氯米芬抵抗型多囊卵巢综合征的助孕策略

多囊卵巢综合征(PCOS)是育龄期女性常见的生殖内分泌疾病。促排卵是其主要治疗方法,临床上枸橼酸氯米芬(CC)是治疗PCOS的一线促排卵药物,但部分患者对CC不敏感,即氯米芬抵抗型PCOS(CCR-PCOS)。临床上应在促排卵前期做好预处理,包括生活方式的管理、改善胰岛素抵抗状态、降低雄激素及血脂水平等,在来曲唑、促性腺激素及腹腔镜卵巢打孔术等治疗方式中选用单一或联合的促排卵治疗方案,以期达到良好的治疗效果。值得注意的是,当CCR-PCOS患者一线、二线方案促排卵治疗失败或者存在其他体外受精(IVF)指征(如高龄、输卵管因素或男方因素等导致不孕)时,可应用IVF方式助孕。综述CCRPCOS的助孕策略。

Assisted Pregnancy Strategy for Patients with Clomiphene-Resistant Polycystic Ovary Syndrome

Polycystic ovary syndrome(PCOS) is a common reproductive endocrine disease for women of childbearing age. Ovulation stimulation is the main treatment of PCOS, and clomiphene citrate(CC) is the firstline medicine of ovulation stimulant. However, some patients are not sensitive to CC, so-called clomiphene resistant PCOS(CCR-PCOS). Clinically, pre-treatments should be done in the early stage of ovulation induction in order to achieve a good therapeutic effect, including lifestyle management, improvement of insulin resistance,reduction of androgens and lipid levels, etc., the single or combined stimulation therapy was then selected among letrozole, gonadotropin and laparoscopic ovarian drilling. It is worth noting that IVF can be used to facilitate pregnancy in those CCR-PCOS patients with the first-and second-line ovulation induction failure or with other IVF indications(such as advanced age, fallopian tube factors or male factors leading to infertility). The pregnancypromoting strategies of CCR-PCOS patients were reviewed in this paper.