ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
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Turkish Journal of Reproductive Medicine and Surgery

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Polikistik Over Sendromlu İnfertilHastalarda Tedavi Seçenekleri
Treatment Modalities for Infertile Patients with Polycystic Ovarian Syndrome
Received Date : 22 Dec 2016
Accepted Date : 15 Jan 2017
Doi: 10.24074/tjrms.2016-54250 - Makale Dili: TR
TJRMS 2017;1(1):23-8
ÖZET
Polikistik over sendromu tanı ve etyolojisi hakkında birçok bilinmeyen ve tartışmalı konuları olan bir hastalık olup 2003 Roterdam Kriterlerine göre androjen fazlalığı yapan diğer sebepler çıkartılarak klinik ya da biokimyasal androjen yüksekliği, oligo-anovülasyon ve ultrasonla bakıldığında polikistik overlerin varlığı olan 3 kriterden en az 2 kriterin varlığı olarak tanımlanmaktadır. Bu kriterlerle beraber obezite, insülin direnci, metabolik sendrom, hirsutizm ve infertilite ile de karakterize bu hastalık doğurgan çağındaki kadınların %4-18’inde görünürken infertil hastaların beşte birinde anovülasyon infertilite sebebi iken çoğunluğunda da polikistik over sendromuna rastlanmaktadır (%90). İnfertil hastaların tedavilerinde polikistik over sendromu varlığında amaç hiperandrojenik ortamı düzelterek ovülasyonu sağlamak olarak tanımlanmaktadır. Bu konuda kullanılan yöntemler şu şekilde sıralanabilir: Obezite ve artmış BMI varlığında kilo verilmesi ve hayat tarzı değişikliği, ovülasyon indüksiyonu için Klomifen Sitrat (CC, tek ajan olarak insülin sensitize edici ajan kullanılması, insülin sensitize edici ajan ve klomifen sitrat, gonadotropinlerle ovülasyon indüksiyonu, insülin sensitize edici ajan ve gonadotropinlerle ovülasyon indüksiyonu, en son olarak ovaryan cerrahi ve/veya tüp bebek tedavisi (IVF) olarak sıralanmaktadır. Bu seçeneklere ek olarak son yıllarda CC yerini alabilecek bir ajan olarak da aromataz inhibitörleri kullanılmaktadır.
ABSTRACT
Polycystic Ovarian Syndrome is a disease which diagnosis and etiology has not been yet clearly described and has a lot of contraversial points. According to Rotterdam criterias this disease was described in 2003 as: exluding other androgen excess causing diseases having biochemical or clinical hyperandrogenism, oligo-anovulation and polycystic ovaries on ultrasound screen. At least two of these three criterias should be met for a polycystic ovary syndrome diagnosis. Besides these criterias this syndrome is characterised with obesity, hirsutism, insulin resistance, metabolic syndrome and infertility. The reported prevelance of polycystic ovarian syndrome is 4-18% in women of reproductive age group. Anovulation is the cause in of infertility in 25% of women and polycystic ovarian syndrome is the most common form of ovulatory dysfunction in them (90%) In cases where polycystic avarian syndrome is the cause of infertility the main target in the treatment is to decrease the hyperandrogenism and restore the ovulation. For this purpose the treatment modalities are as follows: If obesity and high BMI present the patient should be encouraged to loose weight and have some lifestyle modifications, Clomiphene Citrate (CC) for ovulation induction, insulin sensitizing drugs alone or with CC, ovulation induction with gonadotropins alone or with insuline sensitizing agents and aftermost ovarian drilling and in vitro fertilization treatment modalities. Besides these the aromatase inhibitors are nearly replacing the CC in ovulation induction in polycystic ovarian syndrome patients.

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