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首页> 外文期刊>Reviews of Reproduction >Low-dose gonadotropin induction of ovulation in anovulatory women: still needed in the age of IVF
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Low-dose gonadotropin induction of ovulation in anovulatory women: still needed in the age of IVF

机译：低剂量促性腺激素诱导无排卵妇女排卵：IVF时代仍需要

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Low-dose, step-up gonadotropin is the treatment of choice for women with polycystic ovary syndrome (PCOS) who have not conceived after anti-oestrogen treatment and as an effective alternative to pulsatile GnRH in women with hypogonadotropic hypogonadism (HH). There has been, however, no large-scale, comparative study between the two groups using low-dose gonadotropins. Here, we performed a retrospective, comparative analysis, in a single clinic database, of efficacy and safety of induction of ovulation using low-dose gonadotropins in 364 women with PCOS and 80 women with HH. The rate of ovulation was high in both PCOS (83%) and HH (84%) but mono-follicular, ovulatory cycles were more prevalent in PCOS than in HH (77% vs 53%, P??0.0001) and the proportion of cycles that were abandoned was higher in HH than in PCOS (25% vs 15%, P??0.0001). The median threshold dose of gonadotropin required to induce ovulation was 75?IU/day in PCOS and 113?IU/day in HH (P??0.001) and the range of doses was greater in HH women. Forty-nine percent of women with PCOS and 65% of those with HH conceived (more than 90% within 6 cycles of treatment) and had at least one pregnancy. Multiple pregnancies (all twins) occurred in only 4% of women with PCOS and 5% of those with HH. These findings emphasise the efficacy and safety of low-dose gonadotropin treatment for both clomiphene-resistant women with PCOS and those with HH. These results highlight the importance of choosing the more physiological approach of gonadotropin induction of ovulation in both groups as the most appropriate treatment, in preference to IVF.
机译：低剂量，升压型促性腺激素是抗雌激素治疗后仍未怀孕的多囊卵巢综合征（PCOS）妇女的首选治疗方法，并且可作为促性腺激素性性腺功能低下症（HH）妇女的搏动性GnRH的有效替代品。但是，在两组使用低剂量促性腺激素的研究中，还没有大规模的比较研究。在这里，我们在一个单一的临床数据库中对364例PCOS女性和80例HH女性使用低剂量促性腺激素诱导排卵的有效性和安全性进行了回顾性比较分析。 PCOS（83％）和HH（84％）的排卵率均很高，但PCOS的单卵泡排卵周期比HH（77％vs 53％，P≥0.0001）和比例更高。 HH中放弃的周期数比PCOS中的高（25％对15％，P 0.0001）。促排卵所需的促性腺激素的中值阈值剂量在PCOS中为75？IU /天，在HH中为113？IU /天（P <0.001），并且在HH妇女中剂量范围更大。患有PCOS的女性中有49％患有HOS的女性中有65％（在6个治疗周期内超过90％）受孕，并且至少有过一次妊娠。多囊妊娠（全双胞胎）仅在PCOS妇女和HH妇女中分别占4％和5％。这些发现强调了小剂量促性腺激素治疗对氯米芬耐药的PCOS和HH患者的疗效和安全性。这些结果强调了优先选择IVF，两组中选择更生理性的促性腺激素诱导排卵的方法作为最合适的治疗方法的重要性。

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