多囊性卵巢-台中荣总.PPT

多囊性卵巢症候群患者施行人工協助生殖技術時之藥物及手術協助誘導排卵新策略 台中榮總 婦產部 生殖醫學科 陳明哲醫師 PCO(S)多囊性卵巢(症候群) Diagnosis PCO: Readily based on ovarian morphology Polycystic ovaries: ten or more cysts 2-8 mm in diameter, arranged around a dense stroma or scattered throughout an increased amount of stroma Prevalence of polycystic ovaries: 20-25% in young adults PCOS: polycystic ovaries found in association with menstrual disturbance, the complications of hyperandrogen and obesity. PCOS 診斷之演進 Laparotomy and histological confirmation of PCO Stein and Leventhal 1935 Biochemical criteria Raised LH or LH/FSH Raised Testosterone, androstenedione Abnormal estrogen secretion Clinical presentation Menstrual cycle disturbance Obesity Hyperandrogenism (hirsutism, acne, androgen -dependent alopecia) US consensus on the diagnosis of PCOS 美國定義- NIH 1990 Two criteria: Chronic oligo-/anovulation Hyperandrogenism Hirsutism Hyperandrogen Total testosterone 89 ng/dl Free testosterone 0.66 ng/dl Androstenedione 2.97 ng/ml SHBG Excluding: Hyperprolactinemia, Thyroid dysfunction, LOCAH, Cushing’s, Androgen secreting tumor UK definition of the diagnosis of PCOS 英國定義 Polycystic ovaries (PCO) Ovarian area 5.5 cm2 Ovarian volume 11 ml 12 Follicles: 2-9 mm (mean of both ovaries) Associated clinical or biochemical features Oligo-/amenorrhea Hyperandrogenism Obesity Elevated serum testosterone Elevated serum LH PCO without PCOS 如何重要 Incidence: around 20% Normally ovulatory women with PCO Increased incidence of subfertility and miscarriage Frequently develop typical symptoms after gaining significant weight Exaggerated response to gonadotropin Degree of insulin resistance ranked between PCOS and norma