ʻO ka anovulation kekahi o nā kumu maʻamau o ka infertility. ʻO ka polycystic ovary syndrome (PCOS) ka maʻi anovulatory maʻamau maʻamau. I ko mākou ʻike, pili nui ka insulin resistance me PCOS. hiki ke hoʻohana e hoʻoulu i ka ovulation.
He kanaonokūmākahi mau maʻi me PCOS i hoʻokomoʻia i loko o ke aʻoʻana e like me ka hoʻokomo / hoʻokuʻuʻiaʻana ma hope o ka loaʻaʻana o ka'āpono mai ke Kōmike Ethics o ke Kulanui Lapaʻau o Mashhad. Ua māheleʻia nā maʻi iʻelua mau pūʻulu. pioglitazone i kēlā me kēia lā e hoʻomaka ana i ka lua o ka lā o ko lākou manawa menstrual. Ua loaʻa ka lua i kahi placebo.150 mgclomiphene citrateua lawelaweʻia mai ka lā 3 a hiki i ka lā 7 o ka menstrual cycle. Ua hanaʻia ka ultrasonography o ka wahine ma nā wāhine a pau, a ma nā hihia o nā follicles makua, ua hanaʻia ka intrauterine insemination ma hope o ka hoʻokomoʻana i ka gonadotropin chorionic kanaka.
ʻAʻohe ʻokoʻa ma waena o nā pūʻulu e pili ana i nā hiʻohiʻona demographic a me nā ʻano infertility. Ua ʻoi aku ka kiʻekiʻe o ka helu helu kino ma ka hui pioglitazone (28.3 ± 3.8 vs 26.2 ± 3.5, P waiwai = 0.047). ʻAʻole ʻokoʻa ka nui o ka follicle ma waena o nā hui (2.2). ± 1.4 vs 1.3 ± 1.1, P value = 0.742). ʻAʻole like ka helu o ka hāpai ʻana [4 (12.9%) vs 4 (13.3%), P value = 1] i waena o nā hui.
ʻOiai ke kiʻekiʻe o ka nui o nā follicles i ka hui pioglitazone, ʻaʻohe ʻokoʻa o kā mākou noiʻi ʻana i ka hoʻoulu ʻana o ka ovarian a me nā helu hāpai.
Hoʻopilikia ka infertility ma kahi o 10-15% o nā kāne.30% o ka male ʻole o ka wahine ma muli o ka hāʻule ʻana o ka ovulation [1]. ʻO ka polycystic ovary syndrome (PCOS) ka maʻi ʻike a maʻamau e pili ana i nā maʻi ovulatory mau loa [2]. Society for Human Reproduction and Embryology and American Society for Reproductive Medicine (ESHRE/ASRM) diagnostic criteria, ʻo ka prevalence o PCOS ma kahi o 15-20% [3].
ʻO nā pae lipoprotein maʻamau ka mea maʻamau o nā poʻe maʻi PCOS, me ka nui o ka cholesterol (Chol), triglycerides (TG), lipoprotein haʻahaʻa haʻahaʻa (LDL), lipoprotein kiʻekiʻe (HDL), a me AI apoptotic [4], 5,6]. ʻO ka hoʻololi nui loa o nā lipids i hōʻike ʻia he emi ʻana o ka HDL. ʻO ka hyperinsulinemia a me ka insulin resistance (IR) ka mea maʻamau i PCOS. Mustafa et al. Ma kahi o 46% o nā wahine ʻAigupita me PCOS i loaʻa iā IR [4, 7]. Hoʻopilikia ka insulin. steroidogenesis i loko o ka ovary kūʻokoʻa i ka gonadotropin secretion I PCOS [1]. ʻO ka insulin receptors a me ka insulin-like growth factor-1 (IGF-I) aia i loko o nā pūnaewele stromal ovarian [5] . ʻO ka hōʻailona mediated, ʻike ʻia ma 50% o nā wahine me ka PCOS [3].
Hoʻomaikaʻi nui ka metabolism glucose abnormal i ka pohō kaumaha;Hiki i ke kaumaha ke hoʻemi i ka hyperandrogenism a hoʻihoʻi i ka hana ovulatory [7]. ʻO nā wahine momona me ka insulin resistance, ka palena o ka calorie, a me ke kaumaha o ke kaumaha e hoʻemi i ka paʻakikī o ka insulin resistance.
