verezdoВестник репродуктивного здоровьяBulletin of Reproductive Health2075-65692310-421XEndocrinology Research Centre (Moscow)10.14341/brh20081-238-51verezdo-8526Research ArticleСтатьиArticlesПринципы восстановления фертильности у больных с СПКЯPrintsipy vosstanovleniya fertil'nosti u bol'nykh s SPKYaЧеботниковаТ ВChebotnikovaT V-МельниченкоГ АMel'nichenkoG A-СемичеваТ ВSemichevaT V-ФГУ Эндокринологический научный центр Росмедтехнологий20081506200801-2№1-2 (2008)3851Copyright © Чеботникова Т.В., Мельниченко Г.А., Семичева Т.В., 20082008Чеботникова Т.В., Мельниченко Г.А., Семичева Т.В.Chebotnikova T.V., Mel'nichenko G.A., Semicheva T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vrz-endojournals.ru/jour/article/view/8526

Синдром поликистозных яичников (СПкЯ) четко ассоциирован со снижением фертильности— типичными клиническими симптомами заболевания являются олигоовуляция и бесплодие. Современное понимание проблемы и осознание вариабельности клинических проявлений при данном заболевании привело к изменению устойчивых представлений об облигатном наличии бесплодия. В структуре клинических симптомов СПкЯ бесплодие составляет не более 20% при абсолютном преобладании первичного бесплодия [1, 2]. Более справедлива концепция снижения фертильности при СПкЯ, олигоовуляция— причина рождения малого количества детей в семьях больных. Негативные ожидания, страх неудач и косметические дефекты приводят к депрессивным расстройствам и самоизоляции.

ReferencesСиндром поликистозных яичников: Руководство для врачей. Под ред. И.И.Дедова, Г.А.мельниченко. — м.: ООО «медицинское информационное агенство», 2007.Синдром поликистозных яичников: Руководство для врачей. Под ред. И.И.Дедова, Г.А.мельниченко. — м.: ООО «медицинское информационное агенство», 2007.Balen A.H., Conway G.S., Kaltsas G. Polycystic ovary syn-drome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10(8):2107—2111.Balen A.H., Conway G.S., Kaltsas G. Polycystic ovary syn-drome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10(8):2107—2111.Ferrannini E., Natali A., Bell P. on behalf of the European Group for the Study of Insulin Resistance (EGIR). Insulin resistance and hypersecretion in obesity. J Clin Invest. 1997; 100: 1166—1173.Ferrannini E., Natali A., Bell P. on behalf of the European Group for the Study of Insulin Resistance (EGIR). Insulin resistance and hypersecretion in obesity. J Clin Invest. 1997; 100: 1166—1173.Dunaif A., Segal K.R., Futterweit W. Profound peripheral insulin resistance, independent of obesity, in PCOS. Diabetes 38:1165-1174, 1989Dunaif A., Segal K.R., Futterweit W. Profound peripheral insulin resistance, independent of obesity, in PCOS. Diabetes 38:1165-1174, 1989Krauss R.M., Winston M., Fletcher B.J. Obesity: impact on cardiovascular disease. Circulation. 1998 Oct 6;98(14):1472-6.Krauss R.M., Winston M., Fletcher B.J. Obesity: impact on cardiovascular disease. Circulation. 1998 Oct 6;98(14):1472-6.Despres J.P., Lemieux I., Prud’homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ. 2001 Mar 24;322(7288):716-20.Despres J.P., Lemieux I., Prud’homme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ. 2001 Mar 24;322(7288):716-20.Guzick D.S., Wing R., Smith D. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 1994; 61: 598-604.Guzick D.S., Wing R., Smith D. Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. Fertil Steril 1994; 61: 598-604.Pasquali R., Gambineri A. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the PCOS. JCE&M. 2000 Aug;85(8):2767-74.Pasquali R., Gambineri A. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the PCOS. JCE&M. 2000 Aug;85(8):2767-74.Пищулин А.А. Синдром поликистозных яичников: патогенез, диагностика, лечение автореф дмн, 2002.Пищулин А.А. Синдром поликистозных яичников: патогенез, диагностика, лечение автореф дмн, 2002.Clark A.M., Thornley B., Tomlinson L. Weight loss in obese infertile women results in improvement in reproductive out-come for all forms of fertility treatment. Hum Reprod 1998; 13: 1502-5.Clark A.M., Thornley B., Tomlinson L. Weight loss in obese infertile women results in improvement in reproductive out-come for all forms of fertility treatment. Hum Reprod 1998; 13: 1502-5.Schenker J.G. Clinical aspects of ovarian hyperstimula-tion syndrome. Eur J Obstet Gynecol Reprod Biol. 1999 Jul;85(1):13-20.Schenker J.G. Clinical aspects of ovarian hyperstimula-tion syndrome. Eur J Obstet Gynecol Reprod Biol. 1999 Jul;85(1):13-20.Kousta E., White D.M., Franks S. Modern use of clomi-phene citrate in induction of ovulation. Hum Reprod Update. 1997 Jul-Aug;3(4):359-65Kousta E., White D.M., Franks S. Modern use of clomi-phene citrate in induction of ovulation. Hum Reprod Update. 1997 Jul-Aug;3(4):359-65Beck J.I., Boothroyd C., Proctor M. Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev. 2005 Jan 25;(1): CD002249. Review.Beck J.I., Boothroyd C., Proctor M. Oral anti-oestrogens and medical adjuncts for subfertility associated with anovulation. Cochrane Database Syst Rev. 2005 Jan 25;(1): CD002249. Review.Dickey R.P., Taylor S.N., Curole D.N. Incidence of spon-taneous abortion in clomiphene pregnancies. Hum Reprod. 1996 Dec;11(12):2623-8.Dickey R.P., Taylor S.N., Curole D.N. Incidence of spon-taneous abortion in clomiphene pregnancies. Hum Reprod. 1996 Dec;11(12):2623-8.Malkawi H.Y., Qublan H.S., Hamaideh A.H. Medical vs. surgical treatment for clomiphene citrate-resistant women with PCOS. J Obstet Gynaecol, 2003; 23(3): 289-93.Malkawi H.Y., Qublan H.S., Hamaideh A.H. Medical vs. surgical treatment for clomiphene citrate-resistant women with PCOS. J Obstet Gynaecol, 2003; 23(3): 289-93.Lord J.M., Flight I.H., Norman R.J. Metformin in PCOS: systematic review and metaanalysis BMJ 2003;327:951Lord J.M., Flight I.H., Norman R.J. Metformin in PCOS: systematic review and metaanalysis BMJ 2003;327:951Parsanezhad M.E., Alborzi S., Jahromi B.N. A prospec-tive, double-blind, randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with PCOS and nor-mal prolactin level. Int J Fertil Womens Med. 2002 Nov-Dec;47(6):272-7.Parsanezhad M.E., Alborzi S., Jahromi B.N. A prospec-tive, double-blind, randomized, placebo-controlled clinical trial of bromocriptine in clomiphene-resistant patients with PCOS and nor-mal prolactin level. Int J Fertil Womens Med. 2002 Nov-Dec;47(6):272-7.Nugent D., Vandekerckhove P., Hughes E. Gonadotro-phin therapy for ovulation induction in subfertility associated with PCOS. Cochrane Database Syst Rev. 2000; (4): CD000410.Nugent D., Vandekerckhove P., Hughes E. Gonadotro-phin therapy for ovulation induction in subfertility associated with PCOS. Cochrane Database Syst Rev. 2000; (4): CD000410.Wely M., Bayram N., Veen F. Recombinant FSH in al-ternative doses or versus urinary gonadotrophins for ovulation in-duction in subfertility associated with PCOS: a systematic review based on a Cochrane review. Human Reproduction Vol.18, No.6 pp. 1143-1149, 2003Wely M., Bayram N., Veen F. Recombinant FSH in al-ternative doses or versus urinary gonadotrophins for ovulation in-duction in subfertility associated with PCOS: a systematic review based on a Cochrane review. Human Reproduction Vol.18, No.6 pp. 1143-1149, 2003Bayram N., van Wely M., van der Veen F. Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovula-tion induction in subfertility associated with PCOS (Cochrane Re-view) The Cochrane Library, Issue 2, 2006.Bayram N., van Wely M., van der Veen F. Recombinant FSH versus urinary gonadotrophins or recombinant FSH for ovula-tion induction in subfertility associated with PCOS (Cochrane Re-view) The Cochrane Library, Issue 2, 2006.Bayram N., van Wely M., van der Veen F. Pulsatile go-nadotrophin releasing hormone for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2004;(1):CD000412.Bayram N., van Wely M., van der Veen F. Pulsatile go-nadotrophin releasing hormone for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. 