Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis

Frène, Veerle De; Gerris, Jan; Weyers, Steven; Dhont, Marc; Vansteelandt, Stijn; Annemans, Lieven; Sutter, Petra De

doi:10.1159/000373888

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…7 In another study, Begum showed the mean age was 22.67±6.3 years varied from 18 to 35 years and Codner et al found mean age was 24.5±5.0 years varied from 19 to 40 years which are less than the current study. 15 Summed ovarian volume (cm 3 ) were found between responders and non-responders after LOD. A systematic review Badawy et al and Elmashad concluded that ovarian volume has little clinical application in prediction of poor pregnancy response.…”

Section: Resultsmentioning

confidence: 94%

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Banu

Ishrat

Deeba

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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Background: Laparoscopic ovarian drilling (LOD) is an alternative method for ovulation induction in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients instead of gonadotropins. Objective were to identify the changes in clinical and biochemical profiles and the ovulation and pregnancy rate following LOD in CC resistant PCOS patients.Methods: It was an interventional study infertility unit, department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university, Dhaka, between from July 2014 to June 2015. Changes of the above-mentioned parameters were recorded during follow up of patients after LOD. The information is collected and recorded in the preset questionnaire.Results: The characteristics of study population were same before LOD and following LOD. Before LOD, infrequent menstruation was present in 83.3% patients whereas regular menstruation was found in 58.3% patients after 6 months following LOD. Endometrial thickness ≤8 was found in 100.0% in before LOD and endometrial thickness >8 was found in 70.0% after 6 month following LOD. Ovulation was found in 25.0% in after 3-month LOD and was found in 70.0% after 6 months following LOD. Pregnancy was found in 20.0% after 3 months following LOD and 50.0% in after 6 months following LOD. Ovulation and pregnancy outcome was significantly higher in after 6 months following LOD.Conclusions: LOD produces long-term improvement in menstrual regularity and reproductive performance. A sustained improvement observed in acne and BMI. Ovulation and pregnancy were found in 70% and 50.0% respectively after 6 months following LOD.

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Section: Resultsmentioning

confidence: 94%

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Banu

Ishrat

Deeba

et al. 2021

Int J Reprod Contracept Obstet Gynecol

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“…The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1073, 95 % CI 180-1967). This economic evaluation based on real-life data shows that the societal cost up to an ongoing pregnancy is less after hMG treatment when compared with LOD surgery in CC-resistant PCOS patients [10].…”

Section: Discussionmentioning

confidence: 92%

“…A retrospective health-economic evaluation was performed from a societal perspective in which human menopausal gonadotropin (hMG) therapy (n = 43) was compared with LOD (n = 35), followed by OI with CC and/or hMG if spontaneous ovulation did not occur within 2 months [10]. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment.…”

Section: Discussionmentioning

confidence: 99%

Primum Non Nocere

Allahbadia

2015

J Obstet Gynecol India

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Surgical ovarian wedge resection was the first established treatment for women with anovulatory polycystic ovary syndrome (PCOS) but was largely abandoned both due to the risk of postsurgical adhesions and the introduction of medical ovulation induction. Laparoscopic ovarian drilling (LOD) is an alternative method to induce ovulation in PCOS patients with clomiphene citrate resistance instead of gonadotropins. Surgical therapy with LOD may avoid or reduce the need for gonadotropins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve. In over-enthusiastic hands, this day-care procedure might lead to iatrogenic premature ovarian failure in young women. Some trials have compared LOD with gonadotropins, but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies. Today, evidence-based reviews conclude that there is no evidence of a significant difference in rates of clinical pregnancy, live birth or miscarriage in women with clomiphene-resistant PCOS undergoing LOD compared to other medical treatments. The reduction in multiple pregnancy rates in women undergoing LOD is the only pro-LOD argument. However, there are ongoing serious concerns about the long-term effects of LOD on ovarian function.

