ABSTRACT
Background: Laparoscopic ovarian drilling [LOD] has been commonly used for the treatment of clomiphene citrate [CC]-resistant women with polycystic ovarian syndrome [PCOS]. However, about 20-30% of anovulatory women with PCOS fail to respond to LOD. So, identifying factors that can predict the outcome of this modality of treatment may help the clinician for proper selection and counseling of those women about their chances for the success of WD
Objective: The aim of this study is to determine the clinical, endocrinologic, biochemical and ultrasonographic factors that can predict the success of treatment following LOD in CC-resistant women with PCOS. Design: A prospective designed study. Setting: Departments of Obstetrics and Gynecology, Mansoura and Benha University Hospitals
Patients and Methods: Sixty-seven CC-resistant PCOS patients were included in the study. Preoperative evaluation of the known clinical, endocrinologic, biochemical and ultrasongraphic factors associated with PCOS were done initially. Then, all patients included in the study underwent LOD using the triple-puncture technique. Post-operatively, all women were followed-up for the occurrence of either ovulation or pregnancy. Those with persistent anovulation after LOD were offered CC. The effect of the different pre-operative characteristics on the ovulation and pregnancy rates after LOD was assessed. Moreover, women were divided into two or three categories according to the severity of each of the known factors associated with PCOS. The success rates were compared between the categories of each factor. Multiple logistic regression analysis was used to identify independent predictors of success of LOD. Main outcome measure: Ovulation and pregnancy rates
Results: Of the 67 women, 36 [53.7%] ovulated spontaneously and a further 14 women ovulated after the addition of CC, giving an overall ovulation rate of 74.6% [50 out of 67]. From those ovulated spontaneously [36], 26 [38.8%] conceived spontaneously, and the overall pregnancy rate after the help of CC was 49.2% [33 out of 67]. Women with duration of infertility > 6 years, marked obesity [BMI 35 Kg / m[2]], marked hyperandrogenism [serum testosterone >/= 1.8 ng /dL], and insulin resistance [serum fasting insulin >/= 20 uU/ mL, and/or a fasting glucose insulin ratio 10 IU/L] did not reach statistical significance to affect the outcome, but once ovulation was achieved, it appeared to be associated with higher pregnancy rate
Conclusion: Longer duration of infertility, marked obesity, marked hyperandrogenism and marked insulin resistance seemed to be associated with high probability of LOD failure. On the other hand, a high pretreatment LH level appeared to be associated with a high probability of pregnancy once ovulation is achieved