Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome.

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.