The Journal of the American Association of Gynecologic Laparoscopists · 2001
Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome.
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Kriplani A, Manchanda R, Agarwal N, Nayar B
Аннотация
STUDY OBJECTIVE: To analyze the efficacy of laparoscopic ovarian drilling using monopolar diathermy in women with anovulatory infertility with clomiphene-resistant polycystic ovary syndrome (PCOS), and to determine factors influencing pregnancy rate and pregnancy outcomes.
DESIGN: Prospective study (Canadian Task Force classification II-2).
SETTING: Infertility clinic in a tertiary referral teaching hospital.
PATIENTS: Seventy women with clomiphene-resistant PCOS.
INTERVENTION: Laparoscopic ovarian drilling, with follow-up for 4.5 years.
MEASUREMENTS AND MAIN RESULTS: Follow-up data, which were available for 66 patients, showed a spontaneous ovulation rate of 81.8%, cumulative ovulation rate of 93.9%, and pregnancy rate of 54.5%. Successful pregnancies were commonly complicated by gestational diabetes mellitus and pregnancy-induced hypertension. Pregnancy rates (23.5%) were low in women with tuboperitoneal disease and those whose partners had subfertile male factors. Statistical evaluation using a proportion test (Z test) and multivariable logistical regression analysis showed that elevated luteinizing hormone levels (>10 IU/L), short duration of infertility (<3 yrs), and absence of preexisting tubal disease were associated with better outcomes.
CONCLUSION: Laparoscopic ovarian drilling is an effective surgical procedure in women with clomiphene-resistant PCOS.
DESIGN: Prospective study (Canadian Task Force classification II-2).
SETTING: Infertility clinic in a tertiary referral teaching hospital.
PATIENTS: Seventy women with clomiphene-resistant PCOS.
INTERVENTION: Laparoscopic ovarian drilling, with follow-up for 4.5 years.
MEASUREMENTS AND MAIN RESULTS: Follow-up data, which were available for 66 patients, showed a spontaneous ovulation rate of 81.8%, cumulative ovulation rate of 93.9%, and pregnancy rate of 54.5%. Successful pregnancies were commonly complicated by gestational diabetes mellitus and pregnancy-induced hypertension. Pregnancy rates (23.5%) were low in women with tuboperitoneal disease and those whose partners had subfertile male factors. Statistical evaluation using a proportion test (Z test) and multivariable logistical regression analysis showed that elevated luteinizing hormone levels (>10 IU/L), short duration of infertility (<3 yrs), and absence of preexisting tubal disease were associated with better outcomes.
CONCLUSION: Laparoscopic ovarian drilling is an effective surgical procedure in women with clomiphene-resistant PCOS.