Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: Endocrine and ultrasonographic outcomes

Jessop Wing, Sheffield Teaching Hospitals, University of Sheffield, Tree Root Walk, Sheffield S10 2SF, UK.
Human Reproduction (Impact Factor: 4.57). 11/2002; 17(11):2851-7. DOI: 10.1093/humrep/17.11.2851
Source: PubMed


There is considerable controversy as to how long the beneficial effects of laparoscopic ovarian drilling (LOD) last. This follow-up study was undertaken to investigate the long-term effects of LOD.
The study included 116 anovulatory women with polycystic ovary syndrome (PCOS) who underwent LOD between 1991 and 1999 (study group) and 34 anovulatory PCOS women diagnosed during the same period, who had not undergone LOD (comparison group). The hospital records were reviewed and most patients attended for a transvaginal ultrasound scan and blood sampling to measure the serum concentrations of LH, FSH, testosterone, androstenedione and sex hormone-binding globulin. The results before and at different intervals, short- (<1 year), medium- (1-3 years) and long-term (4-9 years), after LOD were compared.
The LH:FSH ratio, mean serum concentrations of LH and testosterone and free androgen index decreased significantly after LOD and remained low during the medium- and long-term follow-up periods. The mean ovarian volume decreased significantly (P < 0.05) from 11 ml before LOD to 8.5 ml at medium-term and remained low (8.4 ml) at long-term follow-up.
The beneficial endocrinological and morphological effects of LOD appear to be sustained for up to 9 years in most patients with PCOS.

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Available from: Saad Amer, Dec 25, 2013
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    • "LOD has been proven to significantly reduce circulating AMH levels [26], with values remaining significantly reduced up to 6 months after the procedure [16]. The mechanic effect of LOD on polycystic ovaries may reside in destruction of small antral and pre-antral follicles, besides stroma, resulting in a relatively long term impact on circulating levels of AMH, LH, and total and free testosterone [27]. As a result of these changes, increased ovulation and pregnancy rates have been documented after LOD in patients with PCOS. "
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    ABSTRACT: To examine whether ovarian puncture for immature oocyte retrieval and in-vitro maturation (IVM) has an effect on the endocrine profile of patients with polycystic ovary syndrome (PCOS). Twenty-two consecutive patients with PCOS undergoing IVM treatment were included. Serum anti-Mullerian hormone (AMH), sex hormone-binding globulin (SHBG), total testosterone (TT) and luteinized hormone (LH) levels were analyzed at the start of the cycle, on the day of immature oocyte retrieval (OR) and at fixed intervals thereafter, for up to three months after OR. Five days after OR circulating AMH, TT, calculated free testosterone (FTc), and LH levels were significantly reduced and circulating SHBG was significantly increased. Two weeks after OR, TT, FTc and LH remained reduced, whereas circulating AMH and SHBG levels recovered to pre-puncture values. Three months after OR, all circulating hormone levels had recovered to baseline values. Ovarian puncture for the retrieval of immature oocytes and IVM in patients with PCOS has a significant impact on the ovarian endocrine profile, but this impact is brief and transient.
    Reproductive Biology and Endocrinology 02/2014; 12(1):18. DOI:10.1186/1477-7827-12-18 · 2.23 Impact Factor
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    • "LOD is an effective procedure in properly selected cases, because drilling appears to be equally effective with lesser chances of multiple pregnancies [45, 46]. In LOD treatment, high success pregnancy rates of around 60 % are expected after treatment within 6 months of time with a low risk of adverse effects in PCOS, and peak pregnancy rate is seen around 6–9 months after surgery [47]. "
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age. In 2006 the Japanese Society of Obstetrics and Gynecology (JSOG) proposed new, revised diagnostic criteria that in the future could also be valued internationally. Based on the new diagnostic criteria, the JSOG has also proposed the revised treatment criteria in 2008. In PCOS obese patients desiring children, weight loss and exercise is recommended. Nonobese patients, or those obese women who do not ovulate after lifestyle changes, are submitted to ovulation-induction therapy with clomiphene citrate (CC). Obese CC-resistant patients who have impaired glucose tolerance or insulin resistance are treated with a combination of metformin and CC. If these treatments options are unsuccessful, ovulation induction with exogenous gonadotropin therapy or laparoscopic ovarian drilling (LOD) is recommended. A low-dose step-up regimen is recommended with careful monitoring in order to reduce the risk of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. Alternatively, with LOD high successful pregnancy rates of around 60 % are expected with a low risk of multiple pregnancies. If ovulation induction is unsuccessful, IVF-ET treatment is indicated. In high OHSS-risk patients, systematic embryo freezing and subsequent frozen embryo transfer cycles are recommended. In nonobese, anovulatory PCOS patients not desiring children, pharmacological treatments such as Holmström, Kaufmann regimens or low-dose oral anticonceptives are used to induce regular withdrawal bleeding. These treatments are especially important for preventing endometrial hyperplasia and endometrial cancer. These new diagnostic and treatment criteria hopefully will contribute to an improved care of PCOS patients in Japan.
    Reproductive Medicine and Biology 07/2013; 12(3):71-77. DOI:10.1007/s12522-013-0145-1
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    • "On the other hand, only 46 (23.5%) of the 196 participants were excluded from the analysis because they did not meet the inclusion criteria or refused to participate and preferred to switch to higher management lines. This rate was acceptable and supports the idea that there is a need for this novel combination treatment in CC-resistant women with PCOS, as treatment with gonadotropin remains expensive, and LOD requires specific skills and is associated with perioperative morbidity [25]. We conclude that ovulation and pregnancy rates are similar following treatment with CC plus tamoxifen or LOD. "
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    ABSTRACT: To compare the efficacy of clomiphene citrate (CC) plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome (PCOS). We randomly allocated 150 women with CC-resistant PCOS to a combined medication group (group 1) or a laparoscopic surgery group (group 2). The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage. There were no significant differences between the groups regarding rates of ovulation (81.3% vs 85.3%), pregnancy (53.3% vs 50.7%), or live births (49.3% vs 44.0%), but the mean endometrium thickness was significantly greater on the day of human chorionic gonadotropin administration in group 1 (P<0.001). Clomiphene citrate plus tamoxifen was as effective as laparoscopic ovarian drilling in promoting ovulation and pregnancy.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 11/2009; 108(3):240-3. DOI:10.1016/j.ijgo.2009.10.004 · 1.54 Impact Factor
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