Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

Apı, Murat

doi:10.1016/j.fertnstert.2009.06.024

Cited by 14 publications

(4 citation statements)

References 8 publications

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“…Some techniques of transvaginal ovarian drilling have been described in elegant studies [7,8], nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation [9], seems to be an easier and feasible approach [10]. …”

Section: Resultsmentioning

confidence: 99%

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Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

et al. 2012

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BackgroundSome techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model.FindingsAn experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path.ConclusionsThis is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome.

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Section: Resultsmentioning

confidence: 99%

“…Although the surgical of new modalities have easy applicability and low cost with shorter hospital stay, the safety of the procedures remain to be defined [7]. …”

Section: Discussionmentioning

confidence: 99%

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

et al. 2012

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“…Although this is the least invasive method for accomplishing ovarian drilling, concerns have been raised that the technique may be limited by more difficulty in assuring correct intraovarian placement with the potential for inadvertent injuries, compromising the ovarian blood supply, and damaging the ovarian cortex. 89 Syritsa performed a pilot study of transvaginal ultrasound-guided ovarian drilling using a unipolar needle in six POCS patients. 90 Most recently, Badawy et al randomized 163 PCOS patients to conventional LOD or simple aspiration of all visible follicles under transvaginal ultrasound guidance, similar to oocyte retrieval for in vitro maturation.…”

Section: Complicationsmentioning

confidence: 99%

Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome

Flyckt

Goldberg

2011

Semin Reprod Med

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Laparoscopic ovarian drilling (LOD) is an alternative to ovulation induction with gonadotropins for polycystic ovarian syndrome (PCOS) patients unresponsive to clomiphene. It is quick and easy to perform, although the number of punctures and energy doses has not been standardized. The mechanism of LOD is unclear, but it is likely mediated by a reduction in intraovarian androgen production. Serum luteinizing hormone and testosterone levels are rapidly normalized, and these changes are sustained over long-term follow-up. Studies have shown that ovulation and pregnancy rates are comparable between ovulation induction with gonadotropins and LOD, but LOD avoids the risks of multiple pregnancy and ovarian hyperstimulation syndrome. LOD is also more cost effective and better tolerated than gonadotropin therapy. Concerns regarding clinically significant adhesion formation and premature ovarian failure are not supported by the available data. Transvaginal hydrolaparoscopy and ultrasound guidance are less invasive techniques for performing ovarian drilling and may encourage LOD earlier in the course of treatment for PCOS.

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“…Seeking to reduce adhesions and simplify ovarian cauterization, microlaparoscopy without general anesthesia [11] and laser-based transvaginal ovarian drilling (TVOD) techniques have been described [11-14]. …”

Section: Introductionmentioning

confidence: 99%

Adequacy of ovarian diathermy under ultrasound control: an experimental model

et al. 2013

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BackgroundTo develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control and evaluate the safety and feasability of monopolar cauterization to cause ovarian injury using female cattle of reproductive age as an experimental model.MethodExperimental study in a university research center was performed. Eleven female bovines of reproductive age were submitted to monopolar transvaginal ovarian cauterization. The right ovary (RO) was punctured at four sites and 40 W was applied for 5 s at each point, resulting in a total of 800 J (Joules) of thermal energy. In the left ovary (LO), the procedure was similar, with the same time and 80 W, resulting in a thermal energy of 1600 J. Macroscopic and microscopic lesions were assessed.ResultsOf 22 ovaries punctured, 20 were cauterized and exhibited macroscopic and typical microscopic lesions. No lesions could be found in the needle path. The measures of the areas of microscopic electrocautery lesions calculated estimating a cylindrical volume showed a median of 1.12% in the right ovary and 1.65% in the left ovary. When the estimate was calculated by spherical shape, the medians were 1.77% in the right ovary and 3.06% in the left ovary. There was a statistically significant difference in these two estimates (sphere, p = 0.008; cylinder, p = 0.021).ConclusionThe experimental animal model described for transvaginal ultrasound-guided ovarian needle cauterization seems to be feasible. The ovaries were successfully cauterized without injuries in needle path and more energy resulted in significantly more thermal lesion. The safety and effectiveness of this technique, theoretically less invasive than current ovarian drilling methods, could be tested in anovulatory women with PCOS.

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Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?

Cited by 14 publications

References 8 publications

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome

Adequacy of ovarian diathermy under ultrasound control: an experimental model

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