Does unilateral laparoscopic diathermy adjusted to ovarian volume increase the chances of ovulation in women with polycystic ovary syndrome?

Abstract

This study represents an advance in the determination of the optimal laparoscopic treatment for women with PCOS, as it was shown that improved results can be achieved using less thermal energy in volume-adjusted ULOD.

Primum Non Nocere

“…Future research should therefore extend the followup beyond 6 months. This study has shown that improved results can be achieved using less thermal energy in volume-adjusted ULOD [15].…”

“…The adjustment of the thermal dose to ovarian volume in bilateral laparoscopic ovarian drilling (BLOD) increases ovulation and pregnancy rates compared with fixed-dose treatment, but BLOD causes the formation of adhesions, particularly on the left ovary, and increases the risk of damage to ovarian tissue [15]. In contrast, unilateral laparoscopic ovarian drilling (ULOD) with a fixed thermal dose minimizes the risk of ovarian tissue damage and can increase the activity in both right and left ovaries, although this varies in humans and in other species.…”

“…In contrast, unilateral laparoscopic ovarian drilling (ULOD) with a fixed thermal dose minimizes the risk of ovarian tissue damage and can increase the activity in both right and left ovaries, although this varies in humans and in other species. A prospective, longitudinal study included 96 infertile women with PCOS who were unresponsive to CC treatment and had underwent either ULOD or BLOD [15]. After surgery, the groups were followed up for 6 months to assess ovulatory response.…”

“…Setting eligibility criteria based on the existing evidence concerning predictors of success of LOD is critical not only to improve its outcome, but also to avoid unnecessary surgery with possible risk of impairment of ovarian reserve and other complications. Abu Hashim [17] in his elegant evidence-based publication summarized that based on the current evidence, LOD could be predicted to result in poor reproductive outcome in women with CC-resistant PCOS when they are obese (BMI [ 25 kg/m 2 ), long duration of infertility [3 years, low basal LH levels \10 IU/l, marked biochemical hyperandrogenism (testosterone levels C4.5 nmol/l, free androgen index [15) and high basal AMH C 7.7 ng/ml. Pirwany and Tulandi [18] evaluated the role of LOD and treatment with metformin in the management of the PCOS.…”

The Impact of Gradually Increasing Energy Dose on AMH Levels in Ovarian Drilling

“…Therefore, to achieve resumption of ovulation in every case, individualizing the amount of energy has been suggested. Many authors evaluated the value of clinical (ovarian volume) and laboratory markers for individualizing the amount of energy in OD [10][11][12][13][14] . Among these, Anti-Müllerian hormone (AMH), which is exclusively secreted by granulosa cells of pre-antral/small antral follicles (4-6 mm) [15,16] , seems to be a potential marker for energy-dose calculation.…”