Long-term outcomes in women with polycystic ovary syndrome initially randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotrophins

Nahuis, Marleen; Kose, Noriko; Bayram, Neriman; Dessel, H.J.H.M. van; Braat, D.D.M.; Hamilton, C.J.C.M.; Hompes, Peter G.A.; Bossuyt, P. M. M.; Mol, Ben Willem J.; Veen, Fulco van der; Wely, Madelon van

doi:10.1093/humrep/der141

Cited by 45 publications

(24 citation statements)

References 14 publications

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“…17,28 In a questionnaire based study of 168 women 8 to 12 years after being randomized to receive LOD or ovulation induction with gonadotrophins, 54% of the LOD-treated women had regular menstrual cycles and had an increased chance of having a second child. 29 Long-term follow-up of our cohort confirm that improvement in ovulation is sustained over time as demonstrated by the 52% of women that still had regular menstrual cycles after three to nine years. Although 45% of pregnancies occurred within the first year, 26% were achieved more than three years after surgery, suggesting a long lasting effect in fertility.…”

Section: Discussionsupporting

confidence: 77%

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Luz¹,

Barros²,

Aguiar³

et al. 2016

Acta Med Port

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Introduction:Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. Material and Methods:This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conception in patients without other infertility factors.Results: Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). Discussion: Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. Conclusion: Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

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Section: Discussionsupporting

confidence: 77%

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Luz¹,

Barros²,

Aguiar³

et al. 2016

Acta Med Port

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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

115

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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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“…Multiple gestation is a possible complication of induction of ovulation as a treatment of the anovulatory cycles in PCOS patients. Nahuis et al reported an incidence of twin pregnancy in PCOS patients in a randomised trial as 5 percent after being treated by laparoscopic electrocautery, and 8 percent after receiving recombinant-FSH [16]. In addition, Zhao et al studied the pregnancy outcome after in vitro maturation of immature oocytes, and found a significant increase in multiple gestation up to 30 percent, low birth weight, and preterm deliveries [17].…”

Section: Discussionmentioning

confidence: 99%

Recurrent Pregnancy Loss in Patients with Polycystic Ovary Syndrome: A Case Control Study

Ashaq¹,

Mazer²,

Qahtani³

2017

OJOG

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Objectives: To identify different biophysical and hormonal factors that could contribute to recurrent pregnancy loss in Saudi women who have been diagnosed with polycystic ovary syndrome. Study Design: Case-control study. Settings: Infertility clinic in Dammam Maternity and Children Hospital. Cases: PCOS patients with recurrent pregnancy loss. Controls: PCOS patients without recurrent pregnancy loss. Results: The prevalence of recurrent abortion in PCOS patients was 31%. There was no significant difference between the cases and the controls in the age, 33.1 years versus 31.9 years, BMI, 31.4 kg/m 2 versus 31.6 kg/m 2 respectively. There was no significant difference in the successful pregnancies outcome in cases and controls, term deliveries 84% versus 90%, preterm deliveries 10% versus 5%, twin pregnancy 6% versus 5% respectively. There was no significant difference in the hormonal profile (prolactin, LH, FSH, LH/FSH ratio, TSH, progesterone, testosterone) between cases and controls. Serum estradiol level was significantly lower in the cases compared to the controls, 55.5 pg/mL versus 83.9 pg/mL respectively (p < 0.01). Conclusion: PCOS patients with recurrent abortions had no significant increase in the age, BMI, preterm pregnancy, multiple gestation and ectopic pregnancy. The hormonal profile (prolactin, LH, FSH, LH/FSH ratio, TSH, progesterone, testosterone) was comparable between the cases and the controls, except for serum estradiol level, which was significantly lower in PCOS patients with recurrent abortions.

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Long-term outcomes in women with polycystic ovary syndrome initially randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotrophins

Cited by 45 publications

References 14 publications

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome

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

Recurrent Pregnancy Loss in Patients with Polycystic Ovary Syndrome: A Case Control Study

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