Stymulacja owulacji
Streszczenie
Brak owulacji dotyczy około 15–25% kobiet z rozpoznaną niepłodnością. Stymulacja owulacji jest metodą leczenia
zaburzeń owulacji i polega na pobudzeniu rozwoju pęcherzyka jajnikowego. Postępowanie to jest zarezerwowane
dla kobiet z brakiem owulacji. Prawidłowo przeprowadzone leczenie daje dobre rezultaty. W ostatnich latach
wprowadzono nowe metody leczenia zaburzeń owulacji. Cytrynian klomifenu pozostaje nadal lekiem pierwszego
wyboru, ale wyniki aktualnych badań zdecydowanie przemawiają za zastąpieniem tego preparatu letrozolem.
Metformina stosowana w monoterapii ma ograniczoną skuteczność, jednak w niektórych sytuacjach może mieć
zastosowanie jako lek zwiększający insulinowrażliwość. Gonadotropiny w tzw. protokole step-up pozostają lekami
drugiego wyboru.
Zgodnie z aktualnymi badaniami stymulacja owulacji jest bezpieczną i skuteczną metodą leczenia niepłodności
spowodowanej brakiem owulacji.
Słowa kluczowe: brak owulacjiniepłodnośćcytrynian klomifenuletrozolgonadotropinystymulacja owulacji
Referencje
- Mosher WD, Pratt WF. Fecundity and infertility in the United States: incidence and trends. Fertil Steril. 1991; 56(2): 192–193.
- Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod. 1991; 6(6): 811–816.
- Jonklaas J, Bianco AC, Bauer AJ, et al. American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670–1751.
- Melmed S, Casanueva FF, Hoffman AR, et al. Endocrine Society. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(2): 273–288.
- Lekarev O, Lin-Su K, Vogiatzi MG. Infertility and reproductive function in patients with congenital adrenal hyperplasia: pathophysiology, advances in management, and recent outcomes. Endocrinol Metab Clin North Am. 2015; 44(4): 705–722.
- Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2015; 104(5): 1116–1126.
- Hughes E, Brown J, Collins JJ, et al. Clomiphene citrate for unexplained subfertility in women. Cochrane Database Syst Rev. 2010(1): CD000057.
- National Institute for Clinical Excellence (NICE) guideline 11: Fertility: Assessment and treatment for people with fertility problems, Clinical Guideline. RCOG press, London 2004.
- Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2015; 103(3): e18–e25.
- Greenblatt RB, Barfield WE, Jungck EC, et al. Induction of ovulation with MRL/41. Preliminary report. JAMA. 1961; 178: 101–104.
- Adashi EY. Clomiphene citrate: mechanism(s) and site(s) of action — a hypothesis revisited. Fertil Steril. 1984; 42(3): 331–344.
- Ghobadi C, Amer S, Lashen H, et al. Evaluation of the relationship between plasma concentrations of en- and zuclomiphene and induction of ovulation in anovulatory women being treated with clomiphene citrate. Fertil Steril. 2009; 91(4): 1135–1140.
- Garcia J, Jones GS, Wentz AC. The use of clomiphene citrate. Fertil Steril. 1977; 28(7): 707–717.
- Imani B, Eijkemans MJ, te Velde ER, et al. Predictors of chances to conceive in ovulatory patients during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab. 1999; 84(5): 1617–1622.
- Out HJ, Coelingh Bennink HJ. Clomiphene citrate or gonadotrophins for induction of ovulation? Hum Reprod. 1998; 13(9): 2358–2361.
- Imani B, Eijkemans MJC, te Velde ER, et al. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril. 2002; 77(1): 91–97.
- Evidence-based guidelines for the assessment and management of polycystic ovary syndrome. Jean Hailes for Women’s Health on behalf of the PCOS Australian Alliance; Melbourne, 2015. https://jeanhailes.org.au/contents/documents/Resources/Tools/PCOS_evidence-based_guideline_for_assessment_and_management_pcos.pdf.
- Practice Committee of the American Society for Reproductive Medicine. Use of clomiphene citrate in infertile women: a committee opinion. Fertil Steril. 2013; 100(2): 341–348.
- Buzdar A, Howell A. Advances in aromatase inhibition: clinical efficacy and tolerability in the treatment of breast cancer. Clin Cancer Res. 2001; 7(9): 2620–2635.
- Palomba S. Aromatase inhibitors for ovulation induction. J Clin Endocrinol Metab. 2015; 100(5): 1741–1747.
- Weil S, Vendola K, Zhou J, et al. Androgen and follicle-stimulating hormone interactions in primate ovarian follicle development. J Clin Endocrinol Metab. 1999; 84(8): 2951–2956.
- Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril. 2001; 75(2): 305–309.
