Transvaginal hydrolaparoscopy in the treatment of polycystic ovary syndrome

Gordts, Stephanie C.; Gordts, S.; Puttemans, Patrick; Valkenburg, Marion; Campo, Rudi; Brosens, Ivo

doi:10.1016/j.fertnstert.2008.04.020

Cited by 41 publications

(21 citation statements)

References 38 publications

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“…In our study, we have no information to justify the duration of the recovery phase. Interestingly, transvaginal hydrolaparoscopic ovarian drilling has been associated with a productivity loss of a maximum of 3 days [18]. Since there is evidence that transvaginal hydrolaparoscopic ovarian drilling results in a similar ovulation and pregnancy rate as LOD and is associated with a low risk of intra- and postoperative complications, this technique might be a valuable alternative to LOD in order to reduce the societal cost of an ovarian drilling [18,19,20,21].…”

Section: Discussionmentioning

confidence: 99%

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

Frène

Gerris²,

Weyers³

et al. 2015

Gynecol Obstet Invest

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Background: Gonadotropin therapy and laparoscopic ovarian drilling (LOD) are treatment options for ovulation induction (OI) in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives. Methods: 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. Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy rate and number of live-born children. Results: The ongoing pregnancy rate was 21/35 (60%) after LOD and 30/43 (69.8%) after hMG treatment (relative risk 0.85, 95% CI 0.61-1.19). The societal cost per patient, up to an ongoing pregnancy, was significantly higher after LOD versus hMG treatment (adjusted mean difference EUR 1,073, 95% CI 180-1,967). Conclusion: 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.

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Section: Discussionmentioning

confidence: 99%

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

Frène

Gerris²,

Weyers³

et al. 2015

Gynecol Obstet Invest

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“…Since 1990, less invasive methods for conducting and ovarian drilling [8,10,11] have been investigated, and a number of surgical procedures that destroy or remove ovarian tissue to restore ovulation in SOP patients have been described [12,13]. Although the surgical of new modalities have easy applicability and low cost with shorter hospital stay, the safety of the procedures remain to be defined [7].…”

Section: Discussionmentioning

confidence: 99%

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

et al. 2012

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BackgroundSome techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model.FindingsAn experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path.ConclusionsThis is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome.

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“…This treatment is costly and time consuming, and carries the increased risks of OHSS and the risk of a multiple pregnancy. 17,19 An alternative to this is the surgical approach. Surgical ovarian wedge resection was first established but was largely abandoned because of the risks of post-surgical adhesions along with the introduction of clomiphene citrate.…”

Section: Ovarian Surgerymentioning

confidence: 99%

“…Surgical ovarian wedge resection was first established but was largely abandoned because of the risks of post-surgical adhesions along with the introduction of clomiphene citrate. 19 Modern techniques are ovarian drilling and several methods have been described, including ovarian biopsy, electrocautery and the use of laser. 19 A Cochrane review compared the effectiveness and safety of laparoscopic drilling (Fig.…”

Section: Ovarian Surgerymentioning

confidence: 99%