腹腔镜卵巢楔切治疗难治性多囊卵巢综合征不孕的临床观察

目的:探讨腹腔镜卵巢楔切治疗难治性多囊卵巢综合征引起不孕的疗效。方法:在腹腔镜下行卵巢楔切或加打孔术治疗51例难治性多囊卵巢综合征患者,术后观察月经恢复及妊娠情况。结果:术后排卵率67.4%,累积妊娠率63.9%,流产率2.8%,异位妊娠率2.8%,多胎妊娠率2.8%。结论:腹腔镜手术是治疗难治性多囊卵巢综合征不孕的简单、疗效肯定的好方法,应在最佳妊娠时间内积极治疗。     

腹腔镜治疗多囊卵巢综合征所致不孕症31例分析

目的：探讨腹腔镜下卵巢表面电凝术对多囊卵巢综合征（PCOS）所致不孕症患者的疗效。方法：对31例PCOS不孕症患者观察术前术后血黄体生成素（LH）、卵泡刺激素（FSH）、睾酮（T）水平,术后排卵情况、妊娠率及妊娠结果。结果：31例患者中失访3例,除1例术后3个月应用克罗米芬（CC）一个疗程后恢复月经外,月经情况均明显改善。术后LH、LH/FSH和T均较术前明显降低,而FSH明显升高,差异具有显著性（P＜0.01)。术后排卵率为89.3%(25/28),排除干扰因素后妊娠率为70.6%（12/17）,早期流产率为15.4%(2/13),术后附件区粘连的发生率为14.3%(3/21)。结论：腹腔镜下卵巢表面电凝术治疗PCOS相对于促性激素治疗和卵巢楔切术具有术后排卵率高、妊娠率高、流产率低、并发症少的优点,是CC治疗失败后的一个有效治疗手段。     

多囊卵巢综合征与相关基因多态性的研究进展

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是一种常见的异质性内分泌疾病,是导致女性不孕的常见因素。该病的病因仍不明了,遗传因素在其发病中起一定作用。分子遗传学研究表明,PCOS发生机制与影响甾体激素、促性腺激素、性腺激素和胰岛素的合成和代谢以及物质能量调节的基因密切相关,其中一些关键基因,如胆固醇侧链裂解(CYP11A)基因、芳香化酶(CYP19)基因、17β-类固醇脱氢酶(17β-HSD)基因、促卵泡素基因受体(FSHR)基因、雄激素受体(AR)基因、雌激素受体(ER)基因、性激素结合球蛋白(SHBG)基因、过氧化物体增殖激活受体(PPARγ)基因、脂联素(adiponectin)基因、胰岛素基因的微卫星(INS VNTR)、胰岛素受体(INSR)基因、胰岛素受体底物蛋白(IRS)基因等的多态性尤其是单核苷酸多态性可能起重要的作用。     

多囊卵巢综合征的表观遗传学研究

多囊卵巢综合征(PCOS)是关乎女性一生的疾病,在其病因学、诊断标准和最佳治疗方案上尚有许多争论和悬而未决的问题。遗传和环境因素共同导致了PCOS的发生,但至今仍未发现与PCOS确切相关的特异基因。而环境因素通过何种介导机制影响PCOS的发生,依然不明确。表观遗传学将环境因素和遗传因素很好地联系起来,PCOS的发生也许与表观遗传学的异常机制有关。     

腹腔镜下卵巢打孔术治疗多囊卵巢综合征合并不孕68例临床观察

目的:探讨腹腔镜下卵巢打孔术对多囊卵巢综合征(PCOS)合并不孕的治疗价值。方法:回顾性分析在我院行腹腔镜下双侧卵巢打孔术的68例PCOS合并不孕患者的临床资料和治疗效果。检测手术前后血清促卵泡生成素(FSH)、黄体生成素(LH)、睾酮(T)、雌二醇(E2)水平并进行对比分析,观察术后排卵情况及妊娠率。结果:术后1个月血清LH、LH/FSH、T显著下降(P<0.05)。术后自然排卵率82.4%(56/68),术后妊娠率77.9%(53/68)。结论:腹腔镜下卵巢打孔术是PCOS合并不孕有效的治疗方法,创伤小、出血少、术后恢复快、并发症少。     

