title: Pregnancy complications and metabolic disease in women with clomiphene citrate-resistant anovulation randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotropins: a 10-year follow-up.
abstract: OBJECTIVE
  To assess long-term effects of laparoscopic electrocautery of the ovaries compared with ovulation induction with gonadotropins in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) on the incidence of pregnancy complications like gestational diabetes, hypertensive disorders, and metabolic or cardiovascular disease.
  
  
  METHODS
  Long-term follow-up study.
  
  
  METHODS
  Twenty-eight hospitals within the Netherlands.
  
  
  METHODS
  One hundred sixty-eight CC-resistant women who had participated in a randomized controlled trial between 1998 and 2001 comparing electrocautery and gonadotropins.
  
  
  METHODS
  Postal questionnaire, search in medical files.
  
  
  METHODS
  Pregnancy complications, metabolic or cardiovascular disease.
  
  
  RESULTS
  Eighty-two percent of follow-up data were obtained. Thirteen of 68 women (19%) allocated to electrocautery, and 14 of 63 women (22%) allocated to gonadotropins had evidence for pregnancy complications (relative risk 0.86; 95% confidence interval 0.43-1.7). At follow-up, 12 of 69 (17%) women allocated to electrocautery, and 13 of 69 (19%) women allocated to gonadotropins had evidence for metabolic or cardiovascular disease (relative risk 0.90; 95% confidence interval 0.39-2.1). The risk of these was modified by body mass index (BMI), but not by female age or treatment allocation. This study is based on questionnaires and data from medical files. In the absence of routine screening, under-reporting in our follow-up study is likely.
  
  
  CONCLUSIONS
  Electrocautery in women with CC-resistant PCOS does not affect pregnancy complications or metabolic or cardiovascular disease later in life compared with ovulation induction with gonadotropins.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, VU Medical Center, Amsterdam, the Netherlands; Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Medisch Spectrum Twente Hospital Group, Enschede, the Netherlands. Electronic address: m.nahuis@vumc.nl.
authors.forename: Marleen J
authors.initials: MJ
authors.lastname: Nahuis
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Obstetrics and Gynaecology, Medisch Spectrum Twente Hospital Group, Enschede, the Netherlands.
authors.forename: Eefje J
authors.initials: EJ
authors.lastname: Oude Lohuis
authors.affiliation: Department of Obstetrics and Gynaecology, Zaans Medical Center, Zaandam, the Netherlands.
authors.forename: Neriman
authors.initials: N
authors.lastname: Bayram
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, VU Medical Center, Amsterdam, the Netherlands.
authors.forename: Peter G A
authors.initials: PG
authors.lastname: Hompes
authors.affiliation: Department of Obstetrics and Gynaecology, Medisch Spectrum Twente Hospital Group, Enschede, the Netherlands.
authors.forename: G Jurjen E
authors.initials: GJ
authors.lastname: Oosterhuis
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Ben Willem J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: van Wely
mesh_terms: D000328:Adult; D000858:Anovulation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D002996:Clomiphene / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects / Q000502:physiology; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005300:Fertility Agents, Female / Q000494:pharmacology / Q000627:therapeutic use; D005500:Follow-Up Studies; D006062:Gonadotropins / Q000494:pharmacology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008659:Metabolic Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D010053:Ovary / Q000187:drug effects / Q000601:surgery; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene
keywords: Metabolic syndrome; long-term follow-up; ovulation induction; polycystic ovary syndrome; surgery