Efficacy of laparoscopic ovarian drilling for polycystic ovary syndrome resistant to clomiphene citrate.
OBJECTIVE
It is difficult to induce ovulation in patients with polycystic ovary syndrome (PCOS) resistant to clomiphene citrate (CC) because of the narrow safety margin of human menopausal gonadotropin preparations. In the present study, patients diagnosed as having PCOS according to the Japanese diagnostic criteria were divided into two groups (Groups H and N). Testosterone level was used as a cut-off value between Groups H and N to examine the usefulness of laparoscopic ovarian drilling (LOD) to induce ovulation.


METHODS
Thirty-two women with PCOS resistant to CC who underwent LOD were evaluated. The patients were divided into a high and a normal androgen group (Groups H and N with 19 and 13 patients, respectively) based on the level of testosterone measured 1 week before surgery using a cut-off value of 50 ng/dL. LOD was performed with microlaparoscopy under intravenous anesthesia.


RESULTS
After LOD, spontaneous ovulation occurred in 16 (84.2%) and nine (69.2%) patients in Groups H and N, respectively. Additional treatment with CC was given to 12 (63.2%) and 11 (84.6%) patients, respectively. No significant difference was noted with regard to the spontaneous ovulation rate after LOD. Eighteen pregnancies were established in 17 patients (53.1%). The pregnancy rate after LOD was not significantly different between Groups H and N: 42.1% (8 patients) and 76.9% (10 patients), respectively.


CONCLUSIONS
Patients with PCOS as diagnosed based on the Japanese diagnostic criteria include those with increased and normal androgen levels. LOD is considered an effective ovulation induction method for both types of patients with PCOS.
Kato
Mariko
M
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan. sanomari2002@yahoo.co.jp
Kikuchi
Iwaho
I
Shimaniki
Hiroto
H
Kobori
Hiroyuki
H
Aida
Takuya
T
Kitade
Mari
M
Kumakiri
Jun
J
Takeuchi
Hiroyuki
H
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D017211:Treatment Failure
D005300:Fertility Agents, Female; D002996:Clomiphene