Studying the Effect of Laparoscopic Ovarian Drilling on Ovarian Reserve via Measurement of Anti-Mullerian Hormone in Polycystic Ovarian Syndrome Patients

Abstract

Background: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulation and it also causes other metabolic and endocrinal disorders. Lines of management of PCOS include several medical options in addition to laparoscopic ovarian diathermy (LOD). However, the effect of LOD on ovarian reserve has always been a concern. Advocates to LOD claimed that the decrease in ovarian reserve following LOD is merit not a drawback. Study Design: A case series study aimed at investigating the effect of LOD on Anti-Mullerian hormone (AMH) and trying to find the relation between AMH levels and success of LOD. Patients and Methods: The study was carried out on 30 clomiphene citrate resistant PCOS patients from EL Shatby maternity hospital. Hormonal profile including; FSH, LH, free testosterone, AMH and progesterone was done preoperatively and 3 months after LOD. Results: After LOD 19/30 cases (63.3%) had spontaneous ovulation. After LOD the mean AMH decreased significantly from 9.12 ng/ml to 7.66 ng/ml (p = 0.006*). Responders had significantly lower preoperative AMH as compared to non-responders (8.01 ng/ml Vs 10.01 ng/ml). Responders had a highly significant (p < 0.01) decrease in AMH post LOD while non-responders did not have a significant change in AMH level in responders. While in non-responders there was no significant change in AMH after LOD. Using ROC curve, pre-treatment AMH level of 7.7 ng/ml is a moderate predictor for patients who ovulated after LOD. Conclusion: Measurement of serum AMH concentration before LOD may be a useful tool in predicting responders to LOD and help in patient selection.

Anti-mullerian hormone levels before and after ovarian drilling in polycystic ovary syndrome: has this an effect on fertility?

“…In a prospective cohort study conducted by Paramu et al in India on 30 women with PCOS under laparoscopic ovarian drilling, there was a significant reduction of up to 33% in the serum AMH level in the post-treatment phase [ 22 ]. The results of Paramu et al and Gaafar et al’s studies were consistent with the present study [ 22 , 23 ].…”

The effect of laparoscopic ovarian drilling in patients with anovulatory polycystic ovary syndrome and high serum levels of anti-Müllerian hormone

“…[ 13 ] in Egypt showed a decrease in serum levels of AMH following both unilateral and bilateral LOD in women with PCOS, which is consistent with the findings of our study. Additionally, an Indian study showed that following LOD for PCOS, the concentration of AMH in 30 women decreased by as much as 33% [ 14 , 15 ]. Previous research indicated that a decrease in AMH levels after LOD is more indicative of a normalization phase than a dysfunctional occurrence.…”