I kēia lā,clomiphene citrateʻO ka lāʻau lapaʻau i manaʻo ʻia no ka induction ovulation i nā wahine me ka PCOS. Hoʻopili nui ʻia ke kūʻē ʻana o ka insulin me ka polycystic ovary syndrome, no laila ua noʻonoʻo ʻia nā lāʻau lapaʻau e hoʻonui ai i ka ʻike ʻana o ka insulin receptor, e like me metformin a me beta-thiazolidinediones, i ka mālama ʻana i kēia mau maʻi. Hiki i ke kū'ē ke hoʻoulu i ka ovulation, ʻoi aku ka nui o nā wahine momona me ke kiʻekiʻe o ke kūʻē ʻana o ka insulin [9].
ʻO ke kūpaʻa ʻana o ka insulin e hōʻike ana i ka hoʻemi ʻana o ka glucose i ka insulin, a ukali ʻia e hyperinsulinemia, e alakaʻi ana i ka triglycerides kiʻekiʻe, hoʻemi ʻia ka HDL-cholesterol, ka intolerance glucose, a me ka pilikia cardiovascular [10] . Ma kekahi mau noiʻi hou, ua hōʻike ʻia ka pioglitazone e hōʻemi i ke kahe o ke koko intra-ovarian. .
I kēia lā, ʻaʻohe haʻawina i nānā i ka hopena o ka pioglitazone i ka momona o kā mākou poʻe maʻi. hāpai keiki kino, a me ka heluna o nā follicles nui i nā wāhine hānau ʻole me ka PCOS.
Ua mālama ʻo Mashhad Medical University i kēia haʻawina hoʻokolohua hoʻokolohua randomized mai 2014 a i 2017 a ua hoʻohana i kahi ʻano laʻana non-probability sampling e kiʻi i nā maʻi PCOS 61 i hoʻouna ʻia i ka Milad Infertility Center no ka mālama ʻana i ka infertility. “Malaki 15, 2014″ a ua loaʻa ka ʻae i kākau ʻia mai nā poʻe a pau i komo.
ʻO nā mea i hoʻokomoʻia he mau wāhine hānaiʻole i ka makahiki 18-38 makahiki me ka hysterosalpingography maʻamau a me ka spermogram.ʻO ka hōʻailona o ka polycystic ovary syndrome e pili ana i nā pae AES (Androgen Excess Society 2006) e pili ana i nā mea i luna: (1) hirsutism a hyperandrogenic symptoms.(2 ) ʻO ka oligomenorrhea ka maʻi o ka ovarian, a i ʻole ka polycystic ovary i ʻike ʻia ma ke ʻano o ka lace cervical e like me ka ultrasound;(3) ʻO ka hoʻolaha ʻana i nā kumu lua e like me ka ovarian a adrenal tumors a me ka pituitary adenomas.Polycystic ovary syndrome ua ʻike ʻia inā he oligomenorrhoea ka menstrual cycle, a inā he 2-9 mm ka nui o nā follicles peripheral i ka ovary ma mua o 9 ma ka Ferriman-Gallway scale.
ʻO ka poʻe maʻi me ka moʻolelo o ka maʻi maʻi maʻi cardiovascular, ka maʻi maʻi maʻi maʻi, ka maʻi diabetes, ka maʻi thyroid, a me ka maʻi māmā.
Ma hope o ke koho ʻana i nā poʻe maʻi kūpono, ua māhele ʻia lākou i ʻelua mau pūʻulu ma ka hoʻohana ʻana i ka polokalamu kamepiula. ʻAʻole hiki ke ʻike ʻia ka envelopp ma waho. ʻO ka pūʻulu A he 30 mau papa o ka pioglitazone, 30 mg, a me 15 mau papa o clomiphene, aʻo ka hui B i waiho ʻia me 30 mau papa o ka placebo a me 15 mau papa o ka clomiphene. Ua makapō nā maʻi i ka lāʻau i hāʻawi ʻia.
