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Slouha E, Segal J, White C, Pallotta T, Ghosh S, Clunes LA, Kollias TF. Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review. Cureus 2024; 16:e62092. [PMID: 38989366 PMCID: PMC11236422 DOI: 10.7759/cureus.62092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
We aimed to conduct a systematic review of the data in the literature on ovarian reserve and ovarian hormone following laparoscopic ovarian drilling (LOD). The PubMed, ScienceDirect, and ProQuest databases were comprehensively searched using a combination of keywords such as "ovarian reserve", "laparoscopic ovarian drilling", "luteinizing hormone", "follicle-stimulating hormone", "inhibin", "LH/FSH ratio", "ovulation", and "testosterone". All studies involving females of reproductive age who were officially diagnosed with polycystic ovarian syndrome (PCOS) and had undergone LOD with reported data concerning at least one of the following parameters were considered for inclusion: ovarian reserve, anti-Mullerian hormone (AMH), inhibin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH ratio, and testosterone. All the included studies were evaluated by the GRADE scale for bias and their findings were synthesized by four independent coauthors. A total of 38 studies involving 3118 female patients were included. Based on our findings, a significant number of participants experienced spontaneous ovulation along with a significant decrease in ovarian reserve, and a significant decrease in AMH, LH, and testosterone, with no significant changes in FSH and inhibin B. With the end goal of LOD being to improve fertility and pregnancy rates among females with PCOS, it is important to look at the first few steps that enable this. As expected, there was a significant improvement in ovulation while the ovarian reserve decreased. Along with the decrease in ovarian reserve, there was a significant normalization in AMH, LH, and testosterone levels. LOD may exert its main effects through the manipulation of the ovarian reserves.
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Affiliation(s)
- Ethan Slouha
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Jeremy Segal
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Colton White
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Theresa Pallotta
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Shanalyn Ghosh
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology, and Pharmacology, St. George's University School of Medicine, True Blue, GRD
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Baradwan S, Abuzaid M, Sabban H, Alshahrani MS, Khadawardi K, AlSghan R, Alnoury A, Bukhari IA, Alyousef A, Belancic A, Persad E, Abu-Zaid A. Transvaginal needle versus laparoscopic ovarian drilling in hormonal profile and pregnancy outcomes of polycystic ovary syndrome: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2023; 52:102606. [PMID: 37207714 DOI: 10.1016/j.jogoh.2023.102606] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/17/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder distinguished by a persistent absence of ovulation. Ovarian drilling is a recognized therapeutic approach for PCOS patients who are unresponsive to medication and can be performed through invasive laparoscopic access or less-invasive transvaginal access. The aim of this systematic review and meta-analysis was to assess the efficacy of transvaginal ultrasound -guided ovarian needle drilling with conventional laparoscopic ovarian drilling (LOD) in patients with PCOS. METHODS PUBMED, Scopus, and Cochrane databases were systematically searched for eligible randomized controlled trials (RCTs) from articles published from inception to January 2023. We include RCTs of PCOS that compared transvaginal ovarian drilling and LOD and reported on ovulation and pregnancy rates as the main outcome variable. We evaluated study quality using the Cochrane Risk of bias 2 tool. A random-effects meta-analysis was performed and the certainty of the evidence was assessed according to the GRADE approach. We registered the protocol prospectively in PROSPERO (CRD42023397481). RESULTS Six RCTs including 899 women with PCOS met the inclusion criteria. LOD was found to significantly reduce anti-Mullerian hormone (AMH) (SMD: -0.22; 95% CI: -0.38, -0.05; I2 = 39.85%) and antral follicle count (AFC) (SMD: -1.22; 95% CI: -2.26, -0.19; I2 = 97.55%) compared to transvaginal ovarian drilling. Our findings also indicated that LOD significantly increased the ovulation rate by 25% compared to transvaginal ovarian drilling (RR: 1.25; 95% CI: 1.02, 1.54; I2 = 64.58%). However, we found no significant difference between the two groups in terms of follicle stimulating hormone (SMD: 0.04; 95% CI: -0.26, 0.33; I2 = 61.53%), luteinizing hormone (SMD: -0.07; 95% CI: -0.90, 0.77; I2 = 94.92%), and pregnancy rate (RR: 1.37; 95% CI: 0.94, 1.98; I2 = 50.49%). CONCLUSION LOD significantly lowers circulating AMH and AFC and significantly increases ovulation rate in PCOS patients compared to transvaginal ovarian drilling. As transvaginal ovarian drillingremains a less-invasive, more cost-effective, and simpler alternative, further studies are warranted to compare these two techniques in large cohorts, with a particular focus on ovarian reserve and pregnancy outcomes.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, Muhayil General Hospital, Muhayil, Saudi Arabia
| | - Hussein Sabban
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Albaraa Alnoury
- Department of Obstetrics and Gynecology, Prince Mohammed Bin Abdulaziz National Guard Hospital, Madinah Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Andrej Belancic
- Department of Clinical Pharmacology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Emma Persad
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, Alfaisal University, Riyadh, Saudi Arabia; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.
