Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome

Mitra, Subarna; Nayak, Prasant; Agrawal, Sarita

doi:10.4103/0976-9668.149076

Cited by 43 publications

(14 citation statements)

References 93 publications

(151 reference statements)

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“…Laparoscopic ovarian drilling (LOD) is currently indicated as a safe, efficacious, and cost-effective alternative to gonadotropins for ovulation induction in infertile women with PCOS and who are CC-resistant. 157 Advantages of LOD consisted in the absence of risk for OHSS and/or multiple pregnancies.…”

Section: Management Of Early Complicationsmentioning

confidence: 99%

“…Despite its advantages, LOD should be considered a non-first-line therapy in PCOS due to the availability of valid, cheaper, and less invasive alternatives. 157 Rather, it should be reserved to well-selected cases, ie, anovulatory CC-resistant PCOS women who are young and/or not compliant to the alternative treatments and/or needing laparoscopic assessment of the pelvis.…”

Section: Management Of Early Complicationsmentioning

confidence: 99%

See 1 more Smart Citation

Complications and challenges associated with polycystic ovary syndrome: current perspectives

Palomba¹,

Santagni²,

Falbo³

et al. 2015

IJWH

190

141

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Polycystic ovary syndrome (PCOS) represents the most common endocrine dysfunction in fertile women and it is considered a heterogeneous and multifaceted disorder, with multiple reproductive and metabolic phenotypes which differently affect the early- and long-term syndrome’s risks. Women with PCOS present an adverse reproductive profile, including a high risk of pregnancy-induced hypertension, preeclampsia, and gestational diabetes mellitus. Patients with PCOS present not only a higher prevalence of classic cardiovascular risk factors, such as hypertension, dyslipidemia, and type-2 diabetes mellitus, but also of nonclassic cardiovascular risk factors, including mood disorders, such as depression and anxiety. Moreover, at the moment, clinical data on cardiovascular morbidity and mortality in women with PCOS are controversial. Finally, women with PCOS show an increased risk of endometrial cancer compared to non-PCOS healthy women, particularly during premenopausal period. Currently, we are unable to clarify if the increased PCOS early- and long-term risks are totally due to PCOS per se or mostly due to obesity, in particular visceral obesity, that characterized the majority of PCOS patients. In any case, the main endocrine and gynecological scientific societies agree to consider women with PCOS at increased risk of obstetric, cardiometabolic, oncology, and psychological complications throughout life, and it is recommended that these women be accurately assessed with periodic follow-up.

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Section: Management Of Early Complicationsmentioning

confidence: 99%

Section: Management Of Early Complicationsmentioning

confidence: 99%

Complications and challenges associated with polycystic ovary syndrome: current perspectives

Palomba¹,

Santagni²,

Falbo³

et al. 2015

IJWH

190

141

View full text Add to dashboard Cite

show abstract

“…A second- or third-line option in infertility treatment of PCOS is ovarian drilling, which is usually done via laparoscopy (laparoscopic ovarian drilling, LOD) [1]. Many studies have evaluated fertility outcome after LOD [3]. Given the fact that endometriosis seems to negatively affect oocyte quality [4], one might hypothesize that the success of LOD was influenced by the presence of concomitant endometriosis.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Hager

Wenzl

Riesenhuber

et al. 2019

JCM

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To evaluate the incidence of endometriosis in polycystic ovary syndrome (PCOS) patients who did not present with any endometriosis symptoms and underwent laparoscopic ovarian drilling (LOD) for clomiphene citrate (CC) resistance, 225 and 630 women with CC-resistant PCOS without classic endometriosis symptoms were included in a retrospective study and a meta-analysis, respectively. All women underwent LOD. The main outcome parameter was the prevalence of incidental endometriosis. Laparoscopy revealed endometriosis in 38/225 (16.9%) women (revised American Fertility Society (rAFS) stage I: 33/38, 86.8%; rAFS stage II: 5/38, 13.2%). When women with CC-resistant PCOS without endometriosis were compared, lower body mass index (BMI) and lower 25-hydroxy-vitamin D levels were associated with the presence of endometriosis at laparoscopy (odds ratios (OR): 0.872, 95% confidence intervals (95%CI): 0.792–0.960; p = 0.005 and OR: 0.980, 95%CI: 0.962–0.999; p = 0.036; respectively). The inclusion criteria for the meta-analysis were fulfilled by 4/230 reports about LOD. After correction for study heterogeneity, the pooled prevalence of incidental endometriosis was 7.7% in women with CC-resistant PCOS. In conclusion, the rate of incidental endometriosis in women with CC-resistant PCOS might reflect the prevalence of asymptomatic endometriosis. All cases were affected by minimal or mild disease. Since the literature lacks reports on associated clinical outcomes, the relevance of this entity in such patients should be the subject of further studies.

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“…All ovarian drilling procedures result in reproductive endocrine changes [12,13]. It is not known which of these changes are the result of ovarian drilling and which are related to the surgery per se.…”

Section: Discussionmentioning

confidence: 99%

Primum Non Nocere

Allahbadia

2015

J Obstet Gynecol India

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Surgical ovarian wedge resection was the first established treatment for women with anovulatory polycystic ovary syndrome (PCOS) but was largely abandoned both due to the risk of postsurgical adhesions and the introduction of medical ovulation induction. Laparoscopic ovarian drilling (LOD) is an alternative method to induce ovulation in PCOS patients with clomiphene citrate resistance instead of gonadotropins. Surgical therapy with LOD may avoid or reduce the need for gonadotropins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve. In over-enthusiastic hands, this day-care procedure might lead to iatrogenic premature ovarian failure in young women. Some trials have compared LOD with gonadotropins, but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies. Today, evidence-based reviews conclude that there is no evidence of a significant difference in rates of clinical pregnancy, live birth or miscarriage in women with clomiphene-resistant PCOS undergoing LOD compared to other medical treatments. The reduction in multiple pregnancy rates in women undergoing LOD is the only pro-LOD argument. However, there are ongoing serious concerns about the long-term effects of LOD on ovarian function.

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Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome

Cited by 43 publications

References 93 publications

Complications and challenges associated with polycystic ovary syndrome: current perspectives

Complications and challenges associated with polycystic ovary syndrome: current perspectives

The Prevalence of Incidental Endometriosis in Women Undergoing Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome: A Retrospective Cohort Study and Meta-Analysis

Primum Non Nocere

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