title: Surgical management of infertility due to polycystic ovarian syndrome after failure of medical management.
abstract: OBJECTIVE
  To evaluate surgical management and fertility and pregnancy outcome in women with polycystic ovarian syndrome (PCOS).
  
  
  METHODS
  Retrospective file review and follow-up of 74 consecutive women with PCOS resistant to citrate clomiphene (CC) who underwent ovarian drilling by fertiloscopy with bipolar energy, together with hysteroscopic surgery when indicated (Canadian TASK FORCE II-2).
  
  
  RESULTS
  Of 77 files, only 3 women were lost to follow-up. Mean age was 30.2 years (SD 5.3) [29.0-31.4 CI 95%], and mean BMI 25.6kg/m(2) (SD 6.2) [24.2-27.0 CI 95%]. Pregnancy occurred after drilling in 47 cases (63%), spontaneously in 20 (27%), after ovarian stimulation in 5 (6.7%) and after in vitro fertilization in 22 (29.7%). Laparoscopic conversion was required in 5 cases (6.7%), due to failure to visualize the adnexa (n=3), or pelvic adhesions (n=1), or uterine hemorrhage (n=1). Hysteroscopy detected and simultaneously treated a uterine anomaly in 18 of 74 patients: uterine septum (n=10, 13%), T-shaped uterine cavity (n=3, 4%), endometrial polyp (n=2, 2.7%), endometrial hypertrophy (n=2, 2.7%), and synechiae (n=1, 1.3%). The mean overall delay to pregnancy was 11.1 months (SD 8.5) [8.7-13.5 CI 95%] and to spontaneous pregnancy, 7 months (SD 7.6) [3.7-10.3 CI 95%]. The mean follow-up was 23.4 months (SD 16.5) [18.1-28.7 CI 95%]. After multivariate analysis, the likelihood of pregnancy was significantly associated with previous ovarian stimulation by FSH (OR=2.28, 95% CI=1.08-4.83) and initial FSH level (OR=0.52, 95% CI=0.29-0.93).
  
  
  CONCLUSIONS
  Ovarian drilling by hydrolaparoscopy is an effective treatment for CC-resistant PCOS. The high rate of associated uterine anomalies justifies simultaneous hysteroscopic surgery.
authors.affiliation: Univ Paris-Sud, Clamart, F-92140, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Poujade
authors.forename: Amélie
authors.initials: A
authors.lastname: Gervaise
authors.forename: Erika
authors.initials: E
authors.lastname: Faivre
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
authors.forename: Hervé
authors.initials: H
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D004564:Electrocoagulation; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D010053:Ovary / Q000601:surgery; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene