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Zahiri Sorouri Z, Sharami SH, Tahersima Z, Salamat F. Comparison between Unilateral and Bilateral Ovarian Drilling in Clomiphene Citrate Resistance Polycystic Ovary Syndrome Patients: A Randomized Clinical Trial of Efficacy. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:9-16. [PMID: 25918587 PMCID: PMC4410042 DOI: 10.22074/ijfs.2015.4202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/08/2014] [Indexed: 01/19/2023]
Abstract
Background Laparoscopic ovarian drilling (LOD) is an alternative method to induce
ovulation in polycystic ovary syndrome (PCOS) patients with clomiphene citrate (CC)
resistant instead of gonadotropins. This study aimed to compare the efficacy of unilateral
LOD (ULOD) versus bilateral LOD (BLOD) in CC resistance PCOS patients in terms of
ovulation and pregnancy rates. Materials and Methods In a prospective randomized clinical trial study, we included
100 PCOS patients with CC resistance attending to Al-Zahra Hospital in Rasht, Guilan
Province, Iran, from June 2011 to July 2012. Patients were randomly divided into two
ULOD and BLOD groups with equal numbers. The clinical and biochemical responses
on ovulation and pregnancy rates were assessed over a 6-month follow-up period. Results Differences in baseline characteristics of patients between two groups prior
to laparoscopy were not significant (p>0.05). There were no significant differences
between the two groups in terms of clinical and biochemical responses, spontaneous menstruation (66.1 vs. 71.1%), spontaneous ovulation rate (60 vs. 64.4%), and
pregnancy rate (33.1 vs. 40%) (p>0.05). Following drilling, there was a significant
decrease in mean serum concentrations of luteinizing hormone (LH) (p=0.001) and
testosterone (p=0.001) in both the groups. Mean decrease in serum LH (p=0.322)
and testosterone concentrations (p=0.079) were not statistically significant between
two groups. Mean serum level of follicle stimulating hormone (FSH) did not change
significantly in two groups after LOD (p>0.05). Conclusion Based on results of this study, ULOD seems to be equally efficacious as BLOD
in terms of ovulation and pregnancy rates (Registration Number: IRCT138903291306N2).
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Affiliation(s)
- Ziba Zahiri Sorouri
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyede Hajar Sharami
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zinab Tahersima
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Salamat
- Research Vice Chancellorship, Guilan University of Medical Sciences, Rasht, Iran
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Connolly F, Rae MT, Butler M, Klibanov AL, Sboros V, McNeilly AS, Duncan WC. The local effects of ovarian diathermy in an ovine model of polycystic ovary syndrome. PLoS One 2014; 9:e111280. [PMID: 25343339 PMCID: PMC4208840 DOI: 10.1371/journal.pone.0111280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/30/2014] [Indexed: 01/01/2023] Open
Abstract
In order to develop a medical alternative to surgical ovarian diathermy (OD) in polycystic ovary syndrome (PCOS) more mechanistic information is required about OD. We therefore studied the cellular, molecular and vascular effects of diathermy on the ovary using an established ovine model of PCOS. Pregnant sheep were treated twice weekly with testosterone propionate (100 mg) from day 30–100 gestation. Their female offspring (n = 12) were studied during their second breeding season when the PCOS-like phenotype, with anovulation, is fully manifest. In one group (n = 4) one ovary underwent diathermy and it was collected and compared to the contralateral ovary after 24 hours. In another group a treatment PCOS cohort underwent diathermy (n = 4) and the ovaries were collected and compared to the control PCOS cohort (n = 4) after 5 weeks. Ovarian vascular indices were measured using contrast-enhanced ultrasound and colour Doppler before, immediately after, 24 hours and five weeks after diathermy. Antral follicles were assessed by immunohistochemistry and ovarian stromal gene expression by quantitative RT-PCR 24 hours and 5 weeks after diathermy. Diathermy increased follicular atresia (P<0.05) and reduced antral follicle numbers after 5 weeks (P<0.05). There was an increase in stromal CCL2 expression 24 hours after diathermy (P<0.01) but no alteration in inflammatory indices at 5 weeks. Immediately after diathermy there was increased microbubble transit time in the ovarian microvasculature (P = 0.05) but this was not seen at 24 hours. However 24 hours after diathermy there was a reduction in the stromal Doppler blood flow signal (P<0.05) and an increased ovarian resistance index (P<0.05) both of which persisted at 5 weeks (P<0.01; P<0.05). In the ovine model of PCOS, OD causes a sustained reduction in ovarian stromal blood flow with an increased ovarian artery resistance index associated with atresia of antral follicles.
