End ocrine methods of ovulation induction英文电子书.pdfVIP

Endocrine methods of ovulation induction A D A M B A L E N MBBS, MD, MRCOG Consultantin ReproductiveMedicineand HonorarySeniorLecturer Department of Obstetrics and Gynaecology, The General Infirmary, Leeds LS2 9NS, UK The rationale of ovulation induction is to achieve the development of a single follicle and ultimately a singleton healthy baby. Problems faced by women with anovulatory poly- cystic ovary syndrome are the sensitivity of the ovary to stimulation and health issues such as obesity. This chapter will discuss medical management including strategies to lose weight, address hyperinsulinaemia with insulin-sensitizing agents, such as metformin, and outline methods of ovulation induction from the usual first-line therapy of clomiphene citrate and the subsequent use of gonadotrophin therapy in clomiphene-resistant patients. Appropriately directed surgical ovulation induction with laparoscopic ovarian diathermy appears to be as efficacious as gonadotrophin therapy but will not be discussed in the context of this chapter. Key words: anovulation; polycystic ovary syndrome; hyperinsulinaemia; clomiphene citrate; metformin; gonadotrophin therapy; follicle-stimulating hormone. The principles of the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS) are first to optimize health before commencing therapy (e.g. weight loss for those who are overweight) and then to induce regular unifollicular ovulation, while minimizing the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. This chapter will deal with medical methods of induction of ovulation and will not discuss surgical methods, namely wedge resection and its modern successor, laparoscopic ov