title: Long-term outcomes in women with polycystic ovary syndrome initially randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotrophins.
abstract: BACKGROUND
  Long-term effects of laparoscopic electrocautery of the ovaries are unknown. To study the long-term effects of laparoscopic electrocautery of the ovaries and gonadotrophins, we followed women with clomiphene-resistant polycystic ovary syndrome (PCOS) randomly allocated to one of these treatments until 8-12 years after their initial treatment.
  
  
  METHODS
  Between February 1998 and October 2001 168 women with clomiphene citrate-resistant PCOS were included in a randomized controlled trial comparing an electrocautery strategy to a strategy starting with rFSH. In 2009 these women were contacted about their reproductive outcome and menstrual cycle regularity. Analysis was by intention-to-treat. We compared time to conception resulting in live birth, subsequent pregnancies, ectopic and multiple pregnancies, menopause, as well as minimal and maximal menstrual cycle length.
  
  
  RESULTS
  After 8-12 years, the cumulative proportion of women with a first child was 86% in women who had been allocated to electrocautery versus 81% in women who had been allocated to immediate rFSH [relative ratio (RR): 1.1; 95% confidence interval (CI): 0.92-1.2]. Treatment with electrocautery resulted in a significantly lower need for stimulated cycles to reach a live birth; 53% after electrocautery versus 76% after rFSH (RR: 0.69; 95% CI: 0.55-0.88).The cumulative proportion of women with a second child was 61% after electrocautery versus 46% after immediate rFSH (RR: 1.4; 95% CI: 1.00-1.9). Overall, there were 7 twins out of 134 deliveries (5%) after electrocautery versus 10 twins out of 124 deliveries (8%) in the rFSH group (RR: 0.65; 95% CI: 0.25-1.6). Fifty-four per cent of the women allocated to electrocautery had a regular menstrual cycle 8-12 years after randomization versus 36% in those allocated to rFSH (RR: 1.5; 95% CI: 0.87-2.6).
  
  
  CONCLUSIONS
  In women with clomiphene-resistant PCOS, laparoscopic electrocautery of the ovaries is as effective as ovulation induction with FSH treatment in terms of live births, but reduces the need for ovulation induction or ART in a significantly higher proportion of women and increases the chance for a second child. Clinicians may use these data when informing clomiphene-resistant anovulatory women about treatment options.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. m.j.nahuis@amc.uva.nl
authors.forename: M J
authors.initials: MJ
authors.lastname: Nahuis
authors.forename: N
authors.initials: N
authors.lastname: Kose
authors.forename: N
authors.initials: N
authors.lastname: Bayram
authors.forename: H J H M
authors.initials: HJ
authors.lastname: van Dessel
authors.forename: D D M
authors.initials: DD
authors.lastname: Braat
authors.forename: C J C M
authors.initials: CJ
authors.lastname: Hamilton
authors.forename: P G A
authors.initials: PG
authors.lastname: Hompes
authors.forename: P M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: M
authors.initials: M
authors.lastname: van Wely
mesh_terms: D000858:Anovulation / Q000188:drug therapy / Q000601:surgery; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D008597:Menstrual Cycle / Q000502:physiology; D010053:Ovary / Q000187:drug effects / Q000601:surgery*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted; D016896:Treatment Outcome
chemical_list: D006062:Gonadotropins