OVERSTIMULATED CYCLES UNDER LOW-DOSE GONADOTROPINS IN PATIENTS WITH POLYCYSTIC-OVARY-SYNDROME - CHARACTERIZATION AND MANAGEMENT
OVERSTIMULATED CYCLES UNDER LOW-DOSE GONADOTROPINS IN PATIENTS WITH POLYCYSTIC-OVARY-SYNDROME - CHARACTERIZATION AND MANAGEMENT
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DOI：
10.1093/oxfordjournals.humrep.a137869
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发表时间：
1993-01-01
影响因子：
6.1
通讯作者：
CASPI, E
中科院分区：
文献类型：
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作者：
HERMAN, A;RONEL, R;CASPI, E
在30例接受低剂量促性腺激素治疗的多囊卵巢综合征患者中，分析了75个周期，以确定过度刺激周期中发生卵巢过度刺激的风险增加。在59个周期（79%）中观察到最佳反应（一个或两个直径大于或等于14毫米的卵泡）。其余16个周期（21%）表现出过度刺激反应，其特征要么是生长两个以上卵泡，要么是雌二醇水平为50 850 pg/ml（比最佳周期中观察到的平均值高2 SD）。当发现雌二醇水平过高时，根据主要卵泡的大小，后者中的6例进行了前瞻性处理。这一阶段被称为发展过度刺激，其识别是基于从最优群体中获得的客观标准。抑制促性腺激素后，卵泡继续生长；然而，与其他六个匹配的过度刺激周期相比，最终雌二醇水平较低。总体而言，14名患者（47%）怀孕，其中3名（21%）为多胎妊娠。出现轻、中度卵巢过度刺激综合征3例；所有这些都涉及过度刺激的周期。低剂量促性腺激素治疗与相当程度的过度刺激反应有关。应仔细监测所有周期，以识别过度刺激的反应，应谨慎管理。
Among 30 patients with polycystic ovary syndrome, treated with low-dose gonadotrophins, 75 cycles were analysed in order to characterize overstimulated cycles that were at increased risk of developing ovarian hyperstimulation. Optimal response (one or two follicles greater-than-or-equal-to 14 mm diameter) was observed in 59 cycles (79%). The remaining 16 cycles (21%) exhibited an overstimulated response characterized either by growing more than two follicles or having an oestradiol level > 850 pg/ml (2 SD above the mean observed in optimal cycles). Six of the latter were handled prospectively when oestradiol levels were found to be too high according to the size of the leading follicle. This stage was termed as developing overstimulation and its identification was based on objective criteria obtained from the optimal group. Following the withholding of gonadotrophin, the follicles continued to grow; however, the final oestradiol level was lower compared with six other matched overstimulated cycles. Overall, 14 patients conceived (47%) of whom three (21%) had multiple pregnancies. Mild or moderate ovarian hyperstimulation syndrome occurred in three cases; all of which involved overstimulated cycles. Low-dose gonadotrophin treatment is associated with a substantial degree of overstimulated response. All cycles should be monitored carefully in order to recognize the overstimulated response, which deserves cautious management.