Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility

Abstract

INTRODUCTIONPolycystic ovarian syndrome (PCOS) is the commonest hyperandrogenic disorder in women and one of the most common causes of anovulatory infertility, with an estimated prevalence of 4-7% worldwide. 1 It is an overdiagnosed and disproportionately treated condition.Lifestyle modification, weight loss, and exercise form the first line of treatment in infertile women with PCOS. 2The recommended first-line drug for ovulation induction remains clomiphene citrate (CC), while metformin is helpful in cases with glucose intolerance, or those with a BMI >35 kg/m. 3 ABSTRACT Background:The current study aims to estimate additional values of laparoscopic intervention for diagnosis and treatment of concomitant pelvic pathologies among infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS) subjected to laparoscopic ovarian drilling (LOD) in comparison to non-PCOS infertile women subjected to diagnostic/therapeutic laparoscopy. Methods: A prospective cross sectional observational study was carried out in the Endoscopic unit of a tertiary care university hospital. The study included 232 infertile women planned for laparoscopy were divided into a study group A (116 cases) with clomiphene-resistant PCOS and a control group B (116 cases) without PCOS. Each group was further subdivided into two subgroups according to the presence and absence of risk factors (RF) for adhesion formation. Diagnostic/operative laparoscopy was done. The main study outcome was the prevalence of any pelvic abnormalities seen during laparoscopy. Results: Both groups showed insignificant difference regarding socio-demographic history and basic data. Laparoscopy detected pelvic pathologies in 44 cases (37.9%) and 86 cases (74.1%) in both groups respectively. In group A, we diagnosed pelvic pathologies in 29 (32.6%) and 15 (55.6%) cases with and without RF respectively while in group B they were diagnosed in 76 (84.4%) and 10 (38.5%) cases with and without RF respectively. If compared to women with unexplained infertility, PCO patients without risk factors have an insignificant but higher prevalence of pelvic abnormalities. All concomitant pelvic pathologies in both groups were treated on a one-stop (see and treat) basis. Conclusions: Detection and proper management of associated pelvic pathologies at laparoscopy is a valuable additional advantage of LOD particularly in women with positive risk factors. LOD plus see and treat associated pathologies is a time saving and prompt management approach for women with PCO-associated infertility.