Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center

Abstract

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women and its prevalence is rising. Management of the disease is usually medical and some resistant cases may require surgical treatment in the form of laparoscopic ovarian drilling (LOD). Medical management exposes the patient to increased risk of multiple pregnancy and hyperstimulation. LOD avoids the need of medical therapy or makes the ovaries more responsive to treatment.

Is There Still a Place for Surgery in Patients with PCOS? A Review

“…Finally, 17 studies were included in the study [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of the 17 articles included in this review, 12 were used to provide an overview of LOD in CC-resistant patients with PCOS [16,17,[19][20][21][22][23][24][25]27,28], with some authors focusing on specific techniques in the laparoscopic field, such as Gjønnaess et al and Van Wely et al, who reported the use of ovarian electrocautery [15,23], and Duleba et al, the laparoscopic ovarian wedge resection using a harmonic scalpel [20]. Of these, five were retrospective studies [15,16,25,27,28] and eight were prospective ones [17,[19][20][21][22][23][24][25].…”

“…Thirty-two articles were evaluated for eligibility after abstract screening. Finally, 17 studies were included in the study [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

“…Of the 17 articles included in this review, 12 were used to provide an overview of LOD in CC-resistant patients with PCOS [ 16 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 28 ], with some authors focusing on specific techniques in the laparoscopic field, such as Gjønnaess et al and Van Wely et al, who reported the use of ovarian electrocautery [ 15 , 23 ], and Duleba et al, the laparoscopic ovarian wedge resection using a harmonic scalpel [ 20 ]. Of these, five were retrospective studies [ 15 , 16 , 25 , 27 , 28 ] and eight were prospective ones [ 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The further five studies focused on the use of THL [ 18 , 25 , 26 , 29 , 30 ], and of these two were retrospective studies [ 26 , 30 ] and three prospective ones [ 18 , 29 , 31 ]; one of these compared a group of patients treated with LOD with a group that had undergone THL in terms of ovarian adhesion formation during follow-up [ 31 ].…”

“…After LOD, a different percentage of women underwent spontaneous ovulation such as 74 [ 16 ], 54 [ 17 ], 127 [ 19 ], 113 [ 22 ], 38 [ 23 ], and more than 50% [ 21 ] patients, respectively; other women ovulated with CC, such as 22 [ 16 ], 6 [ 17 ], 51 [ 19 ], 43 [ 22 ], and 21 [ 23 ] patients, respectively, or with gonadotropins [ 17 ]. In some studies, how ovulation occurred was not specified [ 15 , 20 , 21 , 24 , 25 , 27 , 28 ].…”

“…Not all women who ovulated became pregnant, and ectopic pregnancy or miscarriage were reported [ 16 , 17 , 19 , 21 , 22 , 28 ]. This data is not strictly associated with the disease or the treatment related to it, as there is no scientific data to support this relationship.…”