控制性超排卵：对不采用辅助生殖技术患者做一综述

　　控制性超排卵（Controlled ovarian hyperstimulation, COH）包括口服和/或注射针剂给药方案，对于不能自发排卵的患者，诱发其排卵；对于有排卵但是不孕的患者，促进其超排卵。本文综述控制性超排卵的不同方案。口服药物，如克罗米芬和来曲唑，可作为除低促性腺激素性闭经患者以外大部分患者的首选药物。与口服给药方案相比，注射针剂给药方案，如卵泡刺激素（follicle stimulation hormone, FSH）和人绝经期促性腺激素（human menopausal gonadotropins, hMG）的妊娠率较高；但是，注射给药方案有较高的风险性，如多胎妊娠、卵巢过度刺激综合症、成本和监测。对于多囊卵巢综合症患者，为提高这些药物的反应性，考虑采用二甲双胍和/或地塞米松进行辅助治疗。口服和注射给药联合方案可能会降低风险性和成本，但不会降低妊娠率。对于低促性腺激素性闭经患者，在FSH刺激的基础上，补充黄体生成素（leutinizing hormone, LH），如hMG、重组LH（rLH）或者低剂量人绒毛膜促性腺激素。在排卵期和黄体期补充孕酮，通常建议注射给药，而不建议口服给药。

原文：
Minerva Ginecol. 2011 Apr;63(2):119-35.

Controlled ovarian hyperstimulation: a review for the non-ART patient

Willis MY, Browne AS, Session DR, Spencer JB.
Division of Reproductive Endocrinology and Infertility, Department of Gynecology
and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA -jbspenc@emory.edu.

Controlled ovarian hyperstimulation (COH) involves the administration of oral and/or injectable medications to induce ovulation in the anovulatory infertile patient, and superovulation in the ovulatory infertile patient. The different types of medication and protocols for COH are reviewed. Oral medications such as clomiphene and letrozole should be considered in most patients initially, except in the case of hypogonadotropic amenorrhea. Pregnancy rates are higher with the injectable medications, follicle stimualtion hormone (FSH) and human menopausal gonadotrpins (hMG), than oral medications; however, injectable medications have a higher risk of multiple gestation, ovarian hyperstimulation syndrome, cost and monitoring. Strategies to enhance the responsiveness to these medications in polycystic ovarian syndrome patients including adjunctive treatment with metformin and/or dexamethasone will be discussed. Combined protocols which use oral and injectable gonadotropins may also lower risks and costs without sacrificing chances of pregnancy. Patients with hypogonadotropic amenorrhea benefit from the addition of leutinizing hormone (LH) activity such as hMG, recombinant leutinizing hormone (rLH) or low dose human chroionic gonadotropin to FSH stimulation. Ovulation and luteal phase support with progesterone is generally recommended in injectable cycles but not with oral medications.

PMID: 21508902  [PubMed - in process]