Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

Abstract

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS.

Unilateral versus Bilateral Laparoscopic Ovarian Drilling in Clomiphene Citrate Resistant Polycystic Ovarian Syndrome in Minia Governate: Randomized Clinical Trial

“…Thereby, a suggested recommendation to apply a ULOD rather than a BLOD is generally in agreement with these data (Abu Hashim et al, 2018). Another agreement with our result by Laul et al, (2018) found that there was no statistically significant difference after unilateral and bilateral ovarian drilling in overall clinical response, ovulation rate, change in biochemical parameters, pregnancy rate and miscarriage rate. Youssef and Atallah, (2007) evaluated 87 patients with ovulation failure as a result of PCOS who were randomly allocated to unilateral ovarian drilling (N = 43) and bilateral ovarian drilling (N = 44).…”

“…The body mass index was 27.5 ± 2.4 for group I, and 28.7 ± 2.1 for group II (p < 0.23) (Kandil and Selim, 2005). Another study by Laul et al, (2018) found that the average age of patients in both the groups was found to be 27 years. The duration of marriage in both groups was same with a mean duration of infertility of 4 years.…”

“…Ovarian hyper-stimulation, multiple pregnancy, and high miscarriage rate remains the signifi-cant risk (Laul et al, 2018). Laparoscopic ovarian drilling (LOD) and gonadotrophins are recommended to induce ovulation in those women.…”

“…Both groups were comparable. 50% of patients in group I and 65% in group II had their BMI > 30 (Laul et al, 2018).…”

Effects of Different Methods of Laparoscopic Ovarian Drilling and its Outcome in Patients with Polycystic Ovary Syndrome

“…These results agree with Abdelhafeez et al [23] and Zahiri Sorouri et al [4] who reported a significant decrease in serum levels of LH and testosterone in women after LOD. Laul et al [24] reported that LOD has been associated with a significant decrease of basal serum LH levels. Basal LH reduction was already known to be an indicator of good response to LOD.…”