Decrease in serum anti‐Müllerian hormone level per puncture with laparoscopic ovarian drilling using ultrasonically activated device

Abstract

Laparoscopic ovarian drilling (LOD) has been widely used to treat polycystic ovary syndrome (PCOS). [1][2][3][4][5][6] In general, the clinical results indicate that LOD restores menstrual cyclicity and ovulation in approximately 70-80% of patients, and pregnancy rate following LOD is approximately 40-60%. 2,3,6,7 There was no statistically significant difference in pregnancy or miscarriage rates between LOD and gonadotropin therapy. 3,7 LOD is performed through various methods: electrocautery; lasers including CO 2 , argon, KTP, and Nd-YAG; and ultrasonically activated devices. 2,[8][9][10] In LOD using electrocautery, power setting, duration of

Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review

“…Anti-Mullerian hormone: While it is clear that there is a decrease in the ovarian reserve and volume following LOD, there is some discrepancy in the alterations in AMH concentrations. The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ].…”

“…Most studies also observed no association between BMI and AMH concentrations [7,21,23,29]. However, one study extensively stratified age groups and found otherwise [28].…”

“…In PCOS, enhanced male secondary sex characteristics such as hirsutism and acne were also seen, which were present in 43.2% and 49.1% of patients, respectively [ 8 - 10 , 13 , 34 , 37 ]. Another problem associated with PCOS is the inability to conceive; 65.2% of patients with PCOS report primary infertility, and 34.8% reported secondary infertility [ 9 , 15 , 18 , 25 , 28 , 40 ]. The average amount of punctures done during the procedure was 12.58 in each ovary across all studies (range: 3-120) [ 7 - 10 , 13 - 17 , 19 , 20 , 22 , 23 , 27 - 30 , 36 , 41 , 42 ].…”

“…Menstrual cycle pattern: Menstrual irregularities are common in patients with PCOS, and on average, 12.5% of patients had a regular menstrual pattern, 76.2% experienced oligomenorrhea, and 21% experienced amenorrhea [ 7 - 10 , 13 , 18 , 19 , 28 , 32 - 34 , 39 ]. In the first three months, Kandil et al observed a 75.4% increase in average ovulation, which increased to 77.1%, in line with several other studies [ 10 , 23 , 35 ]; 79.5% of patients had cessation of oligomenorrhea, with an average of 73.9% experiencing spontaneous ovulation [ 8 , 18 , 21 , 25 , 29 , 39 ].…”

“…Ogawa et al observed that when compared to preoperative AMH concentrations, there was a 0.55% change in overall AMH concentrations per puncture in all patients. It is also noted that the percentage of AMH change is significantly increased in patients with a preoperative AMH level of >10 ng/mL, which correlates to an AMH concentration change of 66% per puncture [ 28 ]. There was also no significant difference between AMH concentration decrease and unilateral versus bilateral LOD [ 30 , 31 , 42 ].…”

Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review

“…Anti-Mullerian hormone: While it is clear that there is a decrease in the ovarian reserve and volume following LOD, there is some discrepancy in the alterations in AMH concentrations. The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ].…”

“…Most studies also observed no association between BMI and AMH concentrations [7,21,23,29]. However, one study extensively stratified age groups and found otherwise [28].…”

“…In PCOS, enhanced male secondary sex characteristics such as hirsutism and acne were also seen, which were present in 43.2% and 49.1% of patients, respectively [ 8 - 10 , 13 , 34 , 37 ]. Another problem associated with PCOS is the inability to conceive; 65.2% of patients with PCOS report primary infertility, and 34.8% reported secondary infertility [ 9 , 15 , 18 , 25 , 28 , 40 ]. The average amount of punctures done during the procedure was 12.58 in each ovary across all studies (range: 3-120) [ 7 - 10 , 13 - 17 , 19 , 20 , 22 , 23 , 27 - 30 , 36 , 41 , 42 ].…”

“…Menstrual cycle pattern: Menstrual irregularities are common in patients with PCOS, and on average, 12.5% of patients had a regular menstrual pattern, 76.2% experienced oligomenorrhea, and 21% experienced amenorrhea [ 7 - 10 , 13 , 18 , 19 , 28 , 32 - 34 , 39 ]. In the first three months, Kandil et al observed a 75.4% increase in average ovulation, which increased to 77.1%, in line with several other studies [ 10 , 23 , 35 ]; 79.5% of patients had cessation of oligomenorrhea, with an average of 73.9% experiencing spontaneous ovulation [ 8 , 18 , 21 , 25 , 29 , 39 ].…”

