Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome

Armar, N. A.; Mcgarrigle, H. H. G.; Honour, John W.; Holownia, Peter; Jacobs, Howard S.; Lachelin, Gillian C. L.

doi:10.1016/s0015-0282(16)53214-2

Cited by 196 publications

(78 citation statements)

References 17 publications

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“…Serum levels of testosterone was found reduced significantly after cautery [8]. Concerning the behavior of DHEAS serum levels while some have found no change after surgery, Naether et al [9] found a significant reduction in DHEAS levels.…”

Section: Discussionmentioning

confidence: 93%

“…The FSH levels have been found to rise after surgery causing fall in LH: FSH ratio [10] . Regarding post operative LH levels most authors have found a reduction [8,10]. Inhibin levels fall significantly immediately after ovarian cautery [11].…”

Section: Discussionmentioning

confidence: 99%

“…Armar et al recommended only four diathermy points per ovary [8]. Gjonnaess later used only 6-8 and Greenblatt used 8 points per ovary [13,14].…”

Section: Discussionmentioning

confidence: 99%

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Surgical Approach for Polycystic Ovarian Syndrome in Management of Infertility

Rath¹,

Sharma

Duggal³

2006

Medical Journal Armed Forces India

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Background: In patients with Polycystic Ovarian Syndrome (PCOS), resolution of infertility is an important goal of treatment. Wedge resection of the ovaries described as a means to achieve this was practiced in the middle of twentieth century. With the advent of endoscopic surgery, surgical approach for the same condition has been modified. Multi point biopsy, multiple needle puncture, electofulguration and laser fulguration are being tried in the context of PCOS. This project was taken up to evaluate the scope of electo fulguration in clomiphene resistant PCOS. Methods: Forty patients who did not show sonographic evidence of ovulation with clomiphene citrate (CC) 100mg OD for 05 days in two cycles were subjected to laparoscopy. The patients who did not show any pelvic factor for infertility were alternately assigned to electro -fulguration treatment of ovaries or no fulguration during laparoscopy. These were designated as 'Lap EC' & 'Only CC' group respectively. For 'Only CC' group' stimulation with CC was continued for four cycles with a higher dose 150 mg OD for 05 days. Lap EC group were subjected to CC 100mg OD for 5 days for two cycles in case of non achievement of ovulation in the first two drug free cycles following EC. Folliculometry, HCG administration and Intra Uterine Insemination (IUI) was performed for both groups. Results: Total percentage of ovulatory cycles were 51.8% in EC group compared to 5.26% in the CC group. Overall pregnancy rate of 30% was achieved in the Lap EC group as compared to only 10% in the CC group (p<0.05). Conclusion: Laparoscopic electrofulguration of ovaries increases the chances of ovulation and conception . This being a cheaper one time procedure as compared to other expensive ovulation inducing agents, should be the preferred mode and the primary procedure wherever polycystic ovaries are encountered while evaluating a case of infertility by laparoscopy. MJAFI 2006; 62 : 119-122

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Surgical Approach for Polycystic Ovarian Syndrome in Management of Infertility

Rath¹,

Sharma

Duggal³

2006

Medical Journal Armed Forces India

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“…The laparoscopic approach to PCOS has been described extensively [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Local anesthesia has been used for many gynecologic procedures and has been reported to reduce the postoperative pain after day-surgery diagnostic laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it has been proposed that ovulation induction by laparoscopic ovarian drilling (LOD) may improve the overall outcomes of pregnancies in PCOS patients. A comparison of pregnancy outcomes of women with PCOS, who had undergone LOD and non-PCOS pregnancy controls, demonstrated a significantly higher risk of hypertensive disorders and gestational diabetes mellitus for the PCOS group [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Office microlaparoscopic ovarian drilling versus conventional laparoscopic ovarian drilling for women with polycystic ovary syndrome

Salah

2012

Gynecol Surg

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It is a prospective controlled study to compare the beneficial effects of office microlaparoscopic ovarian drilling (OMLOD) under augmented local anesthesia, as a new modality treatment option, compared to those following ovarian drilling with the conventional traditional 10-mm laparoscope under general anesthesia. The study included 60 anovulatory women with polycystic ovary syndrome (PCOS) who underwent OMLOD (study group) and 60 anovulatory PCOS women, where the conventional laparoscopic ovarian drilling (LOD), using 10-mm laparoscope under general anesthesia, was performed (comparison group). Transvaginal ultrasound scan and blood sampling to measure the serum concentrations of LH, FSH, testosterone, and androstenedione had been performed before and after the procedure. Intra-and postoperative pain score in candidate women had been evaluated during the office microlaparoscopic procedure, in addition to the number of candidates who needed extra analgesia. The women undergoing OMLOD showed a good intra-and postoperative perception pain score. The number of those patients discharged within the first 2 h after office procedure was significantly higher, without the need for postoperative analgesia with most patients. The LH/FSH ratio and mean serum concentrations of LH, testosterone, and free androgen index have decreased significantly after both OMLOD and LOD within a postoperative year follow-up. The mean ovarian volume decreased significantly (P<0.05) within the year after both OMLOD and LOD. There were no significant differences in those results after both procedures. Intra-and postoperative augmented local anesthesia allows outpatient bilateral ovarian drilling by microlaparoscopy without general anesthesia. The relatively high pregnancy rate, the simplicity of the method, and the faster discharge time after the operation offer a new modality option for patients with PCOS, who are resistant to clomiphene citrate ovarian induction. Moreover, ovarian drilling could be performed simultaneously during the routine diagnostic microlaparoscopy and integrated in the fertility work-up investigations for those patients.

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