Matute LÁ, Andrinua LA, Hernández JA

Language: Spanish
References: 11
Page: 167-170
PDF size: 887.83 Kb.

ABSTRACT

Background: Polycystic ovary syndrome is the most frequent endocrine disorder in the women, as well as the first cause of anovulatory infertility. Clinical manifestations vary from a mild menstrual disorder to severe disturbances of reproductive and metabolic functions. Management depends on the symptoms and focuses essentially on ovulatory dysfunction related to infertility, menstrual disorders and hyperandrogenism. Clomiphene citrate is still the non invasive first line treatment. Laparoscopic ovarian drilling has been widely used to induce ovulation in women with polycystic ovary syndrome when the conservative therapy has not been successful. The exact mechanism of laparoscopic ovarian drilling is still uncertain, some authors have reported that it increases the sensitivity of the ovaries to endogenous FSH. Laparoscopic ovarian drilling is now accepted as the invasive gold standard and the second line of treatment for women with polycystic ovary syndrome with anovulatory infertility due to its high efficacy and pregnancy achievement after the treatment.
Objective: To evaluate the fertility and incidence of pregnancy in patients after ovarian drilling for polycystic ovary syndrome.
Patients and method: A retrospective study of 14 patients diagnosed with polycystic ovary syndrome that underwent laparoscopic ovarian drilling using bipolar energy. Follow-up was of 24 months.
Results: There were eight (57.5%) pregnancies, five (62.5%) were spontaneous and three (37.5%) ocurred after ovarian drilling. In one case (12.5%) the pregnancy was multiple. The average time in which pregnancy was achieved was 11 months.
Conclusion: Ovarian drilling represents an effective alternative in polycystic ovarian syndrome.

REFERENCES

1. Cohen BM, Chassagnard N. Analyse de 92 biopsies d’ovaire per-coel ioscopique. Thesis Doctor Of Medicine, Paris VI, 1974.

2. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril 1984;41:20-25.

3. Daniel JF, Miller W. Polycystic ovaries treated by laparoscopic laser vaporization. Fertil Steril 1989;51:232-236.

4. Katz M, Carr Pi, Cohen BM, Millar RP. Hormonal effects of wedge resection of polycystic ovaries. Obstet Gynecol 1978;23:93-99.

5. Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011;3:25-35.

6. Flyckt RL, Goldberg JM. Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome. Semin Reprod Med 2011;29:138-46.

7. Amer SA, Banu Z, Li TC, Cookie ID. Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes. Hum Reprod 2002;17:2851.

8. Ott J, Kurz C, Nouri K, Wirth S, et al. Pregnancy outcome in women with polycystic ovary syndrome comparing the effects of laparoscopic ovarian drilling and clomiphene citrate stimulation in women pre-treated with metformin: a retrospective study. Reprod Biol Endocrinol 2010;8:45.

9. Homburg R. The management of infertility associated with polycystic ovary syndrome. Reprod Biol Endocrinol 2003;1:109.

10. Farquhar C, Brown J, Marjoribanks J. Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2012 Jun 13;6:CD001122.

11. Abdel Gadir A, Mowafi RS, Alnaser HM, Alrashid AH, et al. Ovarian electrocautery versus human menopausal gonadotrophins and pure follicle stimulating hormone therapy in the treatment of patients with polycystic ovarian disease. Clin Endocrinol (Oxf) 1990;33:585-592.