Význam senzitizace inzulinovýchreceptorů pro prevenci ovariálníhohyperstimulačního syndromu

Overview

Objective:
Aim of our study was to analyze the influence of insulin receptor sensitization on thecourse of controlled ovarian stimulation in the program of assisted reproduction and to identify theavailability of ovarian response improvement due to the reduced production of intraovarianandrogens. Further we tried to identify the preventive influence of metformin on development ofovarian hyperstimulation syndrome.Design: Prospective randomized controlled study of 172 patients involved in the assisted reproductionprogram from May 2000 to December 2001.Setting: Centre of Assisted Reproduction, Department of Gynecology and Obstetrics, MedicalFaculty, Masaryk University and University Hospital, Brno.Material and Methods: Patients undergoing the ovarian stimulation with increased risk of developmentof ovarian hyperstimulation syndrome due to the polycystic ovarian syndrome were includedin the study and randomized to two groups. (1) Women in the first group used the insulin receptorsensitizing drug metformin together with gonadotropins, and (2) women in the second groupunderwent the classic stimulation protocol alone. The control group (3) consisted of patients withintact ovarian function anddifferent infertility factor.Complexhormonal statuswas assessed beforethe treatment initiation and the level of androgens in the follicular fluid was investigated in allpatients.Results: Metformin during gonadotropin stimulation has significantly reduced the risk of ovarianhyperstimulation syndrome inwomen with PCOS. Significantly lower intraovarian androgen levelswere documented in comparison to women without metformin and also when compared to patientswith intact ovarian function. Metformin had also significantly reduced estradiol blood levels at theday of hCG application without significant influence on the number of obtained oocytes.Conclusions: The risk of ovarian hyperstimulation syndrome development was significantly decreasedin patients with PCOS in consequence to insulin receptors sensitization.

Klíčová slova:
ovarian hypestimulation syndrome, hyperinsulinemia, polycystic ovary syndrome, metformin