Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Zhang, Jing; Zhou, Kang; Luo, Xiaoyan; Yang, Meng‐Yin; Shen, Xiaoyang; Xu, Liangzhi

doi:10.1016/j.jmig.2019.06.022

Cited by 5 publications

(7 citation statements)

References 29 publications

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“…The standard number and/or depth of the perforation or dose and/or the duration of energy sources applied to the ovary to maximize the therapeutic effects remain controversial [92,93]. Most studies propose the use of three to ten punctures for a single ovary and a power setting of 200-300 watts (W) for 2-4 s [27,28,39,46,52,61,88]. Our suggestion is that the number of punctures should be tailored to the individual ovary in each woman with PCOS depending on the ovarian size [94,95].…”

Section: How Many Punctures Are Needed During the Laparoscopic Ovariamentioning

confidence: 99%

“…LOD may induce overall spontaneous ovulation and pregnancy rates of 30-90% and 13-88% [1,21,28,39,51,60,61,111]. An earlier review showed that there is no statistically significant difference in the ovulation rates following LOD using electrocoagulation and a laser (83% vs. 77.5%; OR 1.4; 95% CI 0.9-2.1) [111].…”

Section: Ovulation and Pregnancy Rates After Laparoscopic Ovarian Drimentioning

confidence: 99%

“…Directly using another agent alone in place of CC in the management of POCS women is also widely used. These agents include metformin [18,19,25,[30][31][32][33][34][35][36][37]40]; rosiglitazone or rosiglitazone alone [21,33,40]; and AIs, such as letrozole [21,23,42] and gonadotropins [20,[22][23][24][26][27][28][29][30][31][32][33][34][35][36][37]. A Cochrane Database Systematic Review in 2017 suggested the potential benefits of a combination of metformin and CC in clinical pregnancy and ovulation among PCOS women with infertility compared to the use of CC alone [40].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical approaches can be performed either via ovarian ablative therapy or via an ovarian drilling procedure. The latter option is further separated into laparoscopic ovarian drilling (LOD) and ultrasound-guided ovarian drilling (UGOD) [10,15,21,[25][26][27][28]38,39].…”

Section: Introductionmentioning

confidence: 99%

“…Wedge resection was the forerunner of LOD and was first introduced by Stein and Leventhal for seven anovulatory women with PCOS and resulted in the resumption of menses and pregnancy [47,48]. Presently, both laparoscopic ovarian electrocautery (diathermy either by unipolar or bipolar) and laser vaporization using carbon dioxide (CO 2 ), argon, or neodymium-doped yttrium aluminum garnet (Nd:YAG; Nd:Y3A15O12) crystal lasers are commonly used in the LOD procedure, either unilaterally or bilaterally [15,25,28,38,39,[48][49][50][51][52][53][54][55][56][57][58][59][60][61]. Compared to the conventional wedge resection of bilateral ovaries, LOD seems to have many advantages, partly due to its minimally invasive strategy.…”

Section: Introductionmentioning

confidence: 99%

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Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Seow¹,

