Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome

Farquhar, Cindy; Lilford, Richard; Marjoribanks, Jane; Vanderkerchove, Patrick

doi:10.1002/14651858.cd001122.pub3

Cited by 84 publications

(57 citation statements)

References 29 publications

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“…According to current evidence, including data on long term follow-up, laparoscopic ovarian drilling is recommended as an effective and economic second line treatment for ovulation induction in women with clomiphene resistant PCOS. [117][118][119][120][121][122] In conclusion, in women with WHO group II anovulation, both letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of ovulation and pregnancy. Letrozole is the only treatment showing a significantly higher rate of live birth when compared with clomiphene alone.…”

Section: Clinical Implications and Conclusionmentioning

confidence: 87%

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Wang

Kim

Wely

et al. 2017

BMJ

116

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Objective To compare the effectiveness of alternative first line treatment options for women with WHO group II anovulation wishing to conceive. Design Systematic review and network meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Medline, and Embase, up to 11 April 2016. Study selection Randomised controlled trials comparing eight ovulation induction treatments in women with WHO group II anovulation: clomiphene, letrozole, metformin, clomiphene and metformin combined, tamoxifen, gonadotropins, laparoscopic ovarian drilling, and placebo or no treatment. Study quality was measured on the basis of the methodology and categories described in the Cochrane Collaboration Handbook. Pregnancy, defined preferably as clinical pregnancy, was the primary outcome; live birth, ovulation, miscarriage, and multiple pregnancy were secondary outcomes. Results Of 2631 titles and abstracts initially identified, 57 trials reporting on 8082 women were included. All pharmacological treatments were superior to placebo or no intervention in terms of pregnancy and ovulation. Compared with clomiphene alone, both letrozole and the combination of clomiphene and metformin showed higher pregnancy rates (odds ratio 1.58, 95% confidence interval 1.25 to 2.00; 1.81, 1.35 to 2.42; respectively) and ovulation rates (1.99, 1.38 to 2.87; 1.55, 1.02 to 2.36; respectively). Letrozole led to higher live birth rates when compared with clomiphene alone (1.67, 1.11 to 2.49). Both letrozole and metformin led to lower multiple pregnancy rates compared with clomiphene alone (0.46, 0.23 to 0.92; 0.22, 0.05 to 0.92; respectively). Conclusions In women with WHO group II anovulation, letrozole and the combination of clomiphene and metformin are superior to clomiphene alone in terms of ovulation and pregnancy. Compared with clomiphene alone, letrozole is the only treatment showing a significantly higher rate of live birth. Systematic review registration PROSPERO CRD42015027579.

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Section: Clinical Implications and Conclusionmentioning

confidence: 87%

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Wang

Kim

Wely

et al. 2017

BMJ

116

View full text Add to dashboard Cite

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“…In some cases, the fertility benefits of ovarian drilling may be temporary and adjuvant therapy after drilling with clomiphene may be necessary. [43] Ovarian drilling does not appear to improve metabolic abnormalities in women with PCOS. [44] Aromatase inhibitors Aromatase inhibitors such as letrozole and anastrazole have been proposed as both first and secondary treatment for ovulation induction (in women with PCOS and also for unexplained infertility).…”

Section: Clomiphene Citratementioning

confidence: 95%

Polycystic ovarian syndrome

Madnani

Khan

Chauhan

et al. 2013

Indian J Dermatol Venereol Leprol

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Polycystic ovarian syndrome (PCOS) is a "multispeciality" disorder suspected in patients with irregular menses and clinical signs of hyperandrogenism such as acne, seborrhoea, hirsutism, irregular menses, infertility, and alopecia. Recently, PCOS has been associated with the metabolic syndrome. Patients may develop obesity, insulin resistance, acanthosis nigricans, Type 2 diabetes, dyslipidemias, hypertension, non-alcoholic liver disease, and obstructive sleep apnoea. Good clinical examination with hematological and radiological investigations is required for clinical evaluation. Management is a combined effort involving a dermatologist, endocrinologist, gynecologist, and nutritionist. Morbidity in addition includes a low "self image" and poor quality of life. Long term medications and lifestyle changes are essential for a successful outcome. This article focuses on understanding the normal and abnormal endocrine functions involved in the pathogenesis of PCOS. Proper diagnosis and management of the patient is discussed.

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“…Given that it is unknown if the ovaries were sick, results are not definite; but based on previous studies [9,20,34], our results can be useful in the treatment of hypo activation of ovary.…”

Section: Resultsmentioning

confidence: 92%

“…One of these diseases is polycystic ovarian syndrome (PCOS) for which laser had been used as complementary therapy [20,34]. The aim of this research was to propose the use of lasers autonomously, without any medical and surgical intervention, in the treatment of ovarian negligence in adult women, unlike the past studies [9,20].…”

Section: Resultsmentioning

confidence: 99%

How do red and infrared low-level lasers affect folliculogenesis cycle in rat’s ovary tissue in comparison with clomiphene under in vivo condition

2017

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Folliculogenesis is a cycle that produces the majority of oocyte. Any disruption to this cycle leads to ovulation diseases, like polycystic ovarian syndrome (PCOS). Treatments include drugs and surgery; lasers have also been used complementarily. Meanwhile, still there is no definite treatment for PCOS. This study investigated the photo-bio stimulation effect of near-infrared and red low-level laser on producing follicles and compared the result with result of using common drug, clomiphene. Therefore, the aim of this study was to propose the use of lasers autonomously treatment. So, there was one question: how do lasers affect folliculogenesis cycle in rat's ovary tissue? In this study, 28 rats were assigned to four groups as follows: control (CT), clomiphene drug (D), red laser (RL), and near-infrared laser (NIRL). Afterwards, 14 rats of RL and NIRL groups received laser on the first 2 days of estrous cycle, each 6 days, for 48 days. During treatment period, each rat received energy density of 5 J/cm 2 . Seven rats in D group received clomiphene. After the experiment, lasers' effects at two wavelengths of 630 and 810 nm groups have been investigated and compared with clomiphene and CT groups. Producing different follicles to complement folliculogenesis cycle increased in NIRL and RL groups, but this increase was significant only in the NIRL group. This indicates that NIRL increases ovarian activity to produce oocyte that certainly can be used in future studies for finding a cure to ovarian negligence to produce more oocyte and treat diseases caused by it like PCOS.

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Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome

Cited by 84 publications

References 29 publications

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis

Polycystic ovarian syndrome

How do red and infrared low-level lasers affect folliculogenesis cycle in rat’s ovary tissue in comparison with clomiphene under in vivo condition

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