乳腺癌药物来曲唑可促进PCOS患者排卵

来源：宾夕法尼亚州赫尔希密尔顿医学科

2016年4月6日

链接：http://www.news-medical.net/news/20160406/Breast-cancer-medication-letrozole-could-increase-ovulation-in-women-with-PCOS.aspx

在乳腺癌治疗中经常使用的一种药物就是来曲唑，而它现在则被认为是治疗一些常见不孕症状的最佳选择。来曲唑被发现能增加多囊卵巢综合征（PCOS）患者的排卵数量，而PCOS是排卵功能障碍的常见形式。采用来曲唑治疗后，患者的妊娠率可以提高多达40%，并且比采用克罗米芬（Clomid）方案治疗能获得更高的排卵量和活产婴儿率。

在乳腺癌患者中，研究人员发现来曲唑可以用来降低雌激素的含量，但其副作用便是增加患者的排卵数量。“我们发现，荷尔蒙以不同的方式影响身体的不同部位”， 宾夕法尼亚州Health Milton S. Hershey医疗科生殖专家Stephanie Estes博士说。由于来曲唑作为不孕不育治疗手段的有效性还未广为人知，她建议那些因为不规则排卵而导致的不孕症患者尽快与她们的家庭医生讨论关于尝试来曲唑的问题。“它服用方便，并且与克罗米芬相比，副作用少且有较低的导致多胎的可能。” Estes博士说。

虽然来曲唑对一些不孕症状有疗效，但如果女性不孕是由男性因素或其它无法解释原因造成的，则医生可能会推荐其他口服及注射药物，或者IVF方案。其中，宫腔内人工授精（IUI）将高浓度的精液直接植入女性的子宫，因此精子可以不经过远途旅行并增加卵细胞的受精机会。而在IVF疗程中，医生从女性体内提取卵子并在胚胎学实验室中将其和精子结合，并将成功发育后的胚胎植入子宫。“IVF越来越成功，因此越来越多的国家和公司都看到了它的重要性，所以现在能提供IVF的诊所也越来越多。” Estes博士说。她还建议那些已经35岁以上、仍然保持规律的月经周期并且尝试了6个月以上仍未成功受孕的夫妇接受由专业的生殖内分泌学家提供的生殖能力测试。如果这些夫妇在35岁以下，但是已经尝试怀孕12个月并且仍未成功，则也应该尽快预约这类测试。如果女性没有保持规律的月经周期，或者有化疗或放疗的历史，或者有已知的男性不育因素，则他们也应尽早接受这类测试。Estes博士认为现在还难以判断是否越来越多的夫妇受到不孕不育问题的困扰，因为科技的发达使我们更经常地听说此类消息。但是可以确信的是，新型的微创外科手术已经可以治疗子宫内膜异位症，并且可以帮助医生评估输卵管的状态，以及清除可能影响生育的大型子宫肌瘤。但是Estes博士认为很多夫妻都忽略了一个影响生育的关键问题：在试图怀孕之前尽量拥有健康的体魄，并且尝试健康的生活方式。“像戒烟、限制咖啡因和酒精的饮用，以及合适的性生活时间都可以最大限度帮助提高你成功怀孕的机会”，Estes博士说。

Breast cancer medication letrozole could increase ovulation in women with PCOS

A medicine used in breast cancer treatment is now considered the best option for treating the most common cause of infertility.

Letrozole has been found to increase ovulation in women with Polycystic Ovarian Syndrome (PCOS), a common form of ovulation dysfunction, leading to a 40 percent increase in pregnancy rates and more ovulation and live births than Clomid, the previous standard.

In breast cancer patients, Letrozole decreases the amount of estrogen, but a side effect is increased ovulation.

"We have found out that the hormonal messages affect different areas of the body in different ways," said Dr. Stephanie Estes, a board certified fertility specialist and director of the Robotic Surgery Program at Penn State Health Milton S. Hershey Medical Center.

She suggests that patients whose infertility is caused by irregular ovulation ask their providers about letrozole, since news of its effectiveness as an infertility treatment hasn't spread very quickly. "It is easy to take, has a low rate of multiple births, and fewer side effects than Clomid," Estes said.

If infertility is caused by male factors or simply unexplainable, doctors may recommend other medicines, injectables, inseminations or in-vitro fertilization (IVF), depending on the diagnosis.

"You always have to look at the underlying cause to pick which treatment is correct," Estes said.

Intra-uterine insemination (IUI) places concentrated sperm directly into the woman's uterus so it doesn't have so far to travel and thus increases chances of fertilization. With IVF, the woman's eggs are harvested and combined with sperm in an embryology laboratory and then an embryo is placed into the uterus.

"IVF is becoming more and more successful, so its availability to patients has improved," Estes said. "More states and companies are seeing the importance of family-building within the job, so now there is a lot more coverage for these treatments."

Estes said most insurance companies will cover fertility testing, even if they don't cover the treatments. "Many people just wait and hope, and their family tells them it will happen when it is supposed to happen," Estes said. "But why not come and see what the issue might be?"

She recommends that fertility evaluations be done by a reproductive endocrinologist, and that couples get evaluated if they are 35 or older with regular menstrual cycles and have been trying to get pregnant for more than six months. If they are under 35 and have been trying to get pregnant for 12 months, it might be time to make an appointment. Women should be seen sooner if they do not have regular menses, have a history of chemotherapy or radiation treatment or if there is a known male factor.

Estes said it's hard to tell whether more couples are struggling with infertility these days or if it is just more common to hear about because of improved technology and successful treatment options: "More people are coming forward because there is more knowledge and availability, but we also have more to offer with success, so that creates a cycle."

Newer minimally invasive surgical procedures can treat endometriosis, help doctors evaluate fallopian tubes and remove large fibroids that may affect fertility.

Then there are complimentary, holistic treatments such as acupuncture, which Estes says have conflicting results as far as how much they help with fertility. "We can't say they will solve the issues, but we don't know of harmful effects from them, so if it decreases a woman's stress, then do it."

One of the most common things many couples don't think about is to make sure they have a clean bill of health and live the most healthy lifestyle they can before trying to get pregnant.

"Things like smoking cessation and limiting caffeine and alcohol use, as well as the appropriate timing of intercourse can all help maximize your chances," Estes said.