多囊卵巢综合征6例诊治体会

我科自 1987年以来收治已确诊的多囊卵巢综合征(ＰＣＯＳ)患者 6例 ,现总结分析如下。1　临床资料1 1　临床表现及辅助检查　患者年龄 2 6～ 39岁 ,平均31 5岁 ,均以不孕为主诉就诊。其中 2例继发闭经 ,4例月经稀发 ,均行诊刮诊为无排卵型月经 ;2例重度肥胖 ,3例中度肥胖 ,1例正常体重 ,此例伴多毛、痤疮及阴毛呈男性化分布。妇科检查有 4例患者可触及双侧增大的卵巢 ,最大的似鸡卵大小、囊性。Ｂ超检查 :4例患者双侧卵巢增大并有多囊性改变 ,2例未探及卵巢。血液放射免疫检验(ＲＩＡ) :采用美国利科公司药盒做ＲＩＡ检验。诊断标准 :黄体生…     

腹腔镜在多囊卵巢综合征诊治中的应用

多囊卵巢综合征 (ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)是育龄女性常见的内分泌紊乱性疾病 ,是无排卵性不孕的主要原因之一。由于ＰＣＯＳ患者临床表现的多样性 ,对其诊断目前尚无统一的标准。典型的腹腔镜下多囊卵巢特征 :包膜增厚呈珍珠色 ,表面不平 (约占 73% ) ;卵巢增大 (约占 80 % ) ;卵巢包膜下有多个卵泡 ,向卵巢表面稍突出 (约占 71% ) ,;卵巢表面血管增多呈网状 (约占 6 4 % ) ;因无排卵卵巢表面平滑无切迹。对于ＰＣＯＳ患者排卵障碍性不孕首选的治疗方案是应用克罗米芬促排卵 ,其治疗后排卵率 >80 %。但…     

多囊卵巢综合征患者IVF治疗中超促排卵方案的对比研究

目的:探讨不同的超排卵方案对多囊卵巢综合征(PCOS)患者实施IVF-ET治疗过程的影响。方法:回顾分析行IVF治疗、长方案超促排卵的PCOS患者134个移植周期,比较分析不同超促排卵方案、促排卵药物的IVF-ET结局。结果:①递增方案组(n=7,6)总Gn使用量明显大于递减方案组(n=74)、Coasting方案组(n=16)和恒量方案组(n=18)(P<0.05)。②后期添加hMG组(n=61)总Gn使用量明显大于单用FSH组(n=73)(P<0.05),着床率也明显降低(P<0.05),但临床妊娠率无显著性差异(P=0.064);③普丽康组(n=43)与果纳芬+hMG组(n=22)及普丽康+hMG组(n=39)相比,总Gn使用量明显减少(P<0.05),而与果纳芬组(n=30)间无统计学差异;普丽康组与普丽康+hMG组相比,获卵数明显增加(P<0.05)。结论:PCOS患者的长方案超排卵方案中,递增方案增加了Gn使用总量而临床妊娠率有偏低的趋势;添加hMG不能提高着床率和临床妊娠率;单纯普丽康超排卵有减少总Gn使用量,增加获卵数的趋势。     

多囊卵巢综合征的研究进展

多囊卵巢综合征 (ｐｏｌｙｃｙｓｔｉｃｏｖａｒｙｓｙｎｄｒｏｍｅ ,ＰＣＯＳ)是育龄妇女最常见的妇科内分泌疾病 ,临床上主要表现为功能性高雄激素血症、持续不排卵和胰岛素拮抗[1] 。尽管做了大量相关研究 ,但其病因仍不清楚 ,临床上也仅限于对症治疗。本文就近几年的有关研究进展作一综述。1　ＰＣＯＳ的发病因素1 1　高胰岛素血症和胰岛素拮抗　ＰＣＯＳ者常有胰岛素拮抗和高胰岛素血症 ,近几年的研究表明高胰岛素在ＰＣＯＳ的发生中起重要作用。1 1 1　高胰岛素刺激卵巢雄激素的合成　动物实验及体外实验均发现胰岛素参与卵巢性类固醇…     

