摘要
在患有多囊卵巢综合征(PCOS)且没有其他不孕因素的克罗米芬抵抗无排卵患者中,二甲双胍联合克罗米芬或促性腺激素均可作为二线治疗药物,尽管促性腺激素更有效。促性腺激素还可用于有PCOS且克罗米芬失败的无排卵患者的二线药物治疗。腹腔镜卵巢手术也可用于克罗米芬抵抗PCOS而无其他不孕症因素的无排卵患者的排卵诱导的二线治疗。来曲唑作为克罗米芬抵抗PCOS患者促排卵的二线药物治疗的有效性需要进一步研究。在提高生育率方面,减肥药和减肥手术被认为是一种对PCOS而无其他不孕因素患者的实验性治疗方法。在一线或二线排卵诱导治疗失败的情况下,体外受精(IVF)/卵胞浆内单精子注射(ICSI)可作为PCOS患者的三线治疗,但缺乏IVF/ICSI的绝对适应证。对于接受IVF/ICSI治疗的PCOS患者,首选促性腺激素释放激素拮抗剂方案,并可考虑选择性冷冻胚胎移植策略。在具有足够专业知识的辅助受孕单位中,可以向PCOS患者提供卵母细胞的体外成熟。
In Clomiphene resistant anovulatory patients with polycystic ovary syndrome(PCOS) and no other infertility factors, either Metformin combined with Clomiphene citrate or Gonadotrophins could be used as a second-line pharmacological therapy, although Gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory patients with PCOS and Clomiphene failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory patients with Clomiphene resistant PCOS and no other infertility factors. The usefulness of Letrozole as a second-line pharmacological treatment for ovulation induction in Clomiphene resistant women with PCOS requires further research. In terms of improving fertility, both phar macological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. First-or second-line ovulation induction therapies have failed, in vitro fertilization(IVF)/intracytoplasmic single sperm injection(ICSI) could be offered as a third-line therapy in patients with PCOS in the absence of an absolute indication for IVF/ICSI. However, absolute indications for IVF/ICSI are lacking. For patients with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation of oocytes could be offered to women with PCOS.
作者
王尧尧
郝松莉
WANG Yaoyao;HAO Songli(Department of Traditional Chinese Medicine,Shandong Yellow River Hospital,Yellow River Shandong Bureau,Shandong Province,Ji′nan 250032,China;Department of Obstetrics and Gynecology,First Affiliated Hospital,Heilongjiang University of Chinese Medicine,Heilongjiang Province,Harbin 150040,China)
出处
《中国医药导报》
CAS
2020年第10期46-49,共4页
China Medical Herald
基金
国家中医药管理局国家中医临床研究基地业务建设科研专项课题(JDZX2015059)。
关键词
多囊卵巢综合征
不孕症
治疗
证据
Polycystic ovary syndrome
Infertility
Treatments
Evidence
作者简介
通讯作者:郝松莉。
