RETRACTED ARTICLE: Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial

Hashim, Hatem Abu; Foda, Osama; Ghayaty, Essam; Elawa, Ahmed

doi:10.1007/s00404-011-1983-x

Cited by 18 publications

(10 citation statements)

References 27 publications

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“…Nevertheless, the strongest effect size was for the studies by Abu Hashim et al, which were large trials with good quality scores. The QE model RR for all 14 data sets that reported this outcome was 1.43 (95% CI 1.22-1.66) suggesting that the lean -Ojaimi (2003) 21.6 ± 2.5 32.9 ± 5.0 Amer et al (2002) 22.2 ± 1.4 30.3 ± 3.5 Amer et al (2004) 22.2 ± 1.5 30.1 ± 3.7 Poujade et al (2011) 22.7 ± 3.4 28.8 ± 3.0 Zhu et al (2010) 22.4 ± 2.1 26.7 ± 2.8 Nasr (2010) 22.1 ± 1.3 30.4 ± 2.1 Abu Hashim et al (2010) 21.7 ± 1.5 32.6 ± 2.1 Abu Hashim et al (2011a) 22.1 ± 1.2 32.4 ± 2.2 Abu Hashim et al (2011b) 21.8 ± 1.6 32.3 ± 2.3 Abu Hashim et al (2011c) 21.4 ± 2.1 28.2 ± 2.7 Ramzy et al (2001) 23.3 ± 1.1 28.6 ± 2.2 Zakherah et al (2010) 23.1 ± 1.5 31.1 ± 1.9 PCOS women had 43% increase in ovulation rate after OAT compared with obese PCOS women (Figure 2). The RE model RR is depicted for comparison in Supplementary Figure S1.…”

Section: Primary Outcome: Ovulation Ratesmentioning

confidence: 99%

“…The final 15 studies meeting the inclusion criteria and included in this meta-analysis are summarized in Table 1. In two studies, only ovulation per women data (Abu Hashim et al, 2011a) or pregnancy per women data (Abu Hashim et al, 2011c) was available. Seven studies were randomized controlled trials (RCT) (Abu Hashim et al, 2010Hashim et al, , 2011bNasr, 2010;Palomba et al, 2010;Zakherah et al, 2010;Zhu et al, 2010), the rest being cohort studies.…”

Section: Characteristics Of Studies and Subjectsmentioning

confidence: 99%

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Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis

Baghdadi

Hashim

Amer

et al. 2012

Reproductive BioMedicine Online

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Obesity is known to interfere with reproductive outcomes in polycystic ovary syndrome. There is no consensus regarding the impact of obesity on reproductive outcomes after ovarian ablative therapy (OAT) and there is no level I evidence to answer this question. This systematic review and meta-analysis assessed the strength of the association between obesity and ovulation or pregnancy rates after OAT. MEDLINE and several other databases were searched from 2000 to September 2011 for studies reporting on OAT and reproductive outcomes. Data were synthesized to determine the relative risk of reproductive outcomes (ovulation and pregnancy) in lean (body mass index <25 kg/m(2)) compared with overweight or obese women. The study obtained 15 data sets (14 articles) for analysis, which included 905 subjects in the obese group and 879 subjects in the lean group. Lean women had increased ovulation rates (RR 1.43, 95% CI 1.22-1.66) compared with obese women. Pregnancy rates also showed a similar trend (RR 1.73, 95% CI 1.39-2.17). Reproductive outcomes were generally better in younger women, more recent studies and randomized controlled trials. It is concluded that lean women respond better to OAT than their obese counterparts. These epidemiological observations indicate that obesity alters reproductive outcomes after OAT negatively. Obesity is known to interfere with reproductive outcomes in polycystic ovary syndrome. There is no consensus regarding the impact of obesity on ovarian ablative therapy (OAT) and there is no level I evidence to answer this question. We therefore undertook a systematic review and meta-analysis to assess the strength of the association between obesity and ovulation or pregnancy rates after OAT. We searched MEDLINE and several other databases from 2000 to September 2011 for studies reporting on OAT and reproductive outcomes. Data were synthesized to determine the risk ratio of reproductive outcomes (ovulation and pregnancy) in lean (BMI <25 kg/m(2)) as opposed to overweight or obese women. We obtained 15 datasets (14 articles) for analysis, which included 905 subjects in the obese group and 879 subjects in the lean group. Lean women had increased ovulation rates (RR 1.43, 95% CI 1.22-1.66) as compared to obese women. Pregnancy rates also showed a similar trend (RR 1.73, 95% CI 1.39-2.17). Reproductive outcomes were generally better in younger women, more recent studies and randomized controlled trials. We conclude that lean women respond better to OAT than their obese counterparts. These epidemiological observations indicate that obesity alters reproductive outcomes after OAT negatively.

