Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Background: Laparoscopic ovarian drilling (LOD) is an alternative method for ovulation induction in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients instead of gonadotropins. Objective were to identify the changes in clinical and biochemical profiles and the ovulation and pregnancy rate following LOD in CC resistant PCOS patients.Methods: It was an interventional study infertility unit, department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university, Dhaka, between from July 2014 to June 2015. Changes of the above-mentioned parameters were recorded during follow up of patients after LOD. The information is collected and recorded in the preset questionnaire.Results: The characteristics of study population were same before LOD and following LOD. Before LOD, infrequent menstruation was present in 83.3% patients whereas regular menstruation was found in 58.3% patients after 6 months following LOD. Endometrial thickness ≤8 was found in 100.0% in before LOD and endometrial thickness >8 was found in 70.0% after 6 month following LOD. Ovulation was found in 25.0% in after 3-month LOD and was found in 70.0% after 6 months following LOD. Pregnancy was found in 20.0% after 3 months following LOD and 50.0% in after 6 months following LOD. Ovulation and pregnancy outcome was significantly higher in after 6 months following LOD.Conclusions: LOD produces long-term improvement in menstrual regularity and reproductive performance. A sustained improvement observed in acne and BMI. Ovulation and pregnancy were found in 70% and 50.0% respectively after 6 months following LOD.

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

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).

AYURVEDIC PERSPECTIVE ON PCOD AND INFERTILITY- A CASE STUDY

Polycystic ovarian syndrome is a syndrome manifested by amenorrhea, hirsuitism and obesity associated with enlarged polycystic ovaries. It is the most common endocrine disorder in a woman of reproductive age. Furthermore it presents with infertility, abnormal bleeding, increased incidences of pregnancy loss and pregnancy related complications. Most patients present with elevated levels of androgens, Luteinizing hormone (LH), Oestrogen and Prolactin. The aetiology is multifactorial with the combination of genetic and environmental factors. Certain hypothesis related to etio-pathogenesis still remains unknown. Pelvic ultrasound is a major diagnostic tool determines the presence of multiple ovarian cysts ranging between 2mm and 9mm. Hormonal therapy and LOD (Laparoscopic Ovarian Drilling) are the only line of treatment in modern science whereas, Ayurvedic management offers lifestyle changes and medications having Tridoshahara, Srotoshodhaka & Anulomaka properties with its holistic approach. So, in the present study – Agnitundi vati, Sukumara kashayam and Nasya with Kalyanaka Ghrita, were administered in a patient complaining of irregular cycles due to PCOD and infertility. As a result of the treatment, patient not only regularised her cycles but even conceived. Nasya is the most effective method of restoring normal ovulation/ menstruation and thus maintains equilibrium of endocrine functions. The above said line of treatment was found to be cost effective and easily accessible. Further clinical trials can be conducted to assess the efficacy of the drugs.