“…Ogawa et al observed that when compared to preoperative AMH concentrations, there was a 0.55% change in overall AMH concentrations per puncture in all patients. It is also noted that the percentage of AMH change is significantly increased in patients with a preoperative AMH level of >10 ng/mL, which correlates to an AMH concentration change of 66% per puncture [ 28 ]. There was also no significant difference between AMH concentration decrease and unilateral versus bilateral LOD [ 30 , 31 , 42 ].…”

Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review

“…Anti-Mullerian hormone: While it is clear that there is a decrease in the ovarian reserve and volume following LOD, there is some discrepancy in the alterations in AMH concentrations. The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ].…”

“…Most studies also observed no association between BMI and AMH concentrations [7,21,23,29]. However, one study extensively stratified age groups and found otherwise [28].…”

“…In PCOS, enhanced male secondary sex characteristics such as hirsutism and acne were also seen, which were present in 43.2% and 49.1% of patients, respectively [ 8 - 10 , 13 , 34 , 37 ]. Another problem associated with PCOS is the inability to conceive; 65.2% of patients with PCOS report primary infertility, and 34.8% reported secondary infertility [ 9 , 15 , 18 , 25 , 28 , 40 ]. The average amount of punctures done during the procedure was 12.58 in each ovary across all studies (range: 3-120) [ 7 - 10 , 13 - 17 , 19 , 20 , 22 , 23 , 27 - 30 , 36 , 41 , 42 ].…”

“…Menstrual cycle pattern: Menstrual irregularities are common in patients with PCOS, and on average, 12.5% of patients had a regular menstrual pattern, 76.2% experienced oligomenorrhea, and 21% experienced amenorrhea [ 7 - 10 , 13 , 18 , 19 , 28 , 32 - 34 , 39 ]. In the first three months, Kandil et al observed a 75.4% increase in average ovulation, which increased to 77.1%, in line with several other studies [ 10 , 23 , 35 ]; 79.5% of patients had cessation of oligomenorrhea, with an average of 73.9% experiencing spontaneous ovulation [ 8 , 18 , 21 , 25 , 29 , 39 ].…”

“…Ogawa et al observed that when compared to preoperative AMH concentrations, there was a 0.55% change in overall AMH concentrations per puncture in all patients. It is also noted that the percentage of AMH change is significantly increased in patients with a preoperative AMH level of >10 ng/mL, which correlates to an AMH concentration change of 66% per puncture [ 28 ]. There was also no significant difference between AMH concentration decrease and unilateral versus bilateral LOD [ 30 , 31 , 42 ].…”

Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review

“…Anti-Mullerian hormone: While it is clear that there is a decrease in the ovarian reserve and volume following LOD, there is some discrepancy in the alterations in AMH concentrations. The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ].…”

“…Most studies also observed no association between BMI and AMH concentrations [7,21,23,29]. However, one study extensively stratified age groups and found otherwise [28].…”

“…In PCOS, enhanced male secondary sex characteristics such as hirsutism and acne were also seen, which were present in 43.2% and 49.1% of patients, respectively [ 8 - 10 , 13 , 34 , 37 ]. Another problem associated with PCOS is the inability to conceive; 65.2% of patients with PCOS report primary infertility, and 34.8% reported secondary infertility [ 9 , 15 , 18 , 25 , 28 , 40 ]. The average amount of punctures done during the procedure was 12.58 in each ovary across all studies (range: 3-120) [ 7 - 10 , 13 - 17 , 19 , 20 , 22 , 23 , 27 - 30 , 36 , 41 , 42 ].…”

“…Menstrual cycle pattern: Menstrual irregularities are common in patients with PCOS, and on average, 12.5% of patients had a regular menstrual pattern, 76.2% experienced oligomenorrhea, and 21% experienced amenorrhea [ 7 - 10 , 13 , 18 , 19 , 28 , 32 - 34 , 39 ]. In the first three months, Kandil et al observed a 75.4% increase in average ovulation, which increased to 77.1%, in line with several other studies [ 10 , 23 , 35 ]; 79.5% of patients had cessation of oligomenorrhea, with an average of 73.9% experiencing spontaneous ovulation [ 8 , 18 , 21 , 25 , 29 , 39 ].…”

“…Ogawa et al observed that when compared to preoperative AMH concentrations, there was a 0.55% change in overall AMH concentrations per puncture in all patients. It is also noted that the percentage of AMH change is significantly increased in patients with a preoperative AMH level of >10 ng/mL, which correlates to an AMH concentration change of 66% per puncture [ 28 ]. There was also no significant difference between AMH concentration decrease and unilateral versus bilateral LOD [ 30 , 31 , 42 ].…”