scholarly journals Letrozole versus laparoscopic ovarian drilling in infertile women with PCOS resistant to clomiphene citrate

2017 ◽  
Vol 22 (4) ◽  
pp. 251-254 ◽  
Author(s):  
Mahmoud H. Ibrahim ◽  
M. Tawfic ◽  
Moamen M. Hassan ◽  
O.H. Sedky
2017 ◽  
Vol 9 (4) ◽  
pp. 336-340 ◽  
Author(s):  
Richa Singh ◽  
Meenal Jain ◽  
Poonam Yadav ◽  
Sarvesh Awasthi ◽  
Pallavi Raj

ABSTRACT Introduction The polycystic ovary syndrome (PCOS) is the most common condition associated with chronic anovulation affecting 4 to 6% of reproductive age women. Aim To compare the effectiveness of laparoscopic ovarian drilling (LOD) for ovulation induction with gonadotropins in clomiphene-resistant PCOS in terms of ovulation, pregnancy, live birth, abortion, multiple pregnancies, and complication like ovarian hyperstimulation syndrome (OHSS). Setting and design A prospective hospital-based randomized trial. Materials and methods It was a prospective study, which was carried out from January 2012 to May 2015. Totally, 89 women were evaluated in the study, out of which 44 women were in gonadotropin group and 45 were in LOD group. Statistical analysis Standard statistical analysis was done and significance of difference in results was tested by chi-square test. Results Ovulation rate in gonadotropin group was 75.0% at 6 months, whereas in LOD group, it was 20% at 3 months and was increased up to 66.66% after addition of clomiphene citrate and gonadotropin. The primary outcome in terms of pregnancy in gonadotropin group was 45.45% after 6 cycles and in LOD group was 11.11% after 3 cycles and 40.00% after 6 cycles with supplementation of clomiphene citrate and gonadotropin. Conclusion The ongoing pregnancy rate from ovulation induction with LOD alone was significantly less but if supplemented by clomiphene citrate and gonadotropin, it seems equivalent to ovulation induction with gonadotropin, but the former procedure carries a lower risk of multiple pregnancies. How to cite this article Yadav P, Singh S, Singh R, Jain M, Awasthi S, Raj P. To Study the Effect on Fertility Outcome by Gonadotropins vs Laparoscopic Ovarian Drilling in Clomiphene-resistant Cases of Polycystic Ovarian Syndrome. J South Asian Feder Obst Gynae 2017;9(4):336-340.


Author(s):  
Ambika Shankar ◽  
Oby Nagar ◽  
Shakuntla . ◽  
Suman Meghwal

Background: PCOS (polycystic ovarian syndrome) is the most common cause of anovulatory infertility, the purpose of our study was to see the effect of laparoscopic ovarian drilling on the ovarian reserve (with AMH as an indicator of ovarian reserve) and its safety as 2nd line of treatment in patients resistant to clomiphene citrate.Methods: This was a prospective interventional study conducted on 40 clomiphene citrate resistant PCOS women attending the infertility OPD. This study was conducted over a period of 1 year May 2019 to May 2020. Laparoscopic ovarian drilling (LOD) was done and these subjects were studied preoperatively and postoperatively on day 7 and day 30 for change in AMH (anti-Mullerian hormone) levels.Results: There is a significant change in the AMH level post LOD day 7 and 30 but not so severe that it will lead to premature ovarian failure. The amount of drop in AMH (day 30) increases till 20 ng/ml beyond which it shows a decrease.Conclusions: If LOD is done in a proper manner in women with sufficient ovarian reserve (high AMH), it will not adversely affect the ovarian reserve (the fall is not enough to cause premature ovarian insufficiency). 


2020 ◽  
Vol 21 (6) ◽  
Author(s):  
Leili Hafizi ◽  
Akram Behrouznia ◽  
Maliheh Amirian ◽  
Mina Baradaran ◽  
Seyedeh Azam Pourhoseini

Background: Laparoscopic ovarian drilling (LOD) is recommended for the treatment of women with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate. Objectives: This study aimed to evaluate the effect of ovarian drilling on the serum levels of anti-mullerian hormone (AMH), androgens, and the number of antral follicles. Methods: This was a pre- and post-clinical trial performed on 30 infertile women with PCOS resistant to clomiphene citrate. Patients underwent standard laparoscopic ovarian drilling. Serum levels of AMH and androgens and antral follicle count (AFC) were surveyed before LOD and three and six months after LOD. The ovarian ovulation rate in each month was also monitored for six months. Then, the association between changes in these parameters, especially the level of AMH, and postoperative ovulation was investigated. A P < 0.05 was considered statistically significant. Results: The number of antral follicles three (3.00 ± 8.00) and six months (7.73 ± 4.14) after ovarian drilling showed a significant decrease compared to preoperative values (12.40 ± 4.02) (repeated-measures ANOVA, P < 0.001). The mean AMH (6.78 ± 1.08 versus 12.25 ± 1.35; P = 0.005) and the antral follicle count (7.71 ± 0.54 versus 12.29 ± 0.67 and P < 0.001) were lower in ovulation than in non-ovulation patients. The significantly more AMH reductions were seen in pregnant women (3.63 ± 5.61) than in non-pregnant women (3.63 ± 1.24) (P = 0.01). Conclusions: It may be possible to use the changes in AMH and AFC to predict the success rate of LOD.


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