Polycystic Ovarian Syndrome and Fertility

Introduction & Aim: Since its introduction in 1984, Laparoscopic Ovarian Drilling (LOD) has evolved into a safe and effective surgical treatment for ovulatory, infertile women with Polycystic Ovary Syndrome (PCOS), unresponsive to Clomiphene Citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates but without the risk of ovarian hyperstimulation syndrome and multiple pregnancies. It improves ovarian responsiveness to successive ovulation induction agents, its favorable reproductive and endocrinal effects are sustained long. The aim of this study was to evaluate the role of laparoscopic ovarian drilling in correcting an ovulation and failure of conception in women with Polycystic Ovarian Syndrome. The investigation was designed as a retrospective study, was undertaken at a tertiary referral unit in KSA, Saudi German Hospital, Asser. The participants comprised of 150 women between 20-30 years old and Body Mass Index (BMI) between 20-30, treated with Clomiphene Citrate but failed to ovulate or get pregnant.

Method: During the period from November 2015-July 2017, 150 patients of PCOS who underwent LOD were included in the diagnosis of PCO was based on Rotterdam criteria which to be present for diagnosis four punctures for 4 seconds at 40 Watts for each ovary using the diathermy needle, diameter per ovary were applied during laparoscopy as standard technique for LOD

and were followed up a patient for one year.

Result: A total of 150 patients with anovulatory infertility associated with PCOS who underwent LOD were included among the 150 patients, only 78 included (52%) ovulates spontaneously after LOD and a further 31 patients ovulated after giving them Clomiphene Citrate in a dose of 100 mg/day for five days starting from the third day of their menses