Ultrasonographic guided ovarian stroma hydrocoagulation for ovarian stimulation in polycystic ovary syndrome

Abstract

Objective. To evaluate the safety and effectiveness of transvaginal ultrasound guided injection of hot saline into the ovarian stroma in polycystic ovary syndrome (PCOS) cases in an office based gynecology practice under local anesthesia. Setting. Outpatient gynecologic clinic. Study design. Pilot study. Participants. Fifty-two anovulatory infertile females diagnosed as PCOS by clinical, chemical and ultrasound criteria were recruited for the study. All cases were resistant to clomiphene citrate for more than 6 months. Intervention. Injection of warm sterile saline (75C) into the ovarian stroma under transvaginal monitoring using ovum pickup needle. Outcome measures. Cycle regularity, ovulation rate and safety were primary outcomes. Pregnancy rate and patient convenience were our secondary outcomes. Results. Ovulation has been achieved in 73.1% of clomiphene citrate resistant PCOS cases and resulted in pregnancy in 26.9% of these cases. No adverse effects were recorded and the procedure was tolerable in most cases. Conclusion. Transvaginal ultrasound guided ovarian stroma hydrocoagulation (TOSH) in an office setting seems to be a safe, economic and practical procedure that is acceptable by the patients. If larger studies confirm its effectiveness it may be an attractive alternative to conventional ovarian drilling.

RETRACTED: Ultrasound-guided transvaginal ovarian needle drilling (UTND) for treatment of polycystic ovary syndrome: a randomized controlled trial

“…The cumulative pregnancy rate after ovarian surgery for PCOS is approximately 55%, which is similar to that obtained by medical induction of ovulation (5)(6)(7). To date, several techniques of laparoscopic surgery have been described, including ovarian biopsy (8), ovarian electrocautery (9,10), laser ovarian drilling (11), and ovarian hydrocoagulation (12). Nevertheless, laparoscopic ovarian drilling is costly and requires hospital treatment and general anesthesia, and the risk of postoperative adhesions cannot be ignored (7).…”

Laparoscopic ovarian drilling (LOD) in patients with polycystic ovary syndrome (PCOS): an alternative approach to medical treatment?

“…The same technique was used by Casa et al [41], giving a 66% ovulation rate and a cumulative pregnancy rate of 76% after 6 months, although 5 of 13 pregnancies needed additional hormonal stimulation [41]. Ramzy et al [73] treated 52 patients by ultrasound-guided transvaginal injection of warm saline (75°C) transvaginally into the ovarian stroma. Ovulation could be achieved in 73.1% of patients, resulting in a pregnancy rate of 26.9%.…”

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

“…In the per woman analysis, the effect size in 12 studies (Amer et al, 2002(Amer et al, , 2004Nasr, 2010;Ott et al, 2009;Palomba et al, 2010;Zhu et al, 2010, Palomba, unpublished observations, Abu Hashim et al, 2010, 2011aRamzy et al, 2001;Zakherah et al, 2010) favoured lean patients and the other two studies (Al-Ojaimi, 2003;Poujade et al, 2011) favoured obese PCOS women in terms of the ovulation outcome. Nevertheless, the strongest effect size was for the studies by Abu Hashim et al, which were large trials with good quality scores.…”

“…Although the author was contacted, there was no response by the time of submission of this manuscript. Therefore, 14 published research reports and one unpublished paper were included in this meta-analysis (Al-Ojaimi, 2003;Amer et al, 2002Amer et al, , 2004Nasr, 2010;Ott et al, 2009;Palomba et al, 2010;Zhu et al, 2010, Palomba, unpublished observations, Abu Hashim et al, 2010, 2011aPoujade et al, 2011;Ramzy et al, 2001;Zakherah et al, 2010). The final 15 studies meeting the inclusion criteria and included in this meta-analysis are summarized in Table 1.…”