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Affiliation(s)
- Fiona Connolly
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael T. Rae
- School of Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Mairead Butler
- Institute of Biophysics, Biochemistry and Bio-Engineering, Heriot Watt University, Edinburgh, United Kingdom
| | - Alexander L. Klibanov
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, United States of America
| | - Vassilis Sboros
- Institute of Biophysics, Biochemistry and Bio-Engineering, Heriot Watt University, Edinburgh, United Kingdom
| | - Alan S. McNeilly
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - W. Colin Duncan
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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3
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Selim MF. The Optimal Number of Ovarian Punctures to Be Applied During Laparoscopic Ovarian Diathermy in Women with Polycystic Ovarian Syndrome. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Wallwiener LM, Rösner S, Goeckenjan M, Strowitzki T, Toth B. Therapieoptionen bei polyzystischem Ovarsyndrom mit oder ohne Kinderwunsch. GYNAKOLOGISCHE ENDOKRINOLOGIE 2011. [DOI: 10.1007/s10304-010-0399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amer SA, Li TC, Metwally M, Emarh M, Ledger WL. Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome. Hum Reprod 2008; 24:219-25. [PMID: 18794162 DOI: 10.1093/humrep/den325] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopic ovarian diathermy (LOD) is currently accepted as a successful second-line treatment for ovulation induction (OI) in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). The aim of this study was to test the hypothesis that LOD may be superior to CC as a first-line treatment. METHODS The study included 72 anovulatory women with PCOS who were randomized to LOD (n = 36) or CC (n = 36). Women who remained anovulatory after LOD were offered CC. Similarly, women receiving CC who failed to ovulate or conceive were offered LOD. Pregnancy rates were compared between the two groups using chi(2) and odds ratio with 95% confidence interval (OR, 95% CI). RESULTS After randomization, six women conceived before starting treatment and another patient postponed treatment. The remaining 65 women received the treatment (33 underwent LOD and 32 received CC). After the primary treatment, more pregnancies (44%) occurred in women receiving CC than in those undergoing LOD (27%), although the difference did not reach statistical significance [P = 0.13, OR 2.1 (0.7 - 5.8)]. After adding the second treatment, the pregnancy rate was still higher, but to a less extent, in the CC group [63% versus 52%, P = 0.2, OR 1.6 (0.6 - 4.2)]. CONCLUSIONS LOD is not superior to CC as a first-line method of OI in women with PCOS. The trial is registered with ClinicalTrials.gov with an identifier number NCT00220545.
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Affiliation(s)
- S A Amer
- Department of Obstetrics and Gynaecology, University of Nottingham, Derby City General Hospital, Derby DE22 3NE, UK.
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Hendriks ML, Ket JCF, Hompes PGA, Homburg R, Lambalk CB. Why does ovarian surgery in PCOS help? Insight into the endocrine implications of ovarian surgery for ovulation induction in polycystic ovary syndrome. Hum Reprod Update 2007; 13:249-64. [PMID: 17208949 DOI: 10.1093/humupd/dml058] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a complex disorder with heterogeneity of clinical and endocrine features. Ovarian surgery for ovulation induction has been used in the management of clomiphene citrate-resistant anovulatory women with PCOS. Various types of ovarian surgery have been employed (wedge resection, electrocautery, laser vaporization, multiple ovarian biopsies and others) and all procedures result in an altered endocrine profile after surgery. The mechanism behind the reversal of endocrinological dysfunction in PCOS after ovarian surgery remains incompletely understood. This review scans the literature systematically to identify the endocrine changes after ovarian surgery in PCOS, in order to glean some knowledge of the mechanism involved. After ovarian surgery in PCOS, a rapid reduction in serum levels of all ovarian hormones is seen, in combination with increased serum levels of pituitary hormones. Folliculogenesis is then initiated and ovarian hormone production increases, synchronically with a reduction of pituitary hormones. Continuation of follicle growth in subsequent cycles after ovarian surgery occurs in an environment with less androgens and lower LH and FSH levels compared with pretreatment levels. The endocrine changes found after ovarian surgery in PCOS women seem to be governed by the ovaries themselves. Rapid reduced secretion of all ovarian hormones restores feedback to the hypothalamus and pituitary, resulting in appropriate gonadotrophin secretion. Initiation of follicular development seems to be induced by increasing FSH levels following a reduction of the follicle excess and (intra-ovarian) androgen levels. Additionally, anti-Müllerian hormone and gonadotrophin surge attenuating factor probably have a role in the endocrine changes.