2004;(1):CD000412.Essah P.A., Apridonidze T., Iuorno M.J. Effects of short-term and long-term metformin treatment on menstrual cyclicity in women with polycystic ovary syndrome. Fertil Steril. 2006, vol. 86, no1, pp. 230-232.Essah P.A., Apridonidze T., Iuorno M.J. Effects of short-term and long-term metformin treatment on menstrual cyclicity in women with polycystic ovary syndrome. Fertil Steril. 2006, vol. 86, no1, pp. 230-232.Kolibianakis E.M., Papanikolaou E.G., Camus M. Effect of oral contraceptive pill pretreatment on ongoing pregnancy rates in patients stimulated with GnRH antagonists and recombinant FSH for IVF. A randomized controlled trial. Human Reproduction 2006. 21(2):352-357.Kolibianakis E.M., Papanikolaou E.G., Camus M. Effect of oral contraceptive pill pretreatment on ongoing pregnancy rates in patients stimulated with GnRH antagonists and recombinant FSH for IVF. A randomized controlled trial. Human Reproduction 2006. 21(2):352-357.Hughes E., Collins J., Vandekerckhove P. (2003e) Go-nadotrophin-releasing hormone analogue as an adjunct to go-nadotropin therapy for clomiphene-resistant polycystic ovarian syn-drome (Cochrane Review). In The Cochrane Library, Issue 1. Ox-ford Update Software.Hughes E., Collins J., Vandekerckhove P. (2003e) Go-nadotrophin-releasing hormone analogue as an adjunct to go-nadotropin therapy for clomiphene-resistant polycystic ovarian syn-drome (Cochrane Review). In The Cochrane Library, Issue 1. Ox-ford Update Software.Palomba S., Falbo A., Russo T. Ovulation Induction in Anovulatory Patients with PCOS. Current Drug Therapy, 2006, 1, 23-29.Palomba S., Falbo A., Russo T. Ovulation Induction in Anovulatory Patients with PCOS. Current Drug Therapy, 2006, 1, 23-29.Velazquez E.M., Mendoza S., Hamer T. Metformin ther-apy in PCOS reduces hyperinsulinemia, insulin resistance, hyper-androgenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994;43:647-54.Velazquez E.M., Mendoza S., Hamer T. Metformin ther-apy in PCOS reduces hyperinsulinemia, insulin resistance, hyper-androgenemia, and systolic blood pressure, while facilitating normal menses and pregnancy. Metabolism 1994;43:647-54.Nestler J.E., Jakubowicz D.J., Evans W.S. Effects of metformin on spontaneous and clomiphene-induced ovulation in the PCOS. N Engl J Med. 1998 Jun 25;338(26):1876-80.Nestler J.E., Jakubowicz D.J., Evans W.S. Effects of metformin on spontaneous and clomiphene-induced ovulation in the PCOS. N Engl J Med. 1998 Jun 25;338(26):1876-80.Moghetti P., Castello R., Negri C. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensi-tivity in polycystic ovary syndrome: a randomized, double-blind, pla-cebo-controlled 6-month trial, followed by open, long-term clinical evaluation. JCE&M Vol. 85, No. 1 139-146Moghetti P., Castello R., Negri C. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensi-tivity in polycystic ovary syndrome: a randomized, double-blind, pla-cebo-controlled 6-month trial, followed by open, long-term clinical evaluation. JCE&M Vol. 85, No. 1 139-146Costello M.F., Chapman M., Conway U. A systematic review and meta-analysis of randomized controlled trials on met-formin co-administration during gonadotrophin ovulation induction or IVF in women with PCOS. Human Reprod 2006 21(6):1387-1399.Costello M.F., Chapman M., Conway U. A systematic review and meta-analysis of randomized controlled trials on met-formin co-administration during gonadotrophin ovulation induction or IVF in women with PCOS. Human Reprod 2006 21(6):1387-1399.Azziz R., Ehrmann D., Legro R.S. Troglitazone Improves Ovulation and Hirsutism