臨床婦人科産科64巻2号

2010年02月発行

今月の臨床 ここが知りたい―PCOSの最新情報

不妊への対応 2．PCOSでのART

PCOSでのART

著者： 栁田薫¹ 片寄治男¹

所属機関： ¹国際医療福祉大学病院リプロダクションセンター

ページ範囲：P.181 - P.185

文献概要

はじめに

　生殖補助医療（assisted reproductive technology : ART）の体外受精（in vitro fertilization : IVF）や顕微授精（ここでは卵細胞質内精子注入法，intracytoplasmic sperm injection : ICSI）にはそれぞれ実施する適応があり，多嚢胞性卵巣症候群（polycystic ovary syndrome : PCOS）だけではARTの適応とはならない．PCOS症例で適応がある場合にARTが実施される．PCOSは生殖年齢層婦人の4～7％に認められ^1），近年，増加傾向にある．不妊原因のなかで排卵因子はメジャーな原因であり，不妊症例の70％に何らかの排卵障害が存在し^2），そのなかで多嚢胞性卵巣はよく遭遇する原因で^3），不妊症例の20％に認められるといわれている^1）．

　通常，ARTは調節過排卵刺激（controlled ovarian hyperstimulation : COH）を行い経腟的に採卵して実施する．PCOSのARTで留意しなければいけない点はCOHによって卵巣過剰刺激症候群（ovarian hyperstimulation syndrome : OHSS）を発症しやすいことである．繰り返して重症OHSSを発症する場合には，卵巣刺激を行わず採卵する未熟卵子体外培養体外受精法（in vitro mature-IVF : IVM-IVF）というオプションがある．この方法ではOHSSを完全に除外することができる．

参考文献

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