The effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, LH/FSH ratio and inhibin B

Abstract

Background:Where laparoscopic ovarian surgery is to be recommended, there may be a small associated risk of lower ovarian reserve or loss of ovarian function. Based on its activities, Anti-Müllerian hormone (AMH) has been proposed to be involved in the pathophysiology of polycystic ovary syndrome (PCOS). AMH has become a useful clinical marker of ovarian reserve (OR) and reproductive disease in women. Its clinical utility has been expanding in scope for use in monitoring ovarian reserve, response to in vitro fertilization protocols, and diagnosis of ovarian diseases such as primary ovarian insufficiency and polycystic ovary syndrome (PCOS). Aim: Comparing AMH to other parameters of ovarian reserve (OR) in evaluating the effect of laparoscopic ovarian drilling (LOD) on OR in treatment of PCO. Patients and Methods: It is a prospective comparative clinical trial study. Serum AMH along with other parameters of OR measurement (LH/FSH ratio and Inhibin B) were done before and after LOD in forty eight PCO women. This study was conducted in Ain Shams University Maternity Hospital. The patients were recruited from the gynecologic outpatient clinic of Ain-Shams University Hospital from January 2014 to December 2017 (about four years). Results: Eight cases of our studied patients got pregnant within the first three months postoperative after LOD and six cases got pregnant after three months. The total number of cases that got pregnant was 14 out of 48 cases before excluding the 8 cases that got pregnant before 3 months (29.16⁒). The mean AMH level before the operation was 6.9 ± 1.4 ng/ml and 8.2 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. While the mean AMH level after 3 months of the operation was 5.1 ± 1.1 ng/ml and 6.3 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. The mean LH/FSH ratio before the operation was 2.04 ± 0.5 and 3.02 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. While the mean LH/FSH ratio after 3 months of the operation was 1.15 ± 0.2 and 1.93 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. The mean inhibin B level before the operation was 52.5 ± 2.2 pg/ml and 52.6 ± 3.9 pg/ml for the patients who got pregnant and those who did not get pregnant ,respectively. While the mean inhibin B level after 3 months of the operation was 48.3 ± 2.1 pg/ml and 49.1 ± 3.6 pg/ml for the patients who got pregnant and those who did not get pregnant, respectively. Lower preoperative AMH levels and LH/FSH ratio and after 3 months postoperatively were associated with increased pregnancy rates in patients who conceived compared to those who did not conceive (p=0.004) and (p=0.002) preoperative versus (p=0.003) and (p=0.004) postoperative, respectively. On the other hand, preoperative and 3 month's postoperative levels of Inhibin B had no effect on pregnancy rates (p=0.954) and (p=0.582). Conclusion:Pregnancy rates were significantly related to t...

Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review

“…Anti-Mullerian hormone: While it is clear that there is a decrease in the ovarian reserve and volume following LOD, there is some discrepancy in the alterations in AMH concentrations. The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ].…”

“…The average amount of AMH present in patients with PCOS was 8.57 ng/mL, which is significantly higher than in healthy controls in most studies [ 7 , 11 - 14 , 16 - 18 , 23 , 27 , 28 , 30 , 31 , 33 , 34 , 37 , 40 , 41 ]. Hendriks et al observed a significant and immediate decrease in AMH concentrations following LOD, whereas the majority of studies found it continued for six months with an average decrease of 36.92% [ 7 , 11 , 12 , 14 , 17 , 20 - 23 , 27 , 29 - 31 , 33 , 34 , 40 - 42 ]. Ogawa et al observed that when compared to preoperative AMH concentrations, there was a 0.55% change in overall AMH concentrations per puncture in all patients.…”

“…Luteinizing hormone/follicle-stimulating hormone ratio: In PCOS, with the increase in LH and decrease in FH, there is an increase in the LH/FSH ratio, which was documented to be at an average of 2.3 [ 8 - 11 , 13 - 15 , 22 , 25 - 27 , 33 - 35 , 38 ]. Al-Ojaimi observed that the LH/FSH ratio was elevated in 45.9% of female participants [ 8 ].…”

The effect of laparoscopic ovarian drilling on pregnancy outcomes in polycystic ovary syndrome women with more than 2 in-vitro fertilization cycle failures: A pilot RCT

“…Laparoscopic ovarian drilling (LOD) appears useful in women with PCOS who do not respond to drug treatment and have no other reasons for infertility. This surgery method is a modified type of ovarian wedge resection (less invasive) during this process, the vascular stroma is destroyed (7). The purpose of this procedure is to increase follicular growth by reducing the amount of androgen and attenuating luteinizing hormone (LH) levels, and enhancing follicle-stimulating hormone (FSH) and sex hormone-binding globulin (4).…”

“…The purpose of this procedure is to increase follicular growth by reducing the amount of androgen and attenuating luteinizing hormone (LH) levels, and enhancing follicle-stimulating hormone (FSH) and sex hormone-binding globulin (4). Both ovarian cauterization methods have been used through laparoscopy and carbon dioxide or neodymium-doped yttrium aluminum garnet lasers to create multiple holes in the ovarian and sternal surfaces (5,7).…”