Management of anovulatory infertility
Management of anovulatory infertility
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DOI：
10.1093/humrep/14.suppl_1.108
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发表时间：
1999-09-01
影响因子：
6.1
通讯作者：
Vegetti, W
中科院分区：
文献类型：
--
作者：
Crosignani, PG;Bianchedi, D;Vegetti, W
慢性无排卵可能是人类不育的主要原因，基本上与四种不同的内分泌疾病有关：高催乳素性无排卵、低促性腺激素性无排卵、正常促性腺激素性无排卵和高促性腺激素性无排卵。高催乳素血症和微催乳素瘤是年轻女性常见的发现，催乳素分泌过多损害卵巢功能，导致无排卵性生育力低下。多巴胺能治疗恢复卵巢功能，缩小泌乳素瘤。在这些患者中，使用降催乳素药物恢复生育能力不会增加多胎妊娠或早期妊娠丢失的发生率。在绝大多数高催乳素血症的妇女怀孕是安全的，可能是有益的。卡麦角林是最有效和耐受性最好的抗催乳素血症药物。促性腺激素减少性无排卵常与急性或慢性情绪应激有关，在这种情况下，患者应接受咨询。解释和保证是第一个重要的管理步骤。使用脉冲促性腺激素释放激素是诱导生育的最佳策略，促性腺激素正常的无排卵患者可能患有多囊卵巢。最具成本效益的生育治疗是服用抗雌激素，如克罗米酚或他莫昔芬。正常促性腺激素无排卵患者的第二选择疗法是使用人促性腺激素制剂进行卵巢刺激。低剂量修改使妊娠率低于传统的高剂量递增方案，需要加强监测，但多胎妊娠不太常见。没有治疗方法可以使高促性腺激素无排卵的妇女怀孕。这些患者的生育能力只能通过卵子捐赠计划来促进。
Chronic anovulation is probably the major cause of human infertility and is essentially associated with four distinct endocrine conditions; hyperprolactinemic anovulation, hypogonadotrophic anovulation, normogonadotrophic anovulation and hypergonadotrophic anovulation. Hyperprolactinaemia and microprolactinoma are frequent findings in young women and excessive prolactin secretion impairs ovarian function causing anovulatory subfertility. Dopaminergic treatment restores ovarian function and shrinks prolacinoma. In these patients restoration of fertility with prolactin lowering drugs does not increase the incidence of multiple pregnancies or early pregnancy loss. In the vast majority of hyperprolactinemic women pregnancy is safe and could be beneficial. Cabergoline is the most effective and tolerated of the antiprolactinemic drugs, Hypogonadotrophic anovulation is frequently associated with acute or chronic emotional stress and in this case the patient should be counselled. Explanation and reassurance are the first important management steps. The use of pulsatile gonadotrophin-releasing hormone is the best strategy to induce fertility, Patients with normogonadotrophic anovulation are likely to have polycystic ovary. The most cost effective profertility treatment is the administration of an anti-oestrogen such as clomiphene or tamoxifen. The second choice therapy for patients with normogonadotrophic anovulation is ovarian stimulation with human gonadotrophin preparations. Low dose modifications give pregnancy rates lower than that with the traditional high-dose step-up protocol and intensive monitoring is required, but multiple pregnancies are less frequent. No treatment is available to enable women with hypergonadotrophic anovulation to conceive. Fertility in these patients can be promoted only by an egg donation programme.