title: Women with clomiphene citrate resistant polycystic ovarian disease: predictors of spontaneous ovulation after laparoscopic ovarian drilling.
abstract: OBJECTIVE
  To evaluate the role of different clinical, biochemical and sonographic factors as predictors of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD).
  
  
  METHODS
  This prospective study recruited 251 infertile women with CCR-PCOD. Several clinical, biochemical and sonographic criteria were tested as possible predictors of spontaneous ovulation after LOD using multivariate analysis.
  
  
  RESULTS
  Women with higher preoperative levels of LH, FSH and/or androstenedione had significantly higher rates of spontaneous ovulation within the first eight weeks after LOD, but only FSH and androstenedione were found to be independent predictors. Other factors including age, BMI, type of infertility, duration of infertility, menstrual pattern, testosterone level, ovarian volume and SHBG were insignificant predictors. Receiver-operating characteristic (ROC) curves derived from FSH, LH, androstenedione, and a logistic regression model showed that the best cut-off values were 4.1IU/l, 7.8IU/l, 1.2ng/ml, and 0.4897, respectively, with sensitivity of 91.18%, 100%, 73.53%, and 88.24% and specificity of 69.57%, 69.57%, 65.22%, and 73.91% for FSH, LH, androstenedione, and logistic regression model respectively. An extended follow up (9 months after LOD) was conducted for the anovulatory and the non-pregnant ovulatory women, who were treated individually according to their clinical situation. Of these women, 53.5% (69/129) got pregnant, resulting in a cumulative pregnancy rate of 48% (82/171). Of these pregnancies, 16/82 (19.5%) were spontaneous while 35.4% (29/82) and 45.1% (37/82) occurred after ovulation induction by CC and gonadotropins, respectively.
  
  
  CONCLUSIONS
  This study supports the use of androstenedione, LH and FSH as a simple reliable tool in triaging patients with CCR-PCOD to select the ideal candidates for LOD.
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
authors.forename: Wessam M
authors.initials: WM
authors.lastname: Abuelghar
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Bayoumy
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt. Electronic address: drmellisy@hotmail.com.
authors.forename: Mohamed I
authors.initials: MI
authors.lastname: Ellaithy
authors.affiliation: Obstetrics and Gynecology Department, Imbaba Hospital, Cairo, Egypt.
authors.forename: Marian S
authors.initials: MS
authors.lastname: Khalil
mesh_terms: D000328:Adult; D000735:Androstenedione / Q000097:blood; D002996:Clomiphene / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D010535:Laparoscopy; D007986:Luteinizing Hormone / Q000097:blood; D010053:Ovary / Q000000981:diagnostic imaging / Q000601:surgery*; D010060:Ovulation; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D017211:Treatment Failure; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D012738:Sex Hormone-Binding Globulin; D002996:Clomiphene; D000735:Androstenedione; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Clomiphene citrate resistance; Laparoscopic ovarian drilling; Polycystic ovarian disease