腹腔镜卵巢打孔术结合药物促排卵治疗难治性多囊卵巢综合征的临床研究

目的　探讨腹腔镜卵巢打孔术 (LOD)后结合克罗米芬 (CC)和中药排卵汤对难治性多囊卵巢综合征(PCOS)不孕的治疗效果。方法　 1998年 2月至 2 0 0 3年 4月将 5 8例患者随机分成A组 (LOD) 18例 ,B组(LOD CC) 2 1例及C组 (LOD CC 排卵汤 ) 19例 ,所有患者进行LOD。手术前后分别测血黄体生成激素、卵泡刺激素、雄激素及雌二醇水平 ,术后第 9天起监测患者卵泡发育和排卵共 3个周期 ,并记录妊娠数和流产数。结果　三组患者术后LH和T水平与术前相比均有显著性下降 (P <0 0 1)。 3个治疗周期内共有 4 5例排卵 ,其中A组 9例 (5 0 0 % ) ,B组 19例 (90 5 % ) ,C组 17例 (89 5 % ) ,三组间排卵率差异有显著性意义 (P <0 0 0 5 )。1年内累计妊娠 2 6例 ,其中A组 3例 ,B组 10例 ,C组 13例。自然流产A组有 1例 ,B组 2例 ,C组无发生。结论　LOD后结合CC和中药排卵汤能明显改善难治性PCOS患者的排卵和受孕机会。     

Persistent anovulation following laparoscopic electrocoagulation of the ovarian surface in a patient with polycystic ovary syndrome (PCOS)

We report on a 32-year-old woman with polycystic ovarian syndrome (PCOS) who showed no ovarian reaction (oestradiol increase, leading follicle) to clomiphene and gonadotropin stimulation before and after laparoscopic electrocoagulation of the ovarian surface (LEOS) although hormone values (LH-FSH ratio, androstenedione) after LEOS were within normal range. The case is discussed in terms of the literature.     

Polycystic ovary syndrome (PCOS)

Polycystic ovaries syndrome (PCOS) is one of the most common female hormonal disorders. Its multiple components--reproductive, metabolic, neoplasic and cardiovascular--have a major impact on the public health. Androgen excess and resistance to insulin, probably from genetic origin, are responsible for most of the clinical symptomatology. Resistance to insulin seems to be accompanied by a greater risk of glucose intolerance, type 2 diabetes, lipidic anomalies and can involve the development of cardiovascular diseases. In addition, sleep apnea syndrome is more progressively described in PCOS. Infertility, menses disorders and hirsutism often push these patients to consult their physician. A better understanding of the physiopathological mechanisms led to the emergence of new therapeutic options increasing the sensitivity to insulin. Besides the pregnancy wishes, cares aim to attenuate the marks of the hyper-androgenism (hormonal treatment and cosmetic) and to correct cardiovascular, respiratory and gynaecological risk factors. In case of infertility by anovulation, cares must be performed by trained experts to minimize the risk of ovarian hyper-stimulation syndrome and multiple pregnancies. A gradation from loose weight to clomiphene citrate ovulation induction, ovarian drilling, low dose gonadotropin, in vitro fertilisation, or in vitro maturation of oocytes should bring back good reproduction potential.     

Changes in circulating hormone levels after ovarian wedge resection in patients with polycystic ovary syndrome

Summary Serum gonadotropin, prolactin, estradiol, sex hormone binding globulin (SHBG) and androgen levels were measured before, 5 days and 6 weeks following ovarian wedge resection in 9 patients with polycystic ovary syndrome. Elevated levels of LH, androstenedione, testosterone and dehydroepiandrosterone-sulphate (DHEA-S) were found before surgery. There was a marked decrease in androstenedione and DHEA-S levels 5 days following wedge resection, but a rebound effect could be observed 6 weeks later. Serum gonadotropin, prolactin, testosterone and SHBG concentrations were practically unaffected by surgery. At 6–12 months follow up patients showed regular, mainly ovulatory cycles, but pregnancy occured only in two cases.     

Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS

OBJECTIVE: To determine the rate of clinically evident polycystic ovary syndrome (PCOS) among first-degree female relatives within families with a proband affected by PCOS. DESIGN: Clinical and biochemical evaluation of the mothers and sisters of 93 patients with PCOS. The diagnosis of PCOS was established by: [1] a history of oligomenorrhea, [2] clinical evidence (i.e., hirsutism) or biochemical evidence (i.e., elevated total or free T) of hyperandrogenism, and [3] the exclusion of related disorders. SETTING: Tertiary care university. PATIENT(S): Patients with PCOS and their mothers and sisters. INTERVENTION(S): Interview, physical examination, and hormonal testing on blood samples were performed for all subjects. MAIN OUTCOME MEASURE(S): The presence of hirsutism and hyperandrogenemia was determined in the mothers and sisters of the patients with PCOS. RESULT(S): Of the 78 mothers and 50 sisters evaluated clinically, 19 (24%) and 16 (32%) were affected with PCOS, respectively. A higher rate of PCOS was observed when only premenopausal women not taking hormones (i.e., untreated) were considered (i.e., 35% of mothers and 40% of sisters), consistent with amelioration of symptoms with hormonal therapy or aging. These rates of PCOS are significantly higher than that observed in our general population (approximately 4%) and suggest the involvement of a major genetic component in the disorder. CONCLUSION(S): The rates of PCOS in mothers and sisters of patients with PCOS were 24% and 32%, respectively, although the risk was higher when considering untreated premenopausal women only.     