- Legro RS, Brzyski RG, Diamond MP, et al. NICHD Reproductive Medicine Network. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014; 371(2): 119–129.
- Franik S, Kremer JAM, Nelen WL, et al. Aromatase inhibitors for subfertile women with polycystic ovary syndrome: summary of a Cochrane review. Fertil Steril. 2015; 103(2): 353–355.
- Lunenfeld B, Sulimovici S, Rabau E, et al. L’induction de l’ovulation dans les amenorrheas hypophysaires par un traitement combine de gonadotropins urinaires manopaisiques et de gonadotropins chorioniques. CR Soc Franc Gynec. CR Soc Franc Gynec. 1962; 35: 346–356.
- Robinson JE, Wakelin M, Ellis JE. Increased pregnancy rate with use of the Clearblue Easy Fertility Monitor. Fertil Steril. 2007; 87(2): 329–334.
- Practice Committee of the American Society for Reproductive Medicine. Current clinical irrelevance of luteal phase deficiency: a committee opinion. Fertil Steril. 2015; 103(4): e27–e32.
- Gardner DK. Textbook of Assisted Reproductive Techniques. 4th ed. CRC Press, Boca Raton, FL 2012.
- de Crespigny LC, O'Herlihy C, Robinson HP. Ultrasonic observation of the mechanism of human ovulation. Am J Obstet Gynecol. 1981; 139(6): 636–639.
- Andersen AG, Als-Nielsen B, Hornnes PJ, et al. Time interval from human chorionic gonadotrophin (HCG) injection to follicular rupture. Hum Reprod. 1995; 10(12): 3202–3205.
- Kosmas IP, Tatsioni A, Fatemi HM, et al. Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis. Fertil Steril. 2007; 87(3): 607–612.
- Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update. 2016; 22(6): 687–708.
- Large MJ, DeMayo FJ. The regulation of embryo implantation and endometrial decidualization by progesterone receptor signaling. Mol Cell Endocrinol. 2012; 358(2): 155–165.
- Fauser BC, Devroey P. Reproductive biology and IVF: ovarian stimulation and luteal phase consequences. Trends Endocrinol Metab. 2003; 14(5): 236–242.
- Green KA, Zolton JR, Schermerhorn SMV, et al. Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and meta-analysis. Fertil Steril. 2017 [Epub ahead of print].
- Hill MJ, Whitcomb BW, Lewis TD, et al. Progesterone luteal support after ovulation induction and intrauterine insemination: a systematic review and meta-analysis. Fertil Steril. 2013; 100(5): 1373–1380.
- Montville CP, Khabbaz M, Aubuchon M, et al. Luteal support with intravaginal progesterone increases clinical pregnancy rates in women with polycystic ovary syndrome using letrozole for ovulation induction. Fertil Steril. 2010; 94(2): 678–683.
- Agha-Hosseini M, Rahmani M, Alleyassin A, et al. The effect of progesterone supplementation on pregnancy rates in controlled ovarian stimulation and intrauterine insemination cycles: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol. 2012; 165(2): 249–253.
- Usadi RS, Merriam KS. On-label and off-label drug use in the treatment of female infertility. Fertil Steril. 2015; 103(3): 583–594.
- Vitek W, Alur S, Hoeger KM. Off-label drug use in the treatment of polycystic ovary syndrome. Fertil Steril. 2015; 103(3): 605–611.
- Bordewijk EM, Nahuis M, Costello MF, et al. Metformin during ovulation induction with gonadotrophins followed by timed intercourse or intrauterine insemination for subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2017; 1: CD009090.
- Legro RS, Arslanian SA, Ehrmann DA, et al. Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013; 98(12): 4565–4592.
- Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. 1992; 136(10): 1184–1203.
- Cetin I, Cozzi V, Antonazzo P. Infertility as a cancer risk factor — a review. Placenta. 2008; 29 Suppl B: 169–177.
- Tomao F, Lo Russo G, Spinelli GP, et al. Clinical use of fertility agents and risk of breast cancer. Curr Opin Obstet Gynecol. 2014; 26(3): 130–137.
- Rossing MA, Daling JR, Weiss NS, et al. Ovarian tumors in a cohort of infertile women. N Engl J Med. 1994; 331(12): 771–776.
- Jensen A, Sharif H, Frederiksen K, et al. Use of fertility drugs and risk of ovarian cancer: Danish Population Based Cohort Study. BMJ. 2009; 338: b249.
- Practice Committee of the American Society for Reproductive Medicine. Fertility drugs and cancer: a guideline. Fertil Steril. 2016; 106(7): 1617–1626.
- Diergaarde B, Kurta ML. Use of fertility drugs and risk of ovarian cance. Curr Opin Obstet Gynecol. 2014; 26(3): 125–129.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)