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Abstract
PCOS remains one of the most intriguing endocrine disorders that physicians encounter even though it was first described over 80 years ago. Although the diagnostic criteria, nomenclature, and ideal therapeutic strategies are areas of active and ongoing debate, there is no doubt that we have made tremendous progress in improving the quality of life and reproductive outcomes of women who suffer from this wide-ranging disorder.
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Doster A, Rösner S, von Horn K, Strowitzki T, Germeyer A. Intraovarielle Extrauteringravidität nach In-vitro-Maturation bei polyzystischen Ovarien. GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Outcomes of in vitro fertilization cycles among patients with polycystic ovary syndrome following ovarian puncture for in vitro maturation. Int J Gynaecol Obstet 2016; 135:319-323. [DOI: 10.1016/j.ijgo.2016.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/16/2016] [Accepted: 08/24/2016] [Indexed: 11/15/2022]
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Giampaolino P, Morra I, Tommaselli GA, Di Carlo C, Nappi C, Bifulco G. Post-operative ovarian adhesion formation after ovarian drilling: a randomized study comparing conventional laparoscopy and transvaginal hydrolaparoscopy. Arch Gynecol Obstet 2016; 294:791-6. [DOI: 10.1007/s00404-016-4146-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/30/2016] [Indexed: 12/31/2022]
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Ma CH, Yang S, Qiao J, Yang Y, Liu P. Evaluation of the tissue damage of porcine ovaries after bipolar drilling under transvaginal hydrolaparoscopy--an in vitro experiment. Gynecol Endocrinol 2010; 26:549-53. [PMID: 20184485 DOI: 10.3109/09513591003632290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the tissue damage of in vitro porcine ovarian drilling in saline solution mimicking transvaginal hydrolaparoscopy (THL). STUDY DESIGN In vitro ovarian drilling with different current and activation time was applied on fresh porcine ovaries, 15 ovaries in each group and 2 punctures in each ovary. Drilling using 5-Fr bipolar needle was performed in saline solution mimicking THL, while saline solution rinsing the ovaries after monopolar electrocoagulation. RESULTS The monopolar drilling caused more tissue damage than the bipolar needle in saline (p < 0.01). The ratio of the damage of monopolar electrocoagulation (40 w, 3s) over that of bipolar diathermy in saline solution (70 w, 15 s) was 7.4 [(16.74 +/- 1.30) mm(3)/(2.27 +/- 0.49) mm(3)]. In the bipolar groups, the 70 w power set (15s and 20 s) caused significantly more tissue damage than the 50 w ones (p < 0.05), and the amount of damage was not stimulation time dependent (p > 0.05). CONCLUSION The tissue damage caused by monopolar electrocoagulation with 40 w for 3 s was about seven times of that caused by 5-Fr bipolar one in saline with 70 w for 15 s . In THL drilling using a 5-Fr bipolar electrode, the current is more crucial than stimulation time.
