OPTIONAL LOGO HERE. Laparoscopic Ovarian Drilling For Polycystic Ovary Syndrome(PCOS) – Are We Wasting Women’s Time? Chima Ezenwa, Stanley Okolo North Middlesex University Hospital NHS Trust. OPTIONAL LOGO HERE. Results. Results Continued. Conclusions. Introduction. Results.
Laparoscopic Ovarian Drilling For Polycystic Ovary Syndrome(PCOS) – Are We Wasting Women’s Time?
Chima Ezenwa, Stanley OkoloNorth Middlesex University Hospital NHS Trust
Overall 22 women conceived a total of 38 pregnancies during a follow-up period of 8 years. Of these 38 pregnancies, 26 (71%) were live births and 10 (24%) were miscarriages. There was one stillbirth and one ectopic pregnancy. 12 women conceived a total of 19 pregnancies (50 % of all pregnancies) within the first year after LOD. Of the 22 women that conceived, 20 had prior treatment with clomiphene and 2 had clomiphene followed by gonadotrophin treatment. Overall, 13 women conceived spontaneously, 7 after further ovulation induction with gonadotrophin, and two after stimulated intrauterine insemination. When women who conceived were compared with those who did not, age (mean 29.8 versus 32.14) and BMI (mean: 29.6 versus 31.96) were found to be important predictors of success but ethnicity, type and duration of infertility were not.
Polycystic ovary syndrome (PCOS) is the single most common diagnostic entity in infertile women presenting with anovulation . It is estimated that in about 10 - 20% of women in the reproductive age group, the ovaries appear morphologically polycystic on ultrasound scanning Although the aetiology of PCOS remains unclear, medical treatment is often successful in achieving ovulation and pregnancy in such women and ameliorating some of the clinical manifestations such as amenorrhea and hirsutism . However, surgical treatment is limited to ovarian drilling, a procedure which acts in a similar way as ovarian wedge resection first described by Stein and leventhal in 1968 , but without the significant loss of ovarian tissue. The relative safety and success of laparoscopic ovarian drilling in achieving ovulation and pregnancy is demonstrated in this poster which presents the results of a study of women attending a fertility clinic in an inner city hospital of London
Women that will conceive after LOD have a 50 % chance of doing so within the first year. The procedure should therefore be offered early to "clomiphene - resistant" anovulatory women with PCOS, and those who remain infertile after 12 months should consider assisted conception techniques.
Consenting anovulatory infertile women with PCOS, as determined by the Rotterdam criteria, seen at the Reproductive Medicine Unit of an inner city hospital in London, and who failed to respond to clomiphene treatment They underwent laparoscopic ovarian (LOD) drilling with monopolar diathermy. Those with other significant cause of infertility such as tubal factor or severe endometriosis were excluded from this study. LOD was performed under general anaesthesia and the women were offered gonadotrophin treatment at 6 months post-operatively if they had not conceived. The achievement of ovulation, regular menstruation and/or pregnancy was ascertained at follow-up visits or via telephone enquiry. There were 57 women with mean age of 30.7 years (SEM 0.73; range 20.2 - 46.3) and mean body mass index of 30.9 (SEM 1.06; range 18 - 51), of which 44 (74.6%) had primary infertility.
To evaluate the outcome of laparoscopic ovarian drilling (LOD) in multi-ethnic women with PCOS and anovulatory infertility and determine the factors that influence such outcome.
Tab. 2 Table Showing the pregnancy Outcome in the 57 Women who received Laparoscopic Ovarian Drilling
1. Revised 2003 Consensus on the diagnostic criteria and long term health risks related to Polycystic Ovary Syndrome. Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Fertil Steril 2004; 81
The results from this study showed that LOD improves fertility outcome in women who undergo this procedure. It has become widely accepted as a suitable treatment option as it has proven to be safer than repeated medical treatment with clomiphene or gonadotrophins; which are associated with a higher rate of Ovarian neoplasm, ovarian hyper stimulation syndrome and morbidities associated with multiple pregnancies. From a socioeconomic aspect it is more cost effective and involves less hospital visits for the patients, making it a preferred treatment option.