叶子，我追着你屁股后面给你上课，呵呵。
曲唑微（英文名femara），和克米一样，不适合卵巢功能差的病人。
Geoffrey Sher医生在美国从事试管研究已经30年，他很反对给卵巢功能不好的病人用微促方案，他说微促用的药含LH太高，LH只是在排卵的时候需要，在卵子发育初期LH含量应该越少越好，过多的LH会造成过多的testosterone（睾酮），睾酮对卵子的发育有着不良的影响。而卵巢功能低的病人，本身的LH就很高，所以促排药LH应该很低才合适。Sher医生发明了一种专门对付卵巢功能不好的促排方案，是在长方案的基础上促腺素和咭抗剂交叉使用，咭抗剂是在打促排药之前几天就用（只是很少的量），目的是抑制LH的量，对于长方案中长时间降调可能会对卵巢抑制过度，他采用雌激素打底，以提高卵巢对促排药的敏感度，而且要求降调时间不能超过21天。
下面是有关来曲唑他和病人的一段对答
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CatherineAug 29 2008, 03:08 PM
My ob is suggesting a cycle with clomid or femara from cd 3-7 - follostim 150 for cd7-9 then menopur 75 cd10, then wait for a couple days till follicle(s) show mature and trigger
she is giving me the option of either the clomid or femara - I had suggested femara, but she said if my goal is more eggs clomid has been shown to produce more follicles than femara - i had thought femara would be better on the lining, but she said the FSH can correct that?
I am 43 and have had 2 blighted ovums and a m/c at 11w in the last year - I DO get pg, but I think I need a few more targets to get a golden egg -
I cannot afford ivf or donor again, this is kinda a last ditch effort, can you give me your opinion on clomid or femara, and if you ever have seen cycles like this succeed?
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Geoffrey Sher, MDAug 29 2008, 04:16 PM
Respectfully I do not prescribe clomid or Femara to women >40 nor to women with diminished ovarian reserve, regardless of their age.
Geoff Sher
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LETROZOLE (FEMARA) FOR OVULATION INDUCTION.
Letrozole, like clomiphene (Serophene, Clomid) is an oral agent induces ovulation. The main source of estrogen is through the conversion of the hormone testosterone to estrogen by the action of a follicular enzyme known aromatase. Letrozole, an aromatase inhibitor blocks this conversion, resulting in a reduction in estrogen concentration, which in turn causes the pituitary gland to respond by releasing large amounts of FSH as well as LH. The FSH promotes follicle development. While the effect on pituitary FSH and LH release is similar to that of clomiphene, unlike the latter, Letrozole does not block estrogen receptors in the endometrial lining or cervical glands and thus does not directly affect the production of cervical mucus (essential for sperm capacitation) or suppress development of the uterine lining.
However, as with clomiphene, Letrozole causes increased LH release. This in turn can lead to overproduction of male hormones (e.g. testosterone) by the ovaries with a potentially adverse effect on egg/embryo quality. This is potentially most disadvantageous in older woman and women who have diminished ovarian reserve, who have the greatest potential for the ovaries to produce excessive testosterone.
Thus while there could be potential advantages in using Letrozole over clomiphene for ovulation induction, the exaggerated LH-induced testosterone effect, especially in women over 40 years of age and/or those with evidence of diminished ovarian reserve (i.e. raised FSH, reduced Inhibin B levels and less than 10 antral follicles on cycle day 3), in the author’s opinion (GS), limits its value in the ART setting.
[ 此帖被nycresident在2010-09-06 22:15重新编辑 ]