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Affiliation(s)
- M L Hendriks
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
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Amer SA, Laird S, Ledger WL, Li TC. Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome. Hum Reprod 2006; 22:389-94. [PMID: 17023489 DOI: 10.1093/humrep/del373] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laparoscopic ovarian diathermy (LOD) frequently induces ovulation in patients with polycystic ovary syndrome (PCOS). The mechanism by which this effect occurs remains largely unexplained. The aim of this study was to measure changes in inhibin B production in response to LOD to see whether this could explain the mechanism of action of LOD. METHODS This prospective study included 50 anovulatory women with PCOS. All women underwent LOD. Blood samples were collected before and after LOD to measure plasma concentrations of inhibin B, gonadotrophins and androgens. RESULTS The pre-operative median plasma concentration of inhibin B was 110.0 pg/ml (range 19.0-567.0 pg/ml). There was a statistically significant inverse correlation (r= -0.286; P < 0.05) between body mass index (BMI) and inhibin B. Non-obese women with PCOS (BMI <or= 30 kg/m2; n=37) displayed significantly (P < 0.05) higher plasma inhibin B concentrations [122.0 pg/ml (range 19.0-567.0 pg/ml)] compared with those [51.0 pg/ml (range 27.0-201.0 pg/ml)] of obese PCOS women (BMI > 30 kg/m2; n=13). Following LOD, 39 women ovulated. No statistically significant change of inhibin B after LOD was observed in the overall group of women with PCOS or in the subgroup of non-obese PCOS women with higher pre-operative inhibin B. CONCLUSIONS The lack of any change of inhibin B after LOD makes it unlikely that this hormone has any role to play in the mechanism of action of LOD.
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Affiliation(s)
- S A Amer
- Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Sheffield, UK.
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Branigan EF, Estes A, Walker K, Rothgeb J. Thorough sonographic oocyte retrieval during in vitro fertilization produces results similar to ovarian wedge resection in patients with clomiphene citrate-resistant polycystic ovarian syndrome. Am J Obstet Gynecol 2006; 194:1696-700; discussion 1700-1. [PMID: 16731088 DOI: 10.1016/j.ajog.2006.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Revised: 03/04/2006] [Accepted: 03/04/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of a thorough sonographic oocyte retrieval to a routine in vitro fertilization retrieval to induce ovulation, pregnancy, and endocrine changes in patients with polycystic ovarian syndrome in their post-in vitro fertilization cycles. STUDY DESIGN Sixty-four patients from a tertiary infertility clinic, with clomiphene citrate-resistant polycystic ovarian syndrome and who were undergoing in vitro fertilization, were assigned randomly into 2 groups. Group 1 (n = 34) had a thorough (every possible follicle punctured) sonographic oocyte retrieval, and group 2 (n = 30) had a routine (only follicles that were likely to contain oocytes) in vitro fertilization retrieval. These patients who did not conceive in their in vitro fertilization cycle were monitored with ultrasound scanning for evidence of ovulation, pregnancy, before and after day 3 gonadotropin, and steroid hormone levels. Analysis of variance and the Student t test were used for statistical significance. RESULTS Ovulation rates of 53% (18/34) and cumulative pregnancy rate of 44% (8/18) were observed in group 1, with no ovulations in group 2. Significant decreases in luteinizing hormone/FSH ratio (4.1 to 1.7) and testosterone (1.2 to 0.7 ng/mL) occurred after treatment in the thorough sonographic oocyte retrieval group, with no change after routine in vitro fertilization. Operating time was increased significantly in the thorough sonographic oocyte retrieval group (45 vs 24 minutes) in group 2. CONCLUSION Thorough sonographic oocyte retrieval during in vitro fertilization cycle can produce significant improvements in the endocrinologic abnormalities, ovulation, and pregnancies that are comparable with ovarian wedge resection in patients with clomiphene citrate-resistant polycystic ovarian syndrome.