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Affiliation(s)
- Cai-Hong Ma
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
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Hackethal A, Ionesi-Pasacica J, Eskef K, Oehmke F, Münstedt K, Tinneberg HR. Transvaginal NOTES with semi-rigid and rigid endoscopes that allow adjustable viewing angles. Arch Gynecol Obstet 2010; 283:131-2. [PMID: 20336463 DOI: 10.1007/s00404-010-1430-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 03/08/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate semi-rigid and rigid endoscopes for transvaginal NOTES surgery. METHODS One rigid endoscope (EndoCAMeleon, KARL STORZ GmbH & Co. KG, Tuttlingen Germany) and one semi-rigid endoscope (EndoEYE LTF-VH, Olympus Deutschland GmbH, Hamburg, Germany) that allow adjustable viewing angles have been used during four transvaginal gynecological NOTES procedures for chronic pelvic pain and infertility. RESULTS Feasibility of transvaginal access to enter the abdominal cavity was shown. Posterior peritoneum, ovaries and tubal patency were evaluated. The evaluated endoscopes did not overcome the inability to explore the anterior pelvic structures. CONCLUSIONS Rigid and semi-rigid endoscopes that allow adjustable viewing angles during transvaginal NOTES approaches cannot explore the whole pelvic anatomical structures.
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Affiliation(s)
- A Hackethal
- Department of Gynaecology and Obstetrics, Justus-Liebig-Universiy Giessen, Klinikstrasse 32, Giessen, Germany.
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Mercorio F, Mercorio A, Di Spiezio Sardo A, Vincenzo Barba G, Pellicano M, Nappi C. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Fertil Steril 2008; 89:1229-1233. [PMID: 17681339 DOI: 10.1016/j.fertnstert.2007.05.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 05/02/2007] [Accepted: 05/02/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the incidence, site, and grade of ovarian adhesion formation after laparoscopic ovarian drilling (LOD) and analyze the association between the number of punctures made and the incidence and grade of adhesions, and evaluate the lateral distribution of the adhesions. DESIGN Prospective clinical study. SETTING University hospital endocrine and infertility center. PATIENT(S) Ninety-six anovulatory infertile women with polycystic ovarian syndrome (PCOS) treated with LOD. INTERVENTION(S) Women were randomized into two study groups of 48 women each, one treated with 6 punctures on the left ovary and 12 on the right, and the other treated with 6 punctures on the right ovary and 12 on the left. A short-term second-look minilaparoscopy was performed to evaluate postsurgical adhesion formation. MAIN OUTCOME MEASURE(S) [1] Evaluation of the incidence and grade (thin, dense, cohesive) of ovarian adhesions; [2] comparative analysis of the incidence and grade of ovarian adhesions between ovaries treated with 6 and 12 punctures; and [3] comparative analysis of the incidence and grade of ovarian adhesions between the two sides. RESULT(S) Adhesion formation was detected in 54 of the 90 women (60%) and in 83 of the 180 ovaries treated (46%). Dense adhesions were more likely to develop on the left ovaries to a statistically significant extent, and independently of the number of ovarian punctures performed (odds ratio [OR] = 4.34, 95% confidence interval [CI] = 1.72-10.94). Logistic regression analysis showed that the incidence of ovarian adhesions was independent of both number of punctures (OR = 1.05, 95% CI = 0.58-1.88) and side (OR = 1.37, 95% CI = 0.76-2.46). CONCLUSION(S) The incidence of ovarian adhesion formation after LOD was high, and their extent and severity was not influenced by the number of ovarian punctures; however, the left ovary appeared more prone to develop severe adhesions than the contralateral one.
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Affiliation(s)
- Francesco Mercorio
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
| | - Antonio Mercorio
- Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Attilio Di Spiezio Sardo
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy
| | - Gian Vincenzo Barba
- Epidemiology of Population Genetics, Institute of Food Science, C.N.R. Avellino, Italy
| | - Massimiliano Pellicano
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy
| | - Carmine Nappi
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy
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