Unilateral versus bilateral ovarian drilling in clomiphene citrate resistant PCOS patients

الملخص EN

This prospective study was designed to compare unilateral and bilateral laparoscopic ovarian drilling in cc resistant PCOS patients concerning : ovarian volume, Hormonal changes (FSH, LH, and LH / FSH), Clinical response (ovulation rate and cycle rhythm) after drilling.

Method : 40 infertile women with anovulatory infertility associated with PCOS were prospectively recruited from March 2010 to August 2011.

All women were primary infertile less than 5 years duration, with age between 21 to less than 35 years.

Exclusion criteria included age < 21 and > 35 years, BMI >35kg / m2, day 3 FSH > 10 IU / ml, associated uterine and ovarian pathology, or day 2 ultrasound shows ovarian cyst and previous ovarian surgery.

The cases were divided into two groups 20 cases in each group.

Group I : Bilateral LOD.

Group II : Unilateral LOD.

Basal hormonal profile determination (FSH, LH, FSH / LH ratio and E2) TV / US assessment of ovarian volume and midluteal serum progestrogen were estimated before and after laparoscopy.

Results : Patients in both groups were comparable with regard to their age, BMI and duration of infertility.

The ovarian volume before drilling was not significantly different between both groups.

On the other hand it was highly significant after LOD (P value 0.00001).

The reduction in ovarian volume after treatment was (65 %) in bilateral and (32 %) in unilateral drilling and, again with high significant difference.

In both groups there was high reduction in LH level after LOD.

The percentage of decrease in LH was insignificant between both groups the reduction was (46 %) in bilateral LOD and (44 %) in unilateral LOD.

The study revealed that the cycles were regular in 16 patients (80 %) in bilateral LOD, and 15 patients (75 %) in bilateral LOD with no significant difference.

Discussing the correlation between age, BMI and duration of infertility, and ovulation rate, the study revealed the longer the infertility duration, the older the woman the lower will be the ovulation success.

Cases that failed to ovulates showed lower LH before treatment and higher LH after treatment, also this group had irregular cycles.

Conclusion : Unilateral LOD is similar to bilateral LOD as regard ovulation rate.

Unilateral LOD preserve ovarian volume and ovarian reserve and may decrease the possibility of post operative adhesion.