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Farquhar CM. An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate-resistant polycystic ovarian syndrome. Curr Opin Obstet Gynecol 2005; 17:347-53. [PMID: 15976539 DOI: 10.1097/01.gco.0000175351.18308.3a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Women with polycystic ovarian syndrome are typically anovulatory and require ovulation induction. Ovarian wedge resection was the first treatment for anovulation but was eventually abandoned because of the increased risk of postsurgical adhesions and as medical ovulation induction with clomiphene and gonadotrophins was introduced. However, with the advent of laparoscopy, there has been a return to surgical approaches. The potential advantages of laparoscopic surgery include avoidance of hyperstimulation and the lowered costs make ovarian surgery an attractive alternative to gonadotrophins. RECENT FINDINGS Clinical trials in New Zealand and the Netherlands have compared costs of laparoscopic ovarian drilling with gonadotrophins. The total cost of treatment in the Netherlands study for the ovarian drilling group was euro 4664 and for the gonadotrophins group was euro 5418. Without the cost of monitoring and the diagnostic laparoscopy then the difference was euro 2110 in favour of ovarian drilling. It was estimated that the cost per term pregnancy would be euro 14,489 for gonadotrophin and euro 11,301 for ovarian drilling (22% lower). The higher rates of multiple pregnancy in the gonadotrophin group were considered to be responsible for the increased costs. In the New Zealand trial the costs of a live birth were one-third lower in the group that underwent laparoscopic ovarian diathermy compared with those women who received gonadotrophins (NZ$19,640 and 29,836, respectively). SUMMARY Treating women with clomiphene-resistant polycystic ovarian syndrome with laparoscopic ovarian diathermy results in reduced direct and indirect costs. The reduction in multiple pregnancies makes the alternative of surgery particularly attractive.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics & Gynaecology, University of Auckland, New Zealand.
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Strowitzki T, von Wolff M. Laparoscopic ovarian drilling (LOD) in patients with polycystic ovary syndrome (PCOS): an alternative approach to medical treatment? ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10397-005-0099-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cleemann L, Lauszus FF, Trolle B. Laparoscopic ovarian drilling as first line of treatment in infertile women with polycystic ovary syndrome. Gynecol Endocrinol 2004; 18:138-43. [PMID: 15255282 DOI: 10.1080/09513590410001667869] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Laparoscopic ovarian drilling (LOD) is used as a first line of treatment, as a second line of treatment after patients have proved resistant to clomiphene or as a third line of treatment after failed ovulation induction with gonadotropins. We present the postoperative pregnancy rates of 57 women to evaluate a potential optimal time of LOD together with the other treatment regimens of infertile women with polycystic ovary syndrome (PCOS). Data on the preoperative and operative treatment, and background data were evaluated for their influence on pregnancy rates. The pregnancy rate was 61% among women with PCOS who had LOD. No difference was found in the clinical data between the women who became pregnant and those who did not. Likewise, no difference was found between the women who had pre- and/or postoperative medical ovulation treatment and those who had none. The median time to pregnancy after LOD was 135 days. LOD alone resolves infertility within 4-6 months in 50-60% of couples. A strategy with diagnostic laparoscopy and LOD as the first line of treatment of infertility in women with PCOS will shorten the time to pregnancy for many women, reduce the need for medical ovulation induction and enable diagnosis of those women with anatomic infertility, who can achieve pregnancy only by in vitro fertilization treatment.
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Affiliation(s)
- L Cleemann
- Department of Gynecology and Obstetrics, Holstebro Hospital, Denmark
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Abstract
Laparoscopic ovarian drilling is a relatively simple procedure performed by minimal access and usually on an outpatient basis. It provides an alternative treatment option for polycystic ovary syndrome (PCOS) patients anovulatory to clomiphene citrate. The mechanism of action of laparoscopic ovarian drilling is unclear; its beneficial effect is apparently due to destruction of the androgen-producing stroma. The procedure appears to have little or no effect on insulin sensitivity and lipoprotein profile. The majority (56-94%) of PCOS patients who are clomiphene citrate resistant ovulate after drilling, and at least half of them go on to achieve a pregnancy. Predictive factors for pregnancy are younger age and lower body mass index. The endocrine changes resulting from ovarian drilling last for an extended period of time. Exogenous gonadotrophin treatment and laparoscopic ovarian drilling appear to yield comparable ovulation and pregnancy rates; however, multiple pregnancy is rare with drilling. There are several complications associated with the procedure, including post-operative periadnexal adhesion formation. Alternative treatment options, including lifestyle modification (diet and exercise) and metformin, may well reduce the need for ovarian drilling in well-selected cases. Progress in understanding of this complex syndrome and effective new treatments will further diminish the need for surgery.
