Поликистоз яичников

[Home doctor]

Можно ли радикально вылечить поликистоз яичников?

[Melnichenko]

Что значит радикально вылечить ? востановить фертильность - можно , снизить инсулинорезистентность - на время лечения можно , решать косметические проблемы - можно....Восстановить рецепторные аномалии , аномалии в деятельности ферментов стероидогенеза ?

[Home doctor]

Если можете, прошу порекомендовать современную литературу по вопросам лечения? Заранее благодарен.

[Melnichenko]

Все отечественные журналы -" Проблемы репродукции ", "Проблемы эндокринологии ", "Акушерство и гинекология " за последние 5 лет переполнены статьями , посвященными этой проблеме , изложение вполне современное .
Все больше крен в инсулинорезистентность , индексы НОМА и Саro из уст гинекологов звучат как родные , все больше метформин -бэби , актос - беременностей ...
Основные отечественные авторы - В.П. Сметник , М.Б. Анциферов , А.А. Пищулин , О. Р. Григорян .... Прошу прощения у тех , кого нечаянно забыла .
Очень приличная ( но абсолютно нечитабельная ) докторская диссертация у Т.А. Зыковой из Архангельска - очень интересный материал , но без поллитра прочесть невозможно - пересыщенный раствор из математики и англицизмов . Ее же статья выйдет в ближайших номерах Проблем эндокринологии ( десятое чтение , статья задерживалась из-за крайне сложного языка автора )
Фирма Берлин - Хеми спонсировала выпуск нескольких сборников .
На PUBMED - ТЫСЯЧИ ССЫЛОК , ЕСТЬ КОНСЕНСУС ПО ГИПЕРАНДРОГЕНИИ .

[Melnichenko]

Посмотрите эту работу
Pregnancy Outcomes Among Women With Polycystic Ovary Syndrome Treated With Metformin
Glueck CJ, Wang P, Goldenberg N, Sieve-Smith L
Human Reproduction. 2002;17(11):2858-2864

Summary
This prospective case series showed that metformin use among women with PCOS was safe during pregnancy. It improved metabolic markers and significantly reduced spontaneous miscarriage rates and the rate of gestational diabetes.

This prospective case series evaluated the effects of metformin on pregnancy and neonatal outcome among women with polycystic ovary syndrome (PCOS). Women with amenorrhea or oligomenorrhea and clinical or laboratory evidence of hyperandrogenism who desired pregnancy were invited to participate. All women were placed on metformin (1.5-2.55 g/day). Metabolic evaluation was performed before the initiation of metformin therapy and then on a regular basis.

Neonatal evaluation was performed by pediatricians, who were not aware of metformin use. Neonatal height and weight were compared with the corresponding Centers for Disease Control and Prevention (CDC) data on the general neonatal population. Seventy-two women were enrolled; 54% of them were amenorrheic. The mean BMI was 33 kg/m2. Fifty-three percent of the women were hyperinsulinemic; 32% had insulin resistance. Eighty-one percent of the women conceived spontaneously on metformin; the rest required ART. The spontaneous abortion rate was similar in both groups (16.7%). The remainder of the pregnancies were either ongoing or resulted in deliveries. When metformin was stopped at 12 weeks gestation, miscarriage rates were similar when compared with those pregnancies when metformin was used until delivery. Spontaneous abortion rate was 5.4% among those women who had no previous pregnancies. With 1 pre-metformin miscarriage, the spontaneous abortion rate was 24% on metformin. The miscarriage rate was 30% among those women who had 1 previous successful delivery before metformin therapy. Forty of the 72 participants had 100 pregnancies pre-metformin with a 62% first-trimester miscarriage rate. The same 40 women had a 26% miscarriage rate while taking metformin.

Birth weight and height of the neonates born to women on metformin were not different from the general neonatal population (CDC data). Weight at 3 and 6 months did not differ either. Height at 3 and 6 months was closer to the top percentiles, but the mothers were taller than the general population. With metformin therapy, insulin levels, body weight, insulin resistance, and BMI all decreased significantly. Gestational diabetes was significantly less frequent on metformin when compared with pregnancies pre-metformin (4% vs 26 %). The only significant variable that was associated with the spontaneous abortion rate was the fasting insulin level. There were no maternal complications attributed to metformin, and there were no major birth defects as a result of metformin use. This prospective case series showed that metformin use among women with PCOS was safe during pregnancy. It improved metabolic markers and significantly reduced spontaneous miscarriage rates and the rate of gestational diabetes.

Clinical Commentary
PCOS is characterized by irregular ovulation and either clinically significant hyperandrogenism or laboratory evidence of hyperandrogenism. It affects about 10% of reproductive age women. Because of the ovulatory defect and the metabolic alterations (lipid and carbohydrate abnormalities and insulin resistance), the chance of spontaneous conception is reduced. Once pregnancy is achieved either on the couples' own or with ART, the pregnancies are at higher risk. Not only are the miscarriage rates significantly higher (> 40%), but the rates of gestational diabetes and hypertensive complications are also increased. About half of the women with PCOS have insulin resistance.

Metformin and other insulin-sensitizer drugs have been shown to have favorable metabolic effects. Metformin also increases the rate of spontaneous ovulation. Some nonrandomized trials suggest that with metformin, the rate of miscarriage is reduced and pregnancy outcome is improved. This study evaluated pregnancy and neonatal outcome with metformin among infertile women with PCOS. Cases were selected by appropriate criteria; some were nulliparous, others multiparous. These patients were obese, and about half of them were diagnosed with insulin resistance. Among those who had previous pregnancies, the current pregnancy was conceived with the same partner. Metformin (>/= 1.5 g/day) was administered at least till the end of the first trimester.

Metformin use was associated with the most benefit among nulliparous women. Spontaneous abortion rates were 5.4 % in this group. Among those who had al least 1 pregnancy before, miscarriage rates were significantly higher. The benefit of metformin was still clearly seen in this group, however. Spontaneous miscarriage rate was significantly correlated with fasting insulin levels. It seems that women with well-documented insulin resistance who had not been pregnant before benefited the most from metformin use.

Obesity is associated with increased miscarriage rate (and insulin resistance). Metformin therapy resulted in significant weight loss, which may have mediated the decreased rate of miscarriage. None of the pregnancies were associated with increased fetal, neonatal, or maternal risk. Metformin use seems to be safe for use during pregnancy. The results of this and some other similar studies should provide sufficient basis for a randomized, prospective, placebo-controlled trial to further evaluate metformin use during pregnancy. Until then, following appropriate counselling, metformin could be offered to women with PCOS who try to conceive, especially if their obstetric history is poor.