Minireview : Up-date Management of Non Responder to Clomiphene Citrate in Polycystic Ovary Syndrome

概要

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Polycystic ovary syndrome (PCOS) is a heterogeneous disorder in which chronicanovulation is a common feature despite the presence of multiple micro- structures inthe ovaries. A growing body of evidence has suggested that serum hyperinsulinemiacontributes to the excess ovarian androgen secretion observed in women with PCOS.The standard therapy for anovulatory women with PCOS is oral administration ofclomiphene citrate (CC). However, a significant proportion of women with PCOS failto ovulate with the use of standard dosage of CC and are called CC-resistant PCOS.The recent introduction of the insulin-sensitizing agents as adjuvants to clomiphenecitrate and gonadotropins has changed the treatment strategy. This is a comprehensivereview of the literature, with an emphasis on the role of hyperinsulinemia in thepathogensis of PCOS and on randomized controlled trials of the medical and surgicaltreatment options for women with CC-resistant PCOS. Although both standard andnovel treatments were addressed in the present review, special attention was paid to theevidence in support of the recent introduction of insulin–sensitizing agents in themanagement of anovulatory women with CC-resistant PCOS.
神戸大学の論文