ʻO nā maʻi āpau i hana i ka ultrasonography transvaginal i ka lua o ka lā o ka menstruation a ua hoʻokomo ʻia i loko o ke aʻo ʻana inā ʻaʻohe ovarian cysts ʻoi aku ka nui ma mua o 20 mm.
ʻIke ʻia ka helu o nā follicles waena a me ka nui a me ka mānoanoa endometrial ma ka lā ʻumi a ʻumikūmākahi o ka menstruation.
Ua loaʻa i ka hui mua he 30 mg o pioglitazone i kēlā me kēia lā;ua loaʻa ka lua o ka hui i kahi placebo e hoʻomaka ana i ka lua o ka lā o ka menstruation.clomiphene citrate.Transvaginal ultrasonography i ka lā 10 a i ʻole 11. E noʻonoʻo i ka gonadotropin chorionic kanaka (HCG) i ukali ʻia e ka insemination intrauterine (IUI) i nā wahine me ka mānoanoa endometrial ʻoi aku ka nui ma mua o 7 mm a me nā follicles ʻoi aku ma mua o 16 mm.
I ka hihia o ka lohi o 5 mau lā i ka menstruation, ua lawe ʻia nā laʻana koko e loiloi i nā pae βHCG. ʻO nā hopena pili pili i ka pioglitazone a me nā helu follicle i ʻoi aku ma mua o 16 mm a ua loiloi ʻia ka mānoanoa endometrial i ka wā o ke aʻo ʻana. hoʻohālikelike ʻia ma waena o nā hui.
Ua helu ʻia ka nui o ka laʻana me ka hoʻohana ʻana i ka polokalamu PASS 11 a ua hoʻohālikelike ʻia ka helu mean o nā follicles i kēlā me kēia hui. ʻO ka mea maʻamau, ʻo 5% nā hewa Type 1 a ʻo 20% nā hewa Type 2. attrition, 30 poʻe i komo i kēlā me kēia hui.
Ua hoʻokomoʻia kaʻikepili i loko o ka SPSS version 16. I ka wā mua, ua weheweheʻia nāʻano o kēlā me kēia hui e nāʻano helu helu wehewehe, e like me keʻano a me nā hoʻololi maʻamau no nā mea hoʻololi mau a me ka helu me nā alapine no nā mea hoʻololi. ua hoʻohana ʻia nā hoʻokolohua kūʻokoʻa a i ʻole Mann-Whitney-U ma hope o ka loiloi ʻana i ka maʻamau me ka hoʻohana ʻana i ka hōʻike Kolmogorov-Smirnov. .
E pili ana i nā koina hoʻokomo, ua komo nā wāhine 93 i ke aʻo ʻana, ua loaʻa iā 19 nā pae hoʻokaʻawale a ua haʻalele ʻo 13. Ua helu ʻia nā maʻi he kanakolu i ka hui placebo a me 31 i ka hui intervention. Hōʻike ʻia ka CONSORT algorithm i ka Figure 1. ʻO nā hiʻohiʻona demographic o nā wahine. i hōʻike ʻia ma ka Papa 1. ʻAʻohe ʻokoʻa ma waena o nā hui e pili ana i nā ʻano demographic a me ke ʻano o ka infertility. .Akā naʻe, ʻoi aku ka kiʻekiʻe o ka helu kino kino (BMI) i ka hui pioglitazone.
Hōʻuluʻulu ka Papa 2 i nā ʻike sonographic o ka mea maʻi, e like me ka helu o nā follicles medium-sized, ka helu o nā follicles nui, ka nui o ka follicle nui, a me ka mānoanoa endometrial. nā follicles liʻiliʻi.
Hōʻike ʻia ka ʻike e pili ana i nā hopena o ka mālama ʻana i ka ovulation induction, e like me ka nui o ka ovulation, kemika, a me ka nui o ka hāpai ʻana i kēlā me kēia pōʻai, ma ka Papa 3.
