2018 SOGC多囊卵巢综合征诱导排卵实践指南(No.362)解读  

Interpretation to SOGC clinical practice guideline: No. 362-Ovulation Induction in Polycystic Ovary Syndrome

作　　者：张巧利[1] 贾婵维[1] 周丽颖[1] 刘艳君[1] 余兰[1] 徐潇雨 王树玉[1] Zhang Qiaoli;Jia Chanwei;Zhou Liying;Liu Yanjun;Yu Lan;Xu Xiaoyu;Wang Shuyu(Department of Human Reproductive Medicine,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院生殖医学中心,100026

出　　处：《中华生殖与避孕杂志》2020年第8期695-700,共6页Chinese Journal of Reproduction and Contraception

基　　金：北京市属医院科研培育计划项目(PX2019053);首都医科大学附属北京妇产医院中青年学科骨干培养专项(fcyy201606)。

摘　　要：多囊卵巢综合征(PCOS)是临床常见的妇科内分泌紊乱性疾病,是引起育龄期女性无排卵性不孕的主要原因。2018年加拿大妇产科医师协会(SOGC)针对PCOS患者制定了诱导排卵的临床实践指南,推荐生活方式干预,雌激素受体拮抗剂枸橼酸氯米芬(CC)和选择性芳香化酶抑制剂来曲唑(LE)为一线治疗,促性腺激素(Gn)为二线治疗,体外受精为三线治疗。胰岛素抵抗者可服用胰岛素增敏剂二甲双胍;CC或LE抵抗者,如果存在腹腔镜手术的其他指征可行腹腔镜卵巢打孔术。指南提出在临床实践过程中应遵循个体化和渐进性原则对PCOS患者进行规范诱导排卵。Polycystic ovary syndrome(PCOS),a common clinical endocrine disorder,is the main cause of anovulatory infertility in women of childbearing age.The clinical practice guideline for ovulation induction in PCOS patients has been supported by the Society of Obstetricians and Gynaecologists of Canada(SOGC)in 2018.First line management of infertility once a diagnosis of PCOS is made should include weight loss and lifestyle modifications.Subsequently,first line medical therapy for ovulation induction should include selective estrogen receptor modulator—clomiphene citrate(CC)and aromatase inhibitor—letrozole(LE).The gonadotropins(Gn)should be considered as the second-line medical therapy,and in vitro fertilization treatment should be the third-line medical therapy.Insulin resistant patients can take the insulin sensitizer—metformin.When there are other indications for laparoscopy,laparoscopic ovarian drilling(LOD)may be considered in cases of CC or LE resistant PCOS.The clinical preventive action,that individual and progressive principles should be followed to normalize ovulation induction in PCOS patients.

关 键 词：多囊卵巢综合征 诱导排卵 胰岛素抵抗 生活方式干预 受精 体外 

分 类 号：R711.75[医药卫生—妇产科学]