[Treatment of female infertility due to hyperandrogenism].
This study reviews the various types of treatment used in infertility due to hyperandrogenism, with the aim of answering the following three questions: How should these drugs be prescribed? What are their side-effects? What are the best diagnostic indications? Possibilities include ovulation inducers but also all types of treatment capable of improving the fertility of these women. The treatment of infertility due to adrenal hyperandrogenism is based upon glucocorticoids. This treatment must be continued for 3 months after conception, to attempt to avoid early spontaneous abortion. The first-line inducer in ovarian hyperandrogenism is clomiphene citrate. The good results obtained using the combination of dexamethasone and clomiphene citrate are explained by an adrenal participation in this type of hyperandrogenism. In case of failure, and in addition to classical menotrophins:--pre-treatment using LHRH agonists avoids the onset of premature luteinisation but does not prevent the possibility of multiple pregnancies;--use of purified FSH reduces, though not sufficiently, the risks of multifollicular maturation but does not greatly increase the overall pregnancy rate;--the "slow" protocol with purified FSH reduces the incidence of multifollicular maturation. Should this fail, prior treatment with an LHRH agonist and if not the pulsed administration of LHRH in non-obese women can be suggested. Surgical treatment provides useful results in severe forms of sterility due to polycystic ovaries syndrome, with new per-celioscopic techniques.
Service d'Endocrinologie, Diabétologie, Nutrition, Hôpital Notre-Dame de Bon Secours, Paris.
J P
JP
Cordray
B
B
Siboulet
R E
RE
Merceron
X
X
Guillerd
P
P
Nys
D002985:Clinical Protocols; D002996:Clomiphene / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications*; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology*; D008596:Menotropins / Q000627:therapeutic use; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple
D005938:Glucocorticoids; D002996:Clomiphene; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins; D003907:Dexamethasone; D005640:Follicle Stimulating Hormone
Traitement des infertilités féminines par hyperandrogénie.