A prospective dose-finding study of the amount of thermal energy required for laparoscopic ovarian diathermy.
BACKGROUND
This prospective dose-finding study was undertaken to determine the optimal amount of thermal energy required for laparoscopic ovarian diathermy (LOD) in women with polycystic ovary syndrome (PCOS).


METHODS
Thirty women with clomiphene-resistant PCOS were included in the study. All women underwent LOD. A modified Monte Carlo up-and-down design was utilized. Women were treated in groups of three (10 groups). The amount of energy applied was standardized at 150 J/puncture. The number of punctures in each group was decreased/increased according to the number of responders in the previous group. The main outcome was ovulation as defined by a serum progesterone concentration of > or =30 nmol/l.


RESULTS
Four groups (n=12) were treated with four punctures/ovary, three groups (n=9) with three punctures, two groups (n=6) with two punctures and one group (n=3) with one puncture. Ovulation occurred in 67, 44, 33 and 33% of women treated with four, three, two and one puncture/ovary respectively. The corresponding pregnancy rates were 67, 56, 17 and 0%. The reductions in the free androgen index and the serum concentrations of testosterone and androstenedione after LOD were observed only in women treated with three and four punctures/ovary.


CONCLUSIONS
The clinical response to LOD seems to be dose-dependent, with an increase in the frequency of ovulation and conception with an increasing dose of thermal energy up to 600 J/ovary.
Amer
S A K
SA
Department of Obstetrics and Gynaecology, The University of Sheffield, Jessop Wing, Sheffield Teaching Hospitals, Tree Root Walk, Sheffield S10 2SF, UK. s.amer@sheffield.ac.uk
Li
T C
TC
Cooke
I D
ID
D000328:Adult; D000728:Androgens / Q000097:blood; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D006801:Humans; D010535:Laparoscopy; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle; D009010:Monte Carlo Method; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies
D000728:Androgens; D043373:Follicle Stimulating Hormone, Human; D011374:Progesterone; D007986:Luteinizing Hormone