Predicting factors for the efficacy of laparoscopic ovarian drilling for ovulation induction in polycystic ovary disease

Abstract EN

Background : Laparoscopic ovarian drilling has been widely used to induce ovulation in women with polycystic ovarian syndrome.

There are factors that affect the outcome of this procedure like age of the patient, duration of infertility, body mass index, hormonal changes and menstrual irregularities.

Laparoscopic ovarian drilling may avoid or decrease the need for gonadotrophins or may facilitate their effectiveness.

The procedure can be done with less trauma and fewer postoperative adhesions than with traditional surgical procedures.

Objective : To evaluate the effectiveness and safety of laparoscopic ovarian drilling for ovulation induction in polycystic ovary patients and to identify which of the mentioned factors help to predict the outcome of the procedure.

Patients and methods : This prospective clinical study included 80 patients with failure of 12 weeks clomiphene citrate treatment for an ovulatory infertility due to (PCOS) who underwent (LOD) in Alhindiya general hospital between January 2008 and September 2011.

The effect of various patients' pre-operative characteristics on the ovulation rate after (LOD) was assessed.

The success rates were compared between these categories of each factor to identify the predictors of success of laparoscopic ovarian drilling.

Results : Women with marked obesity (BMI 35 kg / m2) achieved significantly (P < 0.05) lower ovulation rate (40 %) compared with those (61.5 %) of moderately overweight (BMI 29-34 kg / m2) women and those (75 %) of women with normal and slightly elevated BMI ( < 29 kg / m2).

women with testosterone levels > 4.5 nmol / 1, the rate was 30 %, which was significantly (P < 0.05) lower than those (57 %) of women with moderately elevated testosterone (2.6-4.4 nmol / l).

Patients with normal serum testosterone levels ( < 2.6 nmol / l) showed significantly (P < 0.05) higher success rates (80 %) than the other groups Conclusion : Marked obesity, marked hyperandrogenism and / or long duration of infertility in women with (PCOS) seem to predict resistance to (LOD).

Ovarian drilling by laparoscopy is safe but should be used on selective scale.