Tumor necrosis factor alpha versus LH and androstendione as a reliable predictor of spontaneous ovulation after laparoscopic ovarian drilling for women with clomiphene citrate resistance polycystic ovarian disease

Seyam, Emaduldin; Hefzy, Enas

doi:10.1016/j.ejogrb.2018.01.011

Cited by 7 publications

(6 citation statements)

References 37 publications

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“…Further supporting evidence is that the levels of the insulin receptors, GLUT-4 and PI3K, were all increased after LOD [93]. Finally, the evidence indicates that LOD can successfully reduce serum insulin-like growth factor-1 (IGF-1) levels, which may contribute to the improved IR status of PCOS women [55][56][57][107][108][109][110]. All this evidence provides a rationale to use LOD to overcome anovulation and IR.…”

Section: Metabolic Effects Of Laparoscopic Ovarian Drillingmentioning

confidence: 87%

“…By contrast, El Behery et al found that the LOD procedure can statistically significantly decrease the serum levels of VEGF, as well as the ovarian stromal blood flow Doppler levels, in PCOS women [106]. Increasing evidence indicates that LOD procedures can successfully reduce serum VEGF and also decrease ovarian blood flow velocities [55][56][57][107][108][109][110] (Figure 3). angiogenesis process, both before and after LOD [1,55,57,102].…”

Section: Possible Molecular Mechanisms Of Laparoscopic Ovarian Drillingmentioning

confidence: 96%

“…It is also known that the over-heating and over-electro-cauterization of polycystic ovaries may further result in a continuous decline in AMH. Many studies have shown that LOD procedures can successfully reduce serum AMH levels [55][56][57][107][108][109][110]. However, it remains uncertain whether this result reflects real damage to the ovarian reserve or only provides normalization from high serum AMH in POCS women before LOD.…”

Section: Metabolic Effects Of Laparoscopic Ovarian Drillingmentioning

confidence: 99%

“…A decrease in androgen production is one of the most commonly detectable changes after LOD [94][95][96][97]. Evidence indicates that LOD can successfully reduce serum androgen levels [55][56][57][107][108][109][110]. In this way, the hyperandrogenism associated with metabolic events can be consequently changed [60].…”

Section: Metabolic Effects Of Laparoscopic Ovarian Drillingmentioning

confidence: 99%

“…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%

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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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