in the Polycystic Ovary Syndrome: A Multi-center, Double Blind, Placebo-Controlled Trial. JCE&M, 2001. Vol. 86, No. 4 1626-1632.Azziz R., Ehrmann D., Legro R.S. Troglitazone Improves Ovulation and Hirsutism in the Polycystic Ovary Syndrome: A Multi-center, Double Blind, Placebo-Controlled Trial. JCE&M, 2001. Vol. 86, No. 4 1626-1632.Sepilian V. Effects of Rosiglitazone in obese women with PCOS and severe insulin resistance. JCE&M. 2004.Vol. 90, No. 1 60-65.Sepilian V. Effects of Rosiglitazone in obese women with PCOS and severe insulin resistance. JCE&M. 2004.Vol. 90, No. 1 60-65.Nestler J.E. Inositolphosphoglycans (IPGs) as mediators of insulin’s steroidogenic actions. J Basic Clin Physiol Pharmacol. 1998;9(2-4):197-204.Nestler J.E. Inositolphosphoglycans (IPGs) as mediators of insulin’s steroidogenic actions. J Basic Clin Physiol Pharmacol. 1998;9(2-4):197-204.Baillargeon J.P., Diamanti-Kandarakis E., Ostlund R.E. Altered D-chiro-inositol urinary clearance in women with PCOS. Diabetes Care. 2006 Feb;29(2):300-5.Baillargeon J.P., Diamanti-Kandarakis E., Ostlund R.E. Altered D-chiro-inositol urinary clearance in women with PCOS. Diabetes Care. 2006 Feb;29(2):300-5.Nestler J.E., Jakubowicz D.J., Reamer P. Ovulatory and metabolic effects of D-chiroinositol in the polycystic ovary syn-drome. N Engl J Med. 1999 Apr 29;340(17):1314-20.Nestler J.E., Jakubowicz D.J., Reamer P. Ovulatory and metabolic effects of D-chiroinositol in the polycystic ovary syn-drome. N Engl J Med. 1999 Apr 29;340(17):1314-20.Penna I.A., Canella P.R., Reis R.M. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, random-ized, placebo-controlled study. Hum Reprod. 2005 Sep;20(9):2396-401. Epub 2005 Jul 8.Penna I.A., Canella P.R., Reis R.M. Acarbose in obese patients with polycystic ovarian syndrome: a double-blind, random-ized, placebo-controlled study. Hum Reprod. 2005 Sep;20(9):2396-401. Epub 2005 Jul 8.Лесной С.к. Частичная резекция яичников при олигоменорее и аменорее. Акуш и гин 1928; 7: 16—19.Лесной С.к. Частичная резекция яичников при олигоменорее и аменорее. Акуш и гин 1928; 7: 16—19.Stein I.F., Leventhal M.L. Amenorrhoea assotiated with bilateral polycystic ovaries. Am J Obstet Gynecol 29: 181—191.Stein I.F., Leventhal M.L. Amenorrhoea assotiated with bilateral polycystic ovaries. Am J Obstet Gynecol 29: 181—191.Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of PCOS. Obstet Gynecol Surv. 1998 May;53(5):297-308.Campo S. Ovulatory cycles, pregnancy outcome and complications after surgical treatment of PCOS. Obstet Gynecol Surv. 1998 May;53(5):297-308.Farquhar C., Lilford R.J., Marjoribanks J. Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory PCOS. (Cochrane Review) The Cochrane Library, Issue 2, 2006.Farquhar C., Lilford R.J., Marjoribanks J. Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory PCOS. (Cochrane Review) The Cochrane Library, Issue 2, 2006.Palomba S., Orio F. Jr., Nardo L.G. Metformin admini-stration versus laparoscopic ovarian diathermy in clomiphene cit-rate-resistant women with PCOS: a prospective parallel randomized double-blind placebo-controlled trial. JCE&M. 2004 Oct;89(10):4801-9.Palomba S., Orio F. Jr., Nardo L.G. Metformin admini-stration versus laparoscopic ovarian diathermy in clomiphene cit-rate-resistant women with PCOS: a prospective parallel randomized double-blind placebo-controlled trial. JCE&M. 2004 Oct;89(10):4801-9.The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, “Consensus on infertility treatment related to polycystic ovarian syndrome”, Human reproduction (2008), 23(3):462-477.The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, “Consensus on infertility treatment related to polycystic ovarian syndrome”, Human reproduction (2008), 23(3):462-477.

The authors declare that there are no conflicts of interest present.