Ua hōʻike nā hopena o kēia noiʻi he ʻokoʻa nui ka nui o ka hoʻoulu ʻana o ka ovulation ma waena o nā poʻe maʻi i mālama ʻia me ka pioglitazone.Ultrasonography, i hana ʻia i ka lā 10 o ka menstruation, hōʻike i ka piʻi nui o ka nui o nā follicles i loko o ka hui intervention.O kā mākou ʻike. hōʻoia i nā ʻike o kahi noiʻi 2012 e pili ana i ka hana o ka pioglitazone i ka hoʻokomo ʻana i ka ovulation i nā maʻi hyperinsulinemic me PCOS [12].
ʻAʻohe ʻokoʻa o ka ovulation a me ka hāpai ʻana ma waena o nā hui aʻo ʻelua. ʻO kēia paha ma muli o ka lōʻihi o ka pioglitazone i hoʻohana ʻia ma mua o ka hoʻomaka ʻana i ka clomiphene. Ua hōʻike ʻo Ota i nā hopena 2008 i hōʻike ʻia he 7 o 9 mau maʻi i lawe pioglitazone no 12-30 mau pule ma mua. Ua hāpai ʻo clomiphene [14]. Hōʻike ka haʻawina ʻo Kim i ka makahiki 2010 i ka emi nui o ka nui o nā follicles ma hope o ka hāʻawi ʻia ʻana o pioglitazone. ʻokoʻa i kā mākou hopena, akā hiki ke wehewehe ʻia e nā pae koho koho maʻi, e komo pū me nā maʻi clomiphene-resistant [15].
Ua hōʻike ʻo Ota e hiki i ka pioglitazone ke hoʻomaikaʻi i ka nui o ka hāpai ʻana i nā poʻe maʻi PCOS kū'ē i ka clomiphene a me ka dexamethasone [14]. Me he mea lā e koho pono ʻia nā hihia PCOS me ka hyperandrogenemia. ʻO nā mea maʻi i ka papahana Ota he mau pae like ʻole o nā hormones, hiki ke hoʻopilikia i ka hopena o lapaʻau pioglitazone. Ma kā mākou noiʻi ʻana, ʻaʻole i ʻokoʻa ka nui o ka hormone ma mua a ma hope o ka hana.
I kā mākou noiʻi ʻana, ʻaʻohe ʻokoʻa nui i ka helu o nā follicles nui a me ka mānoanoa endometrial ma waena o nā hui a me nā pūʻulu mana.
I loko o ka noiʻi o kēia manawa, ua loaʻa i ka pūʻulu hana ka BMI kiʻekiʻe, ʻo ia hoʻi, hiki i kēia hui ke hoʻomohala i ka hyperinsulinemia a hoʻopilikia i ka hopena, ʻoiai ʻaʻole kēia ʻokoʻa i ka helu helu ma waena o nā hui ʻelua.
ʻAʻohe o kā mākou mau maʻi i ʻike i nā hopena ʻaoʻao.
ʻO kahi palena nui o kā mākou noiʻi ʻana ua hoʻolālā ʻia ke aʻo ʻana ma ke ʻano he papahana hoʻomalu hihia, i hopena i nā ʻokoʻa o ka BMI ma waena o nā hui ʻelua. Ua hana ʻia ka lāʻau lapaʻau i nā poʻe maʻi ma ko mākou ʻāina. Akā naʻe, ma muli o ka hopena o ka pioglitazone i ka pale ʻana i ka insulin, ʻike ʻia ka piʻi ʻana o ka holomua inā loaʻa nā mea maʻi i ka pioglitazone no kahi manawa lōʻihi ma mua o ka hoʻomaka ʻana i ka ʻai clomiphene. E hoʻoholo i ka manawa kūpono e hoʻohana ai i ka pioglitazone.
ʻOiai ʻoi aku ka nui o nā follicles i ka hui pioglitazone, ʻaʻohe ʻokoʻa o kā mākou noiʻi ʻana i ka hoʻoulu ʻana o ka ovarian a me nā helu hāpai ma waena o nā hui ʻelua.
ʻOiaʻiʻo, ua mālama maikaʻi mākou i nā pilikia kūikawā e like me ka infertility, ke kahe ʻana o ke koko mai ka uterine dysfunction a me ka hirsutism i ka wā ma mua. hiki ke hoʻololi nui i ke olakino holoʻokoʻa a me ka maikaʻi a me ka nui o ke ola).
Ka manawa hoʻouna: Mar-30-2022