Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome.
OBJECTIVE
To analyze the efficacy of laparoscopic ovarian drilling using monopolar diathermy in women with anovulatory infertility with clomiphene-resistant polycystic ovary syndrome (PCOS), and to determine factors influencing pregnancy rate and pregnancy outcomes.


METHODS
Prospective study (Canadian Task Force classification II-2).


METHODS
Infertility clinic in a tertiary referral teaching hospital.


METHODS
Seventy women with clomiphene-resistant PCOS.


METHODS
Laparoscopic ovarian drilling, with follow-up for 4.5 years.


RESULTS
Follow-up data, which were available for 66 patients, showed a spontaneous ovulation rate of 81.8%, cumulative ovulation rate of 93.9%, and pregnancy rate of 54.5%. Successful pregnancies were commonly complicated by gestational diabetes mellitus and pregnancy-induced hypertension. Pregnancy rates (23.5%) were low in women with tuboperitoneal disease and those whose partners had subfertile male factors. Statistical evaluation using a proportion test (Z test) and multivariable logistical regression analysis showed that elevated luteinizing hormone levels (>10 IU/L), short duration of infertility (<3 yrs), and absence of preexisting tubal disease were associated with better outcomes.


CONCLUSIONS
Laparoscopic ovarian drilling is an effective surgical procedure in women with clomiphene-resistant PCOS.
Kriplani
A
A
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Manchanda
R
R
Agarwal
N
N
Nayar
B
B
D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage* / Q000009:adverse effects; D016001:Confidence Intervals; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D011247:Pregnancy / Q000706:statistics & numerical data*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D002996:Clomiphene