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“…Similarly, De Frene et al compared the pregnancy rates of 43 women in whom ovulation was induced with human menopausal gonadotropin and 35 who were treated via LOD; the ongoing pregnancy rates were similar (60% and 69.8%, respectively). 20 Also, Bayram and colleagues reported a pregnancy rate of 49% of women treated with clomiphene citrate/electrocautery and 67% in those given recombinant FSH, in a randomized controlled trial. 21 In a study of PCOS patients resistant to clomiphene citrate, Goudarzi and co-workers reported similar pregnancy rates in LOD groups and groups in whom ovulation was induced with gonadotropins (OR: 0.534; 95% CI: 0.242-1.176; p=0.119; six studies, n=499, I 2 =73.201%).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Ovarian Drilling: Is It a Safe Alternative of Gonadotropin Treatment for Second-line Therapy in Patients with Polycystic Ovary Syndrome Resistant to Clomiphene Citrate?

Eskiyörük¹,

Melekoğlu²,

Çetin³

et al. 2018

TJRMS

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The objective of this study is to compare the effectiveness and outcomes of laparoscopic ovarian drilling (LOD) and ovulation induction with gonadotropins in polycystic ovary syndrome (PCOS) patients resistant to clomiphene citrate. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : The medical records of all women admitted to the Infertility Outpatient retrospectively reviewed. A total of 124 women met the study criteria; of these, 33 constituted the LOD group, and 91 the gonadotropin group. R Re es su ul lt ts s: : Age, body mass index, the duration of infertility, basal follicle-stimulating hormone level, and antral follicle count showed no significant differences between groups. Significant reductions in ovarian volume, luteinizing hormone, and total testosterone level were evident at 2 and 6 months after LOD (p=0.011, p<0.001, and p=0.002, respectively). Eight patients in the gonadotropin group (8.7%) developed ovarian hyperstimulation syndrome (OHSS), a complication; no LOD patient developed OHSS. The clinical pregnancy, abortion, and live birth rates were all similar between the two groups. C Co on nc cl lu us si io on n: : We found that pregnancy outcomes were similar in PCOS patients resistant to clomiphene citrate who underwent LOD and exogenous gonadotropin treatment, but the OHSS risk was significantly lower in the LOD group.K Ke ey yw wo or rd ds s: : Ovarian hyperstimulation syndrome; ovulation induction; pregnancy; infertility; laparoscopy Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmamızın amacı klomifen sitrata dirençli polikistik over sendromu (PKOS) hastalarında, laparoskopik ovaryen drilling(LOD) ve gonadotropinlerle ovulasyon indüksiyonu tedavilerinin etkinliğini ve sonuçlarını karşılaştırmak. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Ocak 2002 ile Temmuz 2015 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi İnfertilite polikliğine başvuran tüm hastaların tıbbi bilgileri retrospektif olarak incelendi.124 hasta çalışma kriterleni karşıladı; bunlardan 33'ü LOD grubunu, 91'i gonadotropin grubunu oluşturdu. B Bu ul lg gu ul la ar r: : Yaş, vücut kütle indeksi, infertilite süresi, bazal follikül stimulan hormon düzeyleri ve antral follikül sayımı açısından gruplar arasında fark saptanmadı. Over hacmi, lüteinizan hormon ve total testosteron düzeylerinde LOD'dan 2 ve 6 ay sonra belirgin azalma saptandı. (p=0.011, sırasıyla p<0.001, and p=0.002) Gonadotropin grubundaki 8 hastada(%8,7), bir komplikasyon olarak değerlendirilen ovaryan hiperstimülasyon sendromu (OHSS) gelişirken, LOD grubunda OHSS oluşmadı. İki grup arasında klinik gebelik, düşük ve canlı doğum oranları benzer saptandı. S So on nu uç ç: : Klomifen sitrat tedavisine dirençli PKOS hastalarında, LOD ve gonadotropin tedavisinin gebelik sonuçlarının benzer, fakat OHSS riskinin LOD grubunda belirgin olarak az olduğunu saptadık.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Ovaryan hiperstimülasyon sendromu; ovulasyon indüksiyonu; gebelik; infertilite; laparosk...

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Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis

Cited by 7 publications

References 22 publications

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Primum Non Nocere

Laparoscopic Ovarian Drilling: Is It a Safe Alternative of Gonadotropin Treatment for Second-line Therapy in Patients with Polycystic Ovary Syndrome Resistant to Clomiphene Citrate?

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