scholarly journals Step-up protocol gonadotrophin versus laparoscopic ovarian drilling in clomiphene citrate resistant PCOS infertile women in two Iraqi hospitals

2019 ◽  
Vol 15 (1) ◽  
pp. 103-109
Author(s):  
Thikra N Abdull
Keyword(s):  
Pregnancy Rate ◽  
Polycystic Ovarian Syndrome ◽  
Polycystic Ovary ◽  
Transvaginal Ultrasound ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Infertile Women ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Syndrome

Background: Polycystic ovarian syndrome is a common endocrine disorder affecting 6-10% of women of reproductive age and the most common cause of anovulatory infertility. Objective: The aim of the study was to compare the effectiveness, side effects and outcomes of step-up gonadotrophin protocol versus laparoscopic ovarian diathermy (LOD) in infertile patients with clomiphene citrate resistant polycystic ovary syndrome. Methods:  The sample included women who attended our infertility clinic at Al-Elwiya Maternity Teaching Hospital and Kamal Al-Samarraee for Infertility and IVF Hospital in Baghdad/ Iraq from November 2013 to November 2014.    Eighty cases of infertile women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate for six months where collected, forty women treated with step-up protocol with low dose recombinant FSH gonadotrophin which increased gradually according to ovulation response, another forty women treated with LOD. Ovulation monitoring in each group was done with transvaginal ultrasound to exclude monofollicullar, bifollicular ovulation, ovarian hyperstimulation syndrome, multiple pregnancy and pregnancy rate in each cycle for 6 cycles. Results: Higher unifollicular ovulation and pregnancy rate in LOD than step-up protocol (91.4% & 25% versus 75% & 10%) respectively, while multifollicular and hyperstimulation rate were higher in gonadotrophin group (24.3% & 0.1% versus 8.50% & nil) respectively. Conclusion: Ovulation induction and pregnancy rate per cycle was higher with LOD group, not time consuming, also there was no risk of hyperstimulation of the ovary or twin pregnancy as compared to the step-up protocol with gonadotrophin

scholarly journals To Study the Effect on Fertility Outcome by Gonadotropins vs Laparoscopic Ovarian Drilling in Clomiphene-resistant Cases of Polycystic Ovarian Syndrome

2017 ◽  
Vol 9 (4) ◽  
pp. 336-340 ◽  
Author(s):  
Richa Singh ◽  
Meenal Jain ◽  
Poonam Yadav ◽  
Sarvesh Awasthi ◽  
Pallavi Raj
Keyword(s):  
Statistical Analysis ◽  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Reproductive Age ◽  
Multiple Pregnancies ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome

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.

scholarly journals Laparoscopic ovarian drilling in clomiphene citrate resistant polycystic ovarian syndrome patients

2018 ◽  
Vol 5 (10) ◽  
pp. 3230
Author(s):  
M. Sridhar ◽  
Chillamherla Susmitha
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Ovarian Function ◽  
Surgical Intervention ◽  
Clomiphene Citrate ◽  
Reproductive Age ◽  
Transvaginal Sonography ◽  
Polycystic Ovarian Disease ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome

Background: Polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) is a common endocrine disorder which commonly affects women in their reproductive age, often leading to anovulatory infertility. There has been a resurgence of surgical intervention with the advent of ovarian drilling. This study was performed to assess the surgical management for patients with PCOS resistant to hormonal therapy.Methods: A thorough history and demographic details were taken from all the patients. A detailed clinical examination, along with transvaginal sonography was done. Laparoscopic ovarian drilling was performed on the patients under general anesthesia.Results: Most of the women were in the 3rd decade of their life and majority of the women had attained menarche at 13 years. The chief complaint of the patients was irregular periods experienced by 80%. 44.4% of the patents had normal BMI, while 31.5% were underweight. Most of the patients (6.7%) showed no evidence of hyperandrogenism, while 20% had hirsutism, 11% had acne.Conclusions: Polycystic ovarian syndrome is quite prevalent among the women of reproductive age. The effective treatment for PCOS which are resistant to hormonal therapy is laparoscopic drilling of the ovaries which results in ovarian function.

scholarly journals Letrozole versus Clomiphene Citrate for Induction of Ovulation in Patients with Polycystic Ovarian Syndrome Undergoing Intrauterine Insemination