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Affiliation(s)
- Victor Gomel
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Pirwany I, Tulandi T. Laparoscopic treatment of polycystic ovaries: is it time to relinquish the procedure? Fertil Steril 2003; 80:241-51. [PMID: 12909478 DOI: 10.1016/s0015-0282(03)00875-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the role of laparoscopic ovarian drilling and treatment with metformin in the management of the polycystic ovary syndrome (PCOS). DESIGN A literature search was conducted using the keywords laparoscopy, laparoscopic ovarian drilling, laparoscopic ovarian diathermy, PCOS, metformin, and ovulation. The MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews were searched. RESULTS No randomized comparisons have been done between laparoscopic ovarian drilling and metformin therapy. However, the ovulation and pregnancy rates appear to be similar for both techniques. Both treatments decrease the incidence of ovarian hyperstimulation and the cancellation rate of IVF cycles. However, unlike laparoscopic ovarian drilling, metformin may decrease the incidence of type 2 diabetes and coronary heart disease. CONCLUSION(S) Given the similar magnitude of the results without the potential risks and complication of surgery, we propose that laparoscopic ovarian drilling should be used sparingly in favor of less invasive treatment with metformin.
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Affiliation(s)
- Imran Pirwany
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
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Crosignani PG, Vegetti W, Colombo M, Ragni G. Resumption of fertility with diet in overweight women. Reprod Biomed Online 2002; 5:60-4. [PMID: 12470549 DOI: 10.1016/s1472-6483(10)61600-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In young women being overweight appears to be one of the major and still neglected causes of subfertility. Not only the excessive amount but also the distribution of body fat is clearly related to loss of fertility. The mechanism through which obesity impairs ovulation and fertility is largely unknown, but it is well known that being overweight lowers the concentration of sex hormone binding globulin and increases androgen and insulin secretion and insulin resistance. These high concentrations of androgen and insulin in turn are important factors in the preferential abnormal localization of body fat. In addition, ovulation induction or ovarian stimulation in overweight women is a not easy task, since these patients are often unresponsive to the stimulatory drugs and, in addition, have a higher rate of miscarriages. Weight reduction improves these patients' biochemical indices and fertility rates. The spontaneous pregnancy rate can be expected to be around 30%, but an additional 40-50% drug-induced pregnancy rate can be achieved with a 10-15% weight loss. Drugs increasing insulin sensitivity also improve spontaneous ovulation and fertility in obese women but still need to be tested in larger controlled trials. In conclusion, appropriate counselling about weight reduction through diets and exercise can restore both health and fertility, avoiding much frustration, and saving time and money.
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Affiliation(s)
- Pier Giorgio Crosignani
- First Department of Obstetrics and Gynaecology, University of Milan, Via della Commenda 12, 20122 Milan, Italy. piergiorgio.crosignani.it
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Ozaki T, Takahashi K, Irikoma M, Kurioka H, Miyazaki K. Utility of early second-look laparoscopy after infertility surgery. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:165-8. [PMID: 10226126 DOI: 10.1016/s1074-3804(99)80096-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of early second-look laparoscopy (ESLL) and the usefulness of the American Fertility Society (AFS) adhesion score at ESLL in terms of reproductive prognosis. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Ninety-two consecutive women undergoing infertility surgery between January 1983 and December 1996. INTERVENTION We performed ESLL in all but 32 patients, 27 of whom underwent surgery before institution of the protocol. MEASUREMENTS AND MAIN RESULTS The pregnancy rate in 1 year was significantly higher in women having ESLL than in those not having the surgery. The AFS score was not significantly different in pregnant and nonpregnant patients. CONCLUSION Early second-look laparoscopy may improve fecundity in women requiring fertility surgery. (J Am Assoc Gynecol Laparosc 6(2):165-168, 1999)
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Affiliation(s)
- T Ozaki
- Department of Obstetrics and Gynecology, Shimane Medical University, 89-1, Enya-cho, Izumo 693-8501, Japan
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