Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate

Debras, Elodie; Fernandez, H.; Neveu, ME; Deffieux, X.; Capmas, P.

doi:10.1016/j.eurox.2019.100093

Cited by 23 publications

(25 citation statements)

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“…Polycystic ovary syndrome is a gynecological disease that causes anovulation. Ovary wedge resection or ovarian drilling methods have been used as surgical approaches to stimulate follicular development and achieve ovulation [18,19]. The mechanism of action of the ovarian drilling method is unclear [20].…”

Section: Discussionmentioning

confidence: 99%

Comparison of ovarian striation and ovarian fragmentation in a rat model of ovarian insufficiency

Okçu¹,

Külahçı²,

Dağlıoğlu³

et al. 2021

Journal of Surgery and Medicine

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Background/Aim: Primary ovarian insufficiency (POI) is defined as the depletion of the primordial follicle pool in women under the age of 40. New methods for stimulating ovarian follicle cells are being investigated in order to ensure the continuity of the menstrual cycle and fertility. The present study aimed to compare follicle reserves after ovarian striation or ovarian fragmentation in rats with ovarian insufficiency. Methods: Thirty adult female rats in the estrus phase were randomized into three groups. Group 1 and Group 2 were medicated with intraperitoneal 7.5 mg/kg paclitaxel to create ovarian insufficiency. Group 3 was the control group, and intraperitoneal 3 mL 0.9% sterile saline solution was administered. The first laparotomy was performed to evaluate ovarian insufficiency 1 week after chemotherapy. In Group 1, the right ovarian cortex was striated using an insulin injector. In Group 2, the right ovary was divided into five parts. These five pieces were transferred to the pocket created under the right pelvic peritoneum. In Group 3, only laparotomy was performed. After 1 month, all rats underwent a second laparotomy, and the number of ovarian follicles (primordial, primary, secondary, antral) were compared, as were their serum follicle-stimulating hormone (FSH) and estradiol (E2) levels. Results: There was a significant difference in the number of follicles among all three groups (P<0.05). The number of follicles (primordial, primary, secondary, antral) was significantly higher in the striated group than in the fragmented group (P<0.001). There were no statistically significant differences between the three groups in terms of mean serum FSH and E2 values measured at the second laparotomy (P>0.05). Conclusion:Ovarian striation on the ovary cortex may be a new method for the treatment of ovarian insufficiency.

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Section: Discussionmentioning

confidence: 99%

Comparison of ovarian striation and ovarian fragmentation in a rat model of ovarian insufficiency

Okçu¹,

Külahçı²,

Dağlıoğlu³

et al. 2021

Journal of Surgery and Medicine

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“…Nevertheless, LOD may have some advantages, such as the absence of adverse effects related to a thin endometrium and increased cervical mucus after applying CC-ovulation induction in PCOS women with anovulation [56]. Table 1 provides a summary of some studies focusing on LOD procedures to ameliorate reproductive performance in CC-resistant PCOS women [31,38,39,42,66,[116][117][118][119][120][121][122].…”

Section: Ovulation and Pregnancy Rates After Laparoscopic Ovarian Drimentioning

confidence: 99%

“…Seyam and Hefzy identified that a higher BMI (≥25 kg/m 2 ), longer duration of infertility (≥3 years), marked biochemical hyperandrogenism (testosterone levels ≥ 4.5 nmol/L, free androgen index > 15), and high IR are associated with a poor response after LOD [108]. Debras found several predictive factors for the effectiveness of using LOD in the management of PCOS women, including a normal BMI, an infertility period of less than three years, antral follicle counts (AFC) < 50, and an age of <35 years of age [66]. Seyam and Hefzy also found that PCOS women with higher preoperative levels of TNF-α, LH, and androstenedione had a statistically significantly higher rate of spontaneous ovulation during the first three months after the LOD procedure [109].…”

Section: Predictors Of Success After Laparoscopic Ovarian Drillingmentioning

confidence: 99%

“…In this situation, ovulation rates can reach 83%, and the pregnancy rate can be up to 67% [131]. A recent French study evaluating 289 PCOS women after LOD with a mean follow-up of 28.4 months found that nearly half of the patients became pregnancy (47.4%, 137/289) and nearly one-fifth (16.6%, 48/289) achieved at least two pregnancies [66]. Among these pregnancies, more than half of the patients (51.8% [71/137] in a single pregnancy and 56.3% [27/48] in at least two pregnancies) conceived spontaneously [66].…”

Section: Long-term Effects Of Laparoscopic Ovarian Drillingmentioning

confidence: 99%

“…Some women without any identified infertility factors who still fail to ovulate after the application of active medications may be good candidates for LOD. Furthermore, some PCOS women may have other surgical indications for infertility, such as tubal factors, endometriosis, and others, highlighting the use of LOD simultaneously during laparoscopic surgery as a good choice [64][65][66]. Therefore, it is worth re-visiting the role of LOD for PCOS women.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Seow¹,

Chang

Chen

et al. 2020

IJMS

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Polycystic ovary syndrome (PCOS) is a common endocrinopathy, characterized by chronic anovulation, hyperandrogenism, and multiple small subcapsular cystic follicles in the ovary during ultrasonography, and affects 5–10% of women of reproductive age. PCOS is frequently associated with insulin resistance (IR) accompanied by compensatory hyperinsulinemia and, therefore, presents an increased risk of type 2 diabetes mellitus (DM). The pathophysiology of PCOS is unclear, and many hypotheses have been proposed. Among these hypotheses, IR and hyperandrogenism may be the two key factors. The first line of treatment in PCOS includes lifestyle changes and body weight reduction. Achieving a 5–15% body weight reduction may improve IR and PCOS-associated hormonal abnormalities. For women who desire pregnancy, clomiphene citrate (CC) is the front-line treatment for ovulation induction. Twenty five percent of women may fail to ovulate spontaneously after three cycles of CC treatment, which is called CC-resistant PCOS. For CC-resistant PCOS women, there are many strategies to improve ovulation rate, including medical treatment and surgical approaches. Among the various surgical approaches, one particular surgical method, called laparoscopic ovarian drilling (LOD), has been proposed as an alternative treatment. LOD results in an overall spontaneous ovulation rate of 30–90% and final pregnancy rates of 13–88%. These benefits are more significant for women with CC-resistant PCOS. Although the intra- and post-operative complications and sequelae are always important, we believe that a better understanding of the pathophysiological changes and/or molecular mechanisms after LOD may provide a rationale for this procedure. LOD, mediated mainly by thermal effects, produces a series of morphological and biochemical changes. These changes include the formation of artificial holes in the very thick cortical wall, loosening of the dense and hard cortical wall, destruction of ovarian follicles with a subsequently decreased amount of theca and/or granulosa cells, destruction of ovarian stromal tissue with the subsequent development of transient but purulent and acute inflammatory reactions to initiate the immune response, and the continuing leakage or drainage of “toxic” follicular fluid in these immature and growth-ceased pre-antral follicles. All these factors contribute to decreasing local and systemic androgen levels, the following apoptosis process with these pre-antral follicles to atresia; the re-starting of normal follicular recruitment, development, and maturation, and finally, the normalization of the “hypothalamus–pituitary–ovary” axis and subsequent spontaneous ovulation. The detailed local and systematic changes in PCOS women after LOD are comprehensively reviewed in the current article.

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