2011 ◽  
Vol 5 ◽  
pp. CMRH.S6598 ◽  
Author(s):  
Sherif F. Hendawy ◽  
Hanan E. Samaha ◽  
Mohamed F. Elkholy
Keyword(s):  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Intrauterine Insemination ◽  
Transvaginal Ultrasound ◽  
Clomiphene Citrate ◽  
Randomized Study ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Induction Of Ovulation ◽  
Significant Difference

Background Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies affecting women in the reproductive age group, and is one of the most common causes of hyperandrogenic anovulatory infertility. The aromatase inhibitor, letrozole, has been used for induction of ovulation. The purpose of this study was to compare the effects of letrozole and clomiphene citrate in induction of ovulation among patients with PCOS undergoing intrauterine insemination. Methods In a double-blind randomized study, 60 infertile patients with PCOS received standard doses of either clomiphene citrate or letrozole as an induction protocol prior to intrauterine insemination. A hormonal profile, pelvic ultrasound, hysterosalpingogram, and/ or laparoscopy were done for all patients. The patients were monitored for ovulation by translational ultrasonographic folliculometry, with measurement of number and size of the follicles, as well as endometrial thickness. Human chorionic gonadotrophin (HCG) was injected intramuscularly when at least one mature follicle > 18 mm diameter was detected, and intrauterine insemination was performed 32-36 hours later. Transvaginal ultrasound and β-HCG measurement were performed for confirmation of pregnancy. Results Letrozole and clomiphene citrate achieved follicle maturation within a mean ± standard deviation (SD) of 13.2 ± 1.53 and 14.1 ± 1.35 days, respectively, showing no significant difference (P > 0.05). The mean number of follicles reaching >18 mm on the day of HCG administration was significantly higher in patients who received clomiphene citrate (2.9 ± 1.77) than in those receiving letrozole (1.2 ± 0.9). Letrozole had a significantly greater effect than clomiphene citrate on endometrial thickness (9.16 ± 1.36 versus 4.46 ± 1.71). The number of pregnancies achieved in the letrozole group was significantly (P < 0.05) greater than in the clomiphene group. Conclusion Letrozole in patients with PCOS is as effective as clomiphene citrate in inducing ovulation, and although the number of follicles produced by induction with letrozole were less than those produced by clomiphene, letrozole had a significantly greater effect on endometrial thickness than clomiphene citrate, and the incidence of pregnancy after intrauterine insemination was significantly higher, with a lower incidence of multiple pregnancy.

CLINICAL ANALYSIS OF CLOMIPHENE CITRATE INDUCED OVULATION IN INFERTILITY PATIENTS WITH POLYCYSTIC OVARIAN DISEASE

2021 ◽  
Vol 4 (5) ◽  
Author(s):  
Preeti Suhas Deshpande
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Follicular Development ◽  
Pregnancy Rates ◽  
Initial Assessment ◽  
Infertile Women ◽  
The Mean

Background: Normo-gonadotrophic anovulation is the most prevalent anovulatory infertility type. Polycystic ovary disease (PCOS) is by far the most common cause in this category, accounting for 85 % of females who are anovulatory. Its prevalence is growing increasingly with increasing modernisation. Ovulation induction in PCOS females is a problem and the best drug for ovulation induction is still debatable. Aims & objectives: In the current research, we evaluated the efficacy of clomiphene citrate in infertile women with polycystic ovary disease for ovulation induction and pregnancy rates. Material and Methods: The present research was a prospective study conducted with PCOS, willing to participate and follow up in women with primary/secondary infertility. Rotterdam criteria were used to diagnose PCOS. Using descriptive statistics, statistical analysis was performed. Results: Initially, 140 patients in the current study were recruited. For the current research, 128 patients either born or cared for a full 6 months were considered. 21-25 years of age was the most common age group. The mean age of the patients examined was 26.34 ± 3.6 years. 55 % were having average BMI patients, while 34% were overweight. Primary infertility was present in 77 percent of patients. 73 per cent of patients had infertility duration of 1-5 years. 30 percent have a history of laparoscopic ovarian drilling in patients. In 58 percent, hirsutism was noted. Following serial USG monitoring, mono-follicular development (55 %) was more prevalent than multi-follicular development at the end of the study (45 percent). The mean thickness of the endometrium was 7.78 ± 2.58 mm. The mean days for clomiphene citrate ovulation are 14.84 ± 3.46. Average P4 values on day 21 were 11.48 ± 6.44 ng/ml. At the end of the study, 66 % ovulation rate, 28 % pregnancy rate, and 2 % multiple pregnancy incidence were noted. Conclusion: Ovulation induction with clomiphene citrate should be considered as the first line of treatment for infertile women with PCOS. Initial assessment and careful selection of patients increases pregnancy rates. Keywords: ovulation induction, polycystic ovary disease, clomiphene citrate, pregnancy rate.

