Serum anti-Mullerian hormone levels after ovarian drilling for the second-line treatment of polycystic ovary syndrome: a pilot-randomized study comparing laparoscopy and transvaginal hydrolaparoscopy

Abstract

Aim of the study was to asses and compare serum anti-Mullerian harmone (AMH) levels after laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL) ovarian drilling in clomifene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients; secondary outcome was to evaluate postoperative pain to estimate the acceptability of procedures. A total of 246 patients with CC-resistant PCOS were randomized into two groups: 123 underwent LOD and 123 underwent THL ovarian drilling. AMH serum levels were evaluated before and after the procedure; moreover, women were asked to rate pain on a visual analog scale (VAS) from 0 (no pain, perfectly acceptable) to 10 (unbearable pain, completely unacceptable). In both groups, postoperative serum AMH levels were significantly reduced compared to preoperative levels (6.06 ± 1.18 and 5.84 ± 1.16 versus 5.00 ± 1.29 and 4.83 ± 1.10; p < 0.0001). Comparing postoperative serum AMH levels, no statistically significant difference was observed between the two surgical technique. After the procedure, mean pain VAS score was significantly higher for women who underwent LOD ovarian drilling in comparison to THL (3.26 ± 1.1 versus 1.11 ± 0.5; p < 0.0001). In conclusion, THL ovarian drilling is comparable to the LOD in terms of reduction in AMH, but it is preferred by patients in terms of acceptability. These results could support to use of THL ovarian drilling in the treatment of patients with CC- resistant PCOS.

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

“…The two arms of this RCT were combined and used as a cohort study in the overall analysis, and then each arm was included separately in subgroup analysis. The other RCT compared laparoscopic vs transvaginal hydro-LOD (TH-LOD) (Giampaolino et al 2016). Only the LOD group of this RCT was included as a cohort study in the current metaanalysis (Giampaolino et al 2016).…”

“…This systematic review included five cohort studies (Amer et al 2009, Elmashad 2011, Farzadi et al 2012, Seyam et al 2014, Sunj et al 2014a) and two RCTs (Giampaolino et al 2016, Rezk et al 2016. The RCT by Rezk and coworkers (Rezk et al 2016) compared unilateral vs bilateral LOD.…”

“…www.reproduction-online.org Farzadi et al 2012, Sunj et al 2014a, Syam et al 2014, Giampaolino et al 2016, Rezk et al 2016. However, given the relatively small numbers of patients included in these studies, further evidence is required to allow a firm conclusion.…”

“…The mean ± s.d. was also missing for AFC in two studies (Farzadi et al 2012, Sunj et al 2014a and for FSH in four studies (Weerakiet et al 2007, Sunj et al 2014a, Giampaolino et al 2016, Rezk et al 2016. We obtained the mean ± s.d.…”

“…of serum AMH and FSH levels from the original data of our previous study (Amer et al 2009). Authors of other studies were contacted and three (Sunj et al 2014a, Giampaolino et al 2016, Rezk et al 2016 responded providing the missing data.…”