Laparoscopic ovarian drilling in polycystic ovary disease : first choice or last resort?

الملخص EN

Background : the problems of anovulation and ovulation induction in women with polycystic ovary disease (PCOD) are well recognized.

Surgical induction of ovulation by wedge resection was applied and it succeeded in some cases, but the success rate and postoperative adhesions make it to disappear from lines of treatment, in favor of laparoscopic surgery.

Usually, surgical induction of ovulation s resorted to after failure of all the conservative lines of management.

Study Objective : to evaluate the role of laparoscopic ovarian drilling in the management of PCO patients; whether it is better for the patients to star t with ovarian drilling or to make it as a last resort for clomiphene resistant patients Design : randomized, controlled trial.

Setting: Tanta University Hospitals.

Participants: from October 2003 till October 2006,160 sub fertile female patients due to pock as first diagnosed after one year of marriage at least with no ovulation induction with clomiphene citrate before were randomly assigned either to undergo laparoscopic ovarian drilling followed by CC group I (80 patients), or to receive medical treatment in the form of clomiphene citrate group H (80 patients).

Intervention : transvaginal pelvic ultrasonography and hormonal assay of pock as FSH, LH and Testosterone Main Outcome Measures: ovulation rate, pregnancy rate and pregnancy events in 6 months follow up period.

Results : ovulation rate was 90 % n group I versus 80 % in group E, pregnancy rate was 68.75 % in group Ivs 62.5 % in group II Multiple pregnancy occurred in one patient in group Ivs 5 patients in group ^spontaneous abortion occurred 2 patients in group I vs 8 patients in group II.

Conclusions : laparoscopic ovarian drilling as the first line of treatment of infertility in women with PCOD followed by CC will increase chances of pregnancy for many women and diagnostic laparoscopy enables diagnosis of those women with anatomic infertility.