scholarly journals Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

2018 ◽  
Vol 7 (3) ◽  
pp. 991
Author(s):  
Poonam Laul ◽  
Pinkee Saxena ◽  
Sonali Kurrey ◽  
Vijay K. Kadam ◽  
Urvashi Migalani
Keyword(s):  
Clinical Outcome ◽  
Pregnancy Rate ◽  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Invasive Procedure ◽  
Serum Testosterone ◽  
Ovulation Rate ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome

Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS.

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

2013 ◽  
Vol 4 (2) ◽  
pp. 39-44 ◽  
Author(s):  
T Shashikala ◽  
Mandeep Kaur ◽  
Gautham Pranesh ◽  
Anjali Gahlan ◽  
K Deepika
Keyword(s):  
Pregnancy Rate ◽  
Live Birth ◽  
Birth Rate ◽  
Polycystic Ovarian Syndrome ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Clinical Pregnancy ◽  
Miscarriage Rate ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Syndrome

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. Aim The objective of this descriptive study was to study the outcome of LOD in patients of PCOS with clomiphene resistance in the form of clinical pregnancy and live birth rate. Setting Tertiary assisted conception center. Design Observational study. Materials and methods 100 patients of clomiphene resistant PCOS who underwent LOD. Outcome measure Primary outcome was clinical pregnancy rate and secondary outcome was ovarian hyperstimulation syndrome (OHSS) rate, multiple pregnancy rate, miscarriage rate, prevalence of hypothyroidism and live birth rate in PCOS patients. Results Clinical pregnancy rate—47.3%, OHSS rate—2.7%, multiple pregnancy rate—4%, miscarriage rate—6.7%, prevalence of hypothyroidism—48% and live birth rate—40.5%. Conclusion Patients with irregular cycles, high LH/FSH ratio usually have CC resistance. PCO patients have high prevalence of hypothyroidism and it should be specifically screened and treated. Low incidence of miscarriage rate, OHSS rate and multiple pregnancy rates is seen after LOD with 47.3% clinical pregnancy and 40.5% live birth rates. Patients with high values of LH/FSH ratio are the candidates who stay nonpregnant in spite of LOD and this information is very useful in prognosticating the patients. How to cite this article Kaur M, Pranesh G, Mittal M, Gahlan A, Deepika K, Shashikala T, Rao KA. Outcome of Laparoscopic Ovarian Drilling in Patients of Clomiphene Resistant Polycystic Ovarian Syndrome in a Tertiary Care Center. Int J Infertility Fetal Med 2013;4(2):39-44.

scholarly journals Effect of laparoscopic ovarian drilling on serum anti-Mullerian hormone in clomiphene citrate resistant polycystic ovarian syndrome patients

2021 ◽  
Author(s):  
Ambika Shankar ◽  
Oby Nagar ◽  
Shakuntla . ◽  
Suman Meghwal
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Interventional Study ◽  
Ovarian Insufficiency ◽  
Common Cause ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome ◽  
Anovulatory Infertility

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). 

scholarly journals A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome

2019 ◽  
Vol 7 (9) ◽  
pp. 95 ◽  
Author(s):  
Michael Costello ◽  
Rhonda Garad ◽  
Roger Hart ◽  
Hayden Homer ◽  
Louise Johnson ◽  
...  
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Supporting Evidence ◽  
First Line ◽  
Ovary Syndrome ◽  
Ultrasound Monitoring

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.

Sign in / Sign up

Export Citation Format

Share Document