经腹腔镜卵巢手术对多囊卵巢综合征的治疗作用

１３名经促排卵药物或楔切术治疗失败的多囊卵巢综合征（ＰＣＯＳ）患者，在腹腔镜下行卵巢开窗（打扎）或大块组织切除术。术后血清雄激素（Ｔ）下降，黄体生成素／卵泡成熟素（ＬＨ／ＦＳＨ）比值降低，排卵率达８５．０％，妊娠率为６１．５％，表明经腹腔镜卵巢手术为治疗ＰＣＯＳ的有效手段。     

Long-term clinical effects of ovarian wedge resection in polycystic ovarian syndrome

Twenty-nine consecutive patients with polycystic ovary (PCO) syndrome (defined as hirsutism plus oligomenorrhea or secondary amenorrhea, and excluding Cushing's syndrome, an androgen-secreting adrenal or ovarian tumor or adrenocortical hyperplasia) were treated with ovarian wedge resection leaving normal-sized ovaries. Long-term follow-up from 2.3-9.5 years (mean 5.7 years) showed that 26 of 29 patients (90%) had established normal menstrual cycles. Fertility and normal pregnancies were achieved in all 10 patients (100%) with normal postoperative menstrual cycles who desired to conceive, but not in the 3 patients with remaining postoperative oligomenorrhea. Eight of 9 patients who were obese preoperatively and who had normal postoperative menstrual cycles showed a major weight loss after wedge resection. In contrast, none of the preoperatively obese patients, who remained oligomenorrheic after surgery, lost weight. Hirsutism was not cured by wedge resection. It is concluded that ovarian wedge resection should still be considered useful in patients with PCO.     

Treatment in polycystic ovarian syndrome (PCOS) with emphasis on ovarian electrocautery

The current opinion about the diagnosis and treatment of polycystic ovarian syndrome is presented. The advantages of ovarian electrocautery, the method pioneered by the author of the paper, is emphasised. Endocrine short and long term effects and the effectiveness of ovarian electrocautery in the infertility treatment are reviewed.     

Role of kisspeptin in polycystic ovary syndrome (PCOS)

Objective: Due to the complex relationship between kisspeptin and the hypothalamic-pituitary-gonadal axis, the study was planned to measure the kisspeptin levels in polycystic ovary syndrome (PCOS) and to analyze the correlations between kisspeptin and PCOS-related reproductive, metabolic changes.

Methods: The study was designed as a prospective study in Dokuz Eylul University between December 2011 and September 2013. A total of 285 PCOS cases and 162 controls were recruited. After the antropometric measeruments and physcial examination, blood samples were taken for biochemical analysis.

Results: PCOS group’s mean BMI was 24.32?±?3.40 and for the control group, BMI value was 23.44?kg/m²?±?4.08 (p?=?0.351). PCOS patients’ FSH level was 5.10?±?2.01 mIU/L, LH value was 7.75?±?4.31 mIU/mL, LH/FSH ratio was 1.70?±?1.28, DHEAS value was 221.84?±?105.02?mg/dl, total testosterone value was 50.51?±?27.93?ng/ml, free testosterone value was 2.52?±?1.05?pg/ml, SHBG was 63.74?±?45.62?nmol/L, LDL was 102.56?±?23.45?mg/dL, HDL value was 51.36?±?12.15?mg/dL, total cholesterol value was 214.85?±?39.27?mg/dL, triglyceride value was 112.95?±?46.88?mg/dL, Apo A1 value was 171.30?±?35.35?mg/dL, Apo B value was 71.08?±?19.07?mg/dL, Apo B/A1 ratio was 0.42?±?0.14, free androgen index was 13.77?±?14.15, fasting glucose value was 80.68?±?13.80?mg/dL, fasting insulin levels was 14.13?±?9.11 μiU/mL, HOMA-IR index was 2.76?±?2.34, AMH value was 5.93?±?3:33 in ng/ml, and found to be significantly higher (p?Conclusion: In this study, kisspeptin had a positive correlation with LH and leptin levels in PCOS. In fact, the serum levels of kisspeptin and leptin does not differ statistically between PCOS and healthy women. There are limited data in the literature with regard to changes in kisspeptin levels and its relation with metabolic and hormonal disturbances.