Women with clomiphene citrate resistant polycystic ovarian disease: predictors of spontaneous ovulation after laparoscopic ovarian drilling

Abuelghar, Wessam; Bayoumy, Hassan Awwad; Ellaithy, Mohamed; Khalil, Marian S.

doi:10.1016/j.ejogrb.2014.01.016

Cited by 12 publications

(12 citation statements)

References 32 publications

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“…Regarding preoperative hormone levels, Abuelghar et al in a prospective study concluded that higher preoperative levels of LH, FSH and/or androstenedione were associated with higher rates of spontaneous ovulation within the first 8 weeks after LOD, but only FSH and androstenedione were independent predictive factors of success. 40 Two small prospective studies found that a higher plasma level of anti-Müllerian hormone before surgery could be an useful predictor of no ovulation after LOD. 41,42 In our study, most of these factors found to be useful predictors were not available in all patients or were not analysed.…”

Section: Discussionmentioning

confidence: 99%

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Luz¹,

Barros²,

Aguiar³

et al. 2016

Acta Med Port

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Introduction:Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. Material and Methods:This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conception in patients without other infertility factors.Results: Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). Discussion: Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. Conclusion: Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

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Section: Discussionmentioning

confidence: 99%

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Luz¹,

Barros²,

Aguiar³

et al. 2016

Acta Med Port

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“…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%

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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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“…Therefore, to achieve resumption of ovulation in every case, individualizing the amount of energy has been suggested. Many authors evaluated the value of clinical (ovarian volume) and laboratory markers for individualizing the amount of energy in OD [10][11][12][13][14] . Among these, Anti-Müllerian hormone (AMH), which is exclusively secreted by granulosa cells of pre-antral/small antral follicles (4-6 mm) [15,16] , seems to be a potential marker for energy-dose calculation.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Gradually Increasing Energy Dose on AMH Levels in Ovarian Drilling

Gürsoy

Kiseli²,

Pabuçcu³

et al. 2016

Gynecol Obstet Invest

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Background: To document alterations in Anti-Müllerian hormone (AMH) levels with different energy doses by monopolar cautery in ovarian drilling (OD) in rats. Methods: Forty Wistar rats were randomly divided into 4 groups that each contained 10 animals. Group A was the Sham group. Groups B, C and D were intervention groups to which OD was applied by monopolar cautery, with 20, 60 and 120 J/ovary, respectively. The total amount of energy was calculated using the following formula: energy (J) = power (W) × duration (s) × number of punctures. Results: The pre- and postoperative AMH levels for Groups A, B and C were not statistically and significantly different according to the Bonferroni correction (p > 0.0125). However, the postoperative AMH levels were significantly lower than the preoperative AMH levels in Group D (1.25 ng/ml (1.07-2.05) vs. 0.40 ng/ml (0.30-0.72); p = 0.012). Conclusions: AMH is a promising marker that can be used for the individualization of the energy dose to increase OD success, but the relationship between the energy and AMH has not been documented yet. This study demonstrates that postoperative changes in AMH levels could be observed only after a certain amount of energy was applied. Further experimental animal models are needed to conclusively address this issue.

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Women with clomiphene citrate resistant polycystic ovarian disease: predictors of spontaneous ovulation after laparoscopic ovarian drilling

Cited by 12 publications

References 32 publications

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

The Impact of Gradually Increasing Energy Dose on AMH Levels in Ovarian Drilling

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