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Section: Primary Outcome: Ovulation Ratesmentioning

confidence: 99%

Section: Characteristics Of Studies and Subjectsmentioning

confidence: 99%

Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis

Baghdadi

Hashim

Amer

et al. 2012

Reproductive BioMedicine Online

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“…The authors concluded that LOD is not superior to CC as a Wrst-line treatment of ovulation induction in women with PCOS [69]. Moreover, in a recent RCT, we compared the eYcacy of LOD versus continuation of CC for up to six further cycles in 176 infertile PCOS patients who failed to achieve pregnancy despite previous successful CC induced ovulation [70]. The clinical pregnancy rate per patient and the cumulative pregnancy rate after six cycles were comparable in both groups (39 vs. 33.7% and 47 vs. 39.2%, respectively).…”

Section: Laparoscopic Ovarian Diathermy (Lod)mentioning

confidence: 94%

“…Miscarriage and live birth rates were comparable in both groups. Accordingly, we concluded that LOD during the 6 months follow up period and CC for up to six further cycles are equally eVective for achieving pregnancy in CC failure PCOS patients [70].…”

Section: Laparoscopic Ovarian Diathermy (Lod)mentioning

confidence: 98%

Clomiphene citrate alternatives for the initial management of polycystic ovary syndrome: an evidence-based approach

Hashim

2012

Arch Gynecol Obstet

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Polycystic ovary syndrome (PCOS) is a prevalent and heterogeneous condition affecting 4-8% of reproductive age women. It is the most common cause of chronic anovulation and is associated with hyperandrogenemia. Clomiphene citrate (CC) is considered as the first-line therapy for ovulation induction in these patients. Despite progress in understanding the pathophysiology of PCOS over the past 20 years, many questions persist to the extent that PCOS was described as "A Riddle Wrapped in a Mystery inside an Enigma". On the other hand, a recent publication from the Centers for Disease Control suggested that CC may be associated with an increased risk of birth defects. The purpose of this review is to critically evaluate and summarize the current literature regarding CC alternatives for the initial management of PCOS focusing specifically on the roles of weight loss and other approaches to ovulation induction as insulin-sensitizing drugs, aromatase inhibitors, minimal stimulation protocol, gonadotrophins and surgery (laparoscopic ovarian drilling). Finally, the efficacy of intrauterine insemination with CC for the initial management of PCOS will be evaluated.

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“…[ 6 9 10 11 15 ] Royal College of Obstetricians and Gynecologists,[ 16 ] American College of Obstetricians and Gynecologists,[ 17 ] Society of Obstetricians and Gynecologists, Canada[ 8 ] and the recent PCOS consensus working group[ 4 ] — All recommend its use in highly selected cases, particularly in those with hypersecretion of luteinizing hormone (LH), normal body mass index, those needing laparoscopic assessment of the pelvis or who live too far away from the hospital for the intensive monitoring required during gonadotropin therapy. Despite its theoretical advantages, LOD is not superior to CC, neither as a first line therapy for OI[ 11 18 ] nor for CC-failure[ 19 ] or prior to in vitro fertilization (IVF). [ 11 ] A recent Cochrane systematic review of 9 RCTs and 16 trials concluded that there was no evidence of a significant difference in rates of clinical pregnancy (39.7 vs. 40.5%) or live birth (34 vs. 38%) in women with clomiphene-resistant PCOS undergoing LOD compared to other medical treatments.…”

Section: Methodsmentioning

confidence: 99%

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

Mitra¹,

Nayak²,

Agrawal³

2015

J Nat Sc Biol Med

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Since its introduction in 1984, laparoscopic ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with polycystic ovary syndrome (PCOS), unresponsive to clomiphene citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates, but without the risks of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long. Despite its advantages, its use in unselected cases of PCOS or for non-fertility indications is not prudent owing to the potential risks of iatrogenic adhesions and ovarian insufficiency.

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RETRACTED ARTICLE: Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial

Abstract: LOD during the 6 months follow-up period and CC for up to six further cycles are equally effective for achieving pregnancy in CC failure PCOS patients.

Cited by 18 publications

References 27 publications

Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis

Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis

Clomiphene citrate alternatives for the initial management of polycystic ovary syndrome: an evidence-based approach

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

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