Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate resistant polycystic ovary syndrome.
BACKGROUND
Laparoscopic electrocautery has been put forward as the treatment of choice in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). In order to make an informed treatment decision it would be helpful if we could identify women with PCOS with a high probability of treatment failure following electrocautery of the ovaries.


METHODS
Eighty-three women with CC-resistant PCOS were allocated to receive laparoscopic electrocautery followed by CC when anovulation persisted as part of a randomized controlled trial. Multivariable logistic regression analyses using clinical, ultrasonographic and endocrinological parameters were performed to predict (i) failure to ovulate within 8 weeks after electrocautery, and (ii) failure to reach an ongoing pregnancy after electrocautery with or without CC.


RESULTS
Of the 83 women, 56 (67%) ovulated within 8 weeks after electrocautery. The model for predicting anovulation after electrocautery included LH/FSH rate, year of menarche and glucose level. Women who were younger at menarche, had a lower LH/FSH ratio and a lower glucose level were more likely to have persistent anovulation. The area under the curve was 0.74. After electrocautery and CC, 41 women reached an ongoing pregnancy. No prognostic parameters could be identified to predict failure to reach an ongoing pregnancy after electrocautery followed by CC.


CONCLUSIONS
Persistence of anovulation after electrocautery could be predicted and women with a high risk of persisting anovulation could be distinguished. We were, however, not able to predict treatment failure after electrocautery followed by CC.
van Wely
Madelon
M
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, Meibergdreef 9, 1109 AZ Amsterdam, The Netherlands. m.vanwely@amc.uva.nl
Bayram
Neriman
N
van der Veen
Fulco
F
Bossuyt
Patrick M M
PM
D000328:Adult; D000858:Anovulation / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D002996:Clomiphene / Q000008:administration & dosage; D004351:Drug Resistance; D004564:Electrocoagulation; D004965:Estrogen Antagonists / Q000008:administration & dosage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D017211:Treatment Failure
D004965:Estrogen Antagonists; D002996:Clomiphene