Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

The infertility treatment related with polycystic ovary syndrome

다낭성난소증후군 환자의 불임치료

  • Koo, Yun-Hee (Department of Obstetrics and Gynecology, Pusan National University College of Medicine) ;
  • Na, Yong-Jin (Department of Obstetrics and Gynecology, Pusan National University College of Medicine)
  • 구윤희 (부산대학교 의학전문대학원 산부인과학교실) ;
  • 나용진 (부산대학교 의학전문대학원 산부인과학교실)
  • Received : 2010.07.15
  • Accepted : 2010.09.20
  • Published : 2010.10.15
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Abstract

The treatment of infertile women with polycystic ovary syndrome (PCOS) has not yet been established. Before any intervention is initiated, lifestyle modification with diet and exercise leading to weight loss should be emphasized in overweight women. The recommended first-line treatment for ovulation induction remains clomiphene citrate. If clomiphene citrate use fails to result in ovulation or pregnancy, the recommended second-line intervention is exogenous gonadotropins. The use of exogenous gonadotropins is related to an increased risk for multiple pregnancies, and, therefore, intense ovarian response monitoring is required. Laparoscopic ovarian surgery is an alternative to gonadotropin therapy because this surgery is as effective as gonadotropin in pregnancy rate or live birth rate. However, the surgery may require additional ovulation induction drug and should be performed by well-trained surgeon, its use solely to induce ovulation is unwarranted. Recommended third-line treatment is in vitro fertilization (IVF). IVF reduces the risk of multiple pregnancies by using single-embryo transfer in women with PCOS. The use of metformin alone as first-line infertility therapy or in combination with clomiphene is surrounded by controversies. Aromatase inhibitors appear to be as effective as clomiphene citrate for induction of ovulation, but the drug is currently not approved for treatment of infertility. Further studies should demonstrate the efficacy and long term safety.

다낭성난소증후군 환자에서 불임에 대한 적절한 치료방법은 아직까지 명확히 정립되어 있지 않다. 가장 중요하게 고려할 사항은 치료를 시작하기 전 충분한 상담을 통해 다른 건강상의 문제점을 찾고, 비만한 여성은 운동 및 식이요법을 통해 체중을 감량해야 한다는 점이다. 다낭성난소증후군 환자에서 배란 유도를 위한 일차 치료제는 클로미펜이며 클로미펜에 반응이 없거나 임신에 실패한 경우 생식샘자극호르몬 투여를 고려할 수 있다. 생식샘자극호르몬을 투여할 경우 다태임신의 위험이 있으므로 난소의 반응을 초음파 검사를 통해 철저히 관찰하도록 하여야 한다. 복강경하 난소수술은 임신율 및 생존아 출생율에 있어서 생식샘자극호르몬과 비슷한 효과를 보이므로 이차적 치료로 고려할 수 있으나 수술적 위험 및 추가적인 배란유도제 사용의 필요성 때문에 배란유도의 목적만으로 시행하기에는 적절하지 않다. 체외수정은 불임 치료의 마지막 단계로 고려되며 단 한 개의 배아만 이식을 하는 방법으로 다태아 임신의 위험을 줄일 수 있다는 점에서 다낭성난소증후군 여성에서 효과적인 치료방법이 될 수 있다. Metformin과 같은 인슐린반응 개선제는 배란유도를 위한 일차 치료제 또는 클로미펜과 병합치료 시 역할에 있어 논란의 여지가 있다. 방향화효소 억제제는 배란 유도에 있어 클로미펜만큼 효과적이나 아직까지 불임치료제로서 승인이 되지 않은 상태로 향후 연구를 통해 효과 및 장기적 안정성이 입증되어야 할 것이다.

Keywords

References

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