Chang

Chen

et al. 2020

IJMS

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Polycystic ovary syndrome (PCOS) is a common endocrinopathy, characterized by chronic anovulation, hyperandrogenism, and multiple small subcapsular cystic follicles in the ovary during ultrasonography, and affects 5–10% of women of reproductive age. PCOS is frequently associated with insulin resistance (IR) accompanied by compensatory hyperinsulinemia and, therefore, presents an increased risk of type 2 diabetes mellitus (DM). The pathophysiology of PCOS is unclear, and many hypotheses have been proposed. Among these hypotheses, IR and hyperandrogenism may be the two key factors. The first line of treatment in PCOS includes lifestyle changes and body weight reduction. Achieving a 5–15% body weight reduction may improve IR and PCOS-associated hormonal abnormalities. For women who desire pregnancy, clomiphene citrate (CC) is the front-line treatment for ovulation induction. Twenty five percent of women may fail to ovulate spontaneously after three cycles of CC treatment, which is called CC-resistant PCOS. For CC-resistant PCOS women, there are many strategies to improve ovulation rate, including medical treatment and surgical approaches. Among the various surgical approaches, one particular surgical method, called laparoscopic ovarian drilling (LOD), has been proposed as an alternative treatment. LOD results in an overall spontaneous ovulation rate of 30–90% and final pregnancy rates of 13–88%. These benefits are more significant for women with CC-resistant PCOS. Although the intra- and post-operative complications and sequelae are always important, we believe that a better understanding of the pathophysiological changes and/or molecular mechanisms after LOD may provide a rationale for this procedure. LOD, mediated mainly by thermal effects, produces a series of morphological and biochemical changes. These changes include the formation of artificial holes in the very thick cortical wall, loosening of the dense and hard cortical wall, destruction of ovarian follicles with a subsequently decreased amount of theca and/or granulosa cells, destruction of ovarian stromal tissue with the subsequent development of transient but purulent and acute inflammatory reactions to initiate the immune response, and the continuing leakage or drainage of “toxic” follicular fluid in these immature and growth-ceased pre-antral follicles. All these factors contribute to decreasing local and systemic androgen levels, the following apoptosis process with these pre-antral follicles to atresia; the re-starting of normal follicular recruitment, development, and maturation, and finally, the normalization of the “hypothalamus–pituitary–ovary” axis and subsequent spontaneous ovulation. The detailed local and systematic changes in PCOS women after LOD are comprehensively reviewed in the current article.

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Section: How Many Punctures Are Needed During the Laparoscopic Ovariamentioning

confidence: 99%

Section: Ovulation and Pregnancy Rates After Laparoscopic Ovarian Drimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Seow¹,

Chang

Chen

et al. 2020

IJMS

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Effects of Different Methods of Laparoscopic Ovarian Drilling and its Outcome in Patients with Polycystic Ovary Syndrome

Hamoda

Megahed

Oun

2021

International Journal of Medical Arts

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Background: Polycystic ovary syndrome [PCOS] is an important and common etiology for anovulatory infertility. Clomiphene citrate [CC] is the first line of treatment. One fourth of females are resistant to CC. Laparoscopic ovarian drilling [LOD] has developed manage CC-resistant cases. However, no consensus was established on the ideal drilling method. Aim of the work: This study aimed to evaluate the efficacy of different LOD methods for anovulatory infertility in CC-resistant PCOS patients. Patients and Methods: The study participants [200] were assigned randomly to one of four equal groups. Group [I] treated by unilateral cutting LOD. Group [II] treated by unilateral electro-coagulative LOD. Group [III] treated by bilateral cutting LOD. Group [IV] treated by bilateral electro-coagulative LOD. All participants were submitted to history taking, clinical examination, laboratory investigation, antral follicular count [AFC], and transvaginal ultrasound. After LOD, follow up included regularity of menstrual cycle, ovulation, and hormonal assay [at six months after ovarian drilling]. Also, ovulation, pregnancy and miscarriage rates were documented. Results:The study groups showed no significant difference regarding patient characteristics [e.g., body mass index, infertility duration and menstrual cycle history], and hormonal profile before and after LOD. The spontaneous ovulation rate was 40%, 42.0%, 46.0% and 40.0% in groups I, II, III and IV, respectively. The pregnancy rate was 32.0%, 38.0%, 44.0% and 42.0% in groups I, II, III and IV, respectively.in all groups, hormonal profile and AFC showed significant improvement after LOD compared with corresponding pre-LOD values. However, levels of FSH are significantly nonsignificant. Conclusion:Different techniques of LOD are equally effective and safe [e.g., unilateral ovarian drilling is as effective and safe as bilateral drilling, regardless of the drilling method [coagulative or cutting] with comparable ovulation, pregnancy and miscarriage rates.

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The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education

Tica

Wilde

2022

JCM

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Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment (that may bring value for future advance), standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery (in close harmonization with personalized medicine) would lead to effective delivery of better clinical services and provide excellent training and education.

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Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Cited by 5 publications

References 29 publications

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

Effects of Different Methods of Laparoscopic Ovarian Drilling and its Outcome in Patients with Polycystic Ovary Syndrome

The Future in Standards of Care for Gynecologic Laparoscopic Surgery to Improve Training and Education

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