Hormone profiles and clinical outcome after laparoscopic ovarian drilling in women with polycystic ovary syndrome.
BACKGROUND
The aim of our study was to evaluate the results of laparoscopic treatment in women with polycystic ovary syndrome, and to compare their response with ovulation, homocysteine levels, hormone profiles and clinical outcome before and after drilling.


METHODS
We studied twenty-two nulliparous oligomenorrheic women with polycystic ovaries, complaining of infertility refractory to clomiphene-citrate treatment and subsequently underwent laparoscopic ovarian drilling (LOD) with a needle electrocautery. Endocrine assays, lipoproteins, homocysteine determinations and ultrasound evaluation were performed in all women before and after the procedure. Ovulatory and pregnancy rates and clinical outcome were assessed.


RESULTS
After the procedure, serum T, LH, homocysteine levels and LH-FSH ratio were significantly lower than at baseline (0.93 +/- 0.15 vs 0.67 +/- 0.11 ng/ml, p < 0.001; 12.72 +/- 1.13 vs 7.36 +/- 0.57 mlU/ml, p < 0.001; 9.77 +/- 1.06 vs 7.13 +/- 0.99 micromol/L, p < 0.001; 2.16 +/- 0.22 vs 1.29 +/- 0.13, p < 0.001, respectively). In addition, SHBG levels were higher than at baseline (370.7 +/- 19.08 vs 404.7 +/- 16.71 nmol/L, p < 0.001) No reduction in high-density lipoprotein cholesterol was observed after the procedure. Similarly, no differences were observed between treating women with LOD and their baseline measurements in E2, FSH, DHEAS, and PRL concentrations (p = 0.255, p = 0.140, p = 0.250, p = 0.137, respectively). Ovulation occurred spontaneously in 77% of women after the procedure. The chance of conception at 12 months after surgery was 54%.


CONCLUSIONS
LOD appears to be a promising alternative treatment for patients with PCOS. Our results show that LOD may cause a significant reduction in serum concentration of homocysteine in patients with PCOS.
Kucuk
Mustafa
M
Department of Obstetrics and Gynecology, Trakya University Faculty of Medicine, Edirne, Turkey. drmustafakucuk@yahoo.com
Kilic-Okman
Tulay
T
D002784:Cholesterol / Q000097:blood / Q000378:metabolism; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006710:Homocysteine / Q000097:blood / Q000378:metabolism; D006728:Hormones / Q000097:blood / Q000378:metabolism*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D010535:Laparoscopy / Q000379:methods; D010060:Ovulation; D011085:Polycystic Ovary Syndrome / Q000378:metabolism* / Q000601:surgery; D011247:Pregnancy
D005300:Fertility Agents, Female; D006728:Hormones; D006710:Homocysteine; D002996:Clomiphene; D002784:Cholesterol