy rate compared with clomiphene citrate.Gonadotropins are second line ovulation induction agents for anovulatory PCOS with higher efficacy.To prevent overstimulation and multiple pregnancy,gonadotropins should be administered with either low-dose step-up regimens or step-down regimens.Metformin can improve insulin resistance and ovulation,and is generally used in combination with other medications.Laparoscopic ovarian drilling could be used as second line treatment for women with PCOS who are clomiphene citrate resistance or have failed to ovulation induction.

关 键 词：多囊卵巢综合征 促排卵治疗 克罗米芬 来曲唑 促性腺激素 二甲双胍 腹腔镜下卵巢打孔术 

分 类 号：R711.6[医药卫生—妇产科学] R711.75[医药卫生—临床医学]