Factors Affecting the Outcome of Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome in Women With Anovulatory Infertility

Abstract

Objective To describe and analyse the factors affecting the pregnancy rate of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Design A retrospective study. Setting A specialist infertility clinic based at a teaching hospital in England. Population One hundred and eighteen women, for whom hospital records and follow up data were available, with polycystic ovarian syndrome who underwent laparoscopic ovarian surgery for anovulatory infertility over a five year period, between January 1991 and December 1995. Main Outcome measures Ovulation and pregnancy rate. Results The cumulative conception rate 12 months after the treatment was 54%. Women who conceived following the surgery had a shorter duration of infertility, were treated with diathermy (rather than laser), had higher pre‐operative luteinising hormone levels, were younger and were more likely to have ultrasonographic evidence of polycystic ovarian disease. Logistic multiple regression analysis showed that the duration of infertility, modality used in treatment (laser or diathermy) and the preoperative levels were the main determinants of the outcome. Conclusion Women with polycystic ovarian syndrome respond favourably to laparoscopic ovarian drilling. The success rate in women with infertility duration of less than three years, treated with diathermy, in whom the pre‐operative level was more than 10 IU/L reached 79%.

Transvaginal, ultrasound‐guided, ovarian, interstitial laser treatment in anovulatory women with clomifene‐citrate‐resistant polycystic ovary syndrome

“…We do not know whether the women who undergo ovarian interstitial laser treatment will have recurring clinical or hormonal problems, but because of a minimal surface damage of the ovaries, it is possible that ovarian interstitial laser treatment can be an improved surgical approach to restore ovulation with a minimal risk of adhesion formation in women with PCOS who are CC resistant or unresponsive to hormone therapy. Several previous studies have shown electrocautery to be superior to laser for LOD in terms of safety, simplicity, effectiveness and costs; 5,16,17 however, interstitial therapy is greatly superior to electrocautery or LOD in safety, simplicity and costs and in our experience is at least equal in effectiveness.…”

“…Laparoscopic ovarian diathermy or drilling (LOD) has been used in the management of anovulatory women with clomifene‐citrate(CC)‐resistant polycystic ovary syndrome (PCOS) for the past two decades. With ovulation rates of 70–80% and pregnancy rates of 30–60% within 6–12 postoperative months, the effectiveness of LOD has been well documented in the literature 1–8 . However, about 20–30% of women fail to respond to LOD, and about 50% of those who initially respond to the treatment became anovulatory again after a few months 1 .…”

“…With ovulation rates of 70-80% and pregnancy rates of 30-60% within 6-12 postoperative months, the effectiveness of LOD has been well documented in the literature. [1][2][3][4][5][6][7][8] However, about 20-30% of women fail to respond to LOD, and about 50% of those who initially respond to the treatment became anovulatory again after a few months. 1 Some workers have reported that women who have had LOD develop mild to moderate postoperative abdominal adhesions, 9 although it is unclear whether these adhesions can induce a subfertile state.…”

Office microlaparoscopic ovarian drilling versus conventional laparoscopic ovarian drilling for women with polycystic ovary syndrome

“…This simple procedure appears to be particularly useful for outpatient microlaparoscopies, in which the average discharge time is 2 to 3 h after the operation. The effect of local anesthesia is temporary; however, this approach allows the possibility of a quicker discharge at 2 h after surgery [19][20][21][22][23][24].…”

Omental Fat Receptor Interacting Protein 140 mRNA Expression in Women with Polycystic Ovary Syndrome

“…Laparoscopic ovarian electrocautery (LOE) is an alternative treatment for PCOS women who are clomiphene citrate-resistant [12] . Ovarian wedge resection is the forerunner of LOE which was first introduced by Stein and Leventhal [13] for women with PCOS.…”