Comparison Laparoscopic Ovarian Drilling Success Between Two Standard and Dose-Adjusted Methods in Polycystic Ovary Syndrome

Purpose: One of the treatment methods for increasing the ovarian response to ovulation induction in polycystic ovary syndrome (PCOS) is laparoscopic ovarian drilling (LOD). The optimal amount of the electrosurgical energy discharged in the ovaries to achieve maximum treatment response with minimal follicle injury, is yet unknown. This study was performed to compare the success level of laparoscopic ovarian drillind by means of standard and dose-adjusted (on the basis of ovarian volume) treatment methods among infertile clomiphene resistant PCO women.Design: A randomized clinical trialMethods and Materials: This trial was conducted on infertile clomiphene citrate resistant PCOS women in the Gynecology department of Imam Reza Hospital between 2016 and 2017. The patients were randomly divided into two groups based on the ovarian cautery method: group A (standard method) and group B (cautery on the basis of ovarian volume). The two groups were examined and compared regarding the antral follicles, serum level of AMH and androgens and midluteal progesterone one month after the operation. Regularity of cycles, ovulation and pregnancy were examined monthly up to 6 months of the operation. The significance level was set at P<0.05.Results: In total 60 women received bilateral LOD (n=30 per group). The level of AMH, testosterone and DHEAS was not significantly different at study entrance (P= 0.73, 0.91 and 0.16, respectively). The same result was obtained after one month of ovarian cautery (P= 0.94, 0.46 and 0.12, respectively) and also for postoperative midluteal progesterone (P = 0.31). Regarding intragroup comparisons, the decrease in the number of antral follicles and testosterone in group A (P = 0.02) and AMH level in group B (P = 0.04) was statistically significant. During the 6 months after treatment, the two groups had no meaningful difference in the cycles regularity, ovulation and pregnancy (P= 0.22, 0.11 and 0.40, respectively)Conclusion: According to the results of this study, none of the two methods of ovarian cautery has priority to the other with regard to establishing cycles, regularity and ovulation, but both methods are highly effective in establishing regular cycles. Moreover, the standard treatment was effective on decreasing the numbers of antral follicles and testosterone level whereas the dose-adjusted method significantly affected the decrease in AMH level. Therefore conducting similar studies with a larger samples size is highly recommended.

کلیدواژه ها:

Polycystic ovary syndrome ، PCOS ، Infertility ، Laparoscopic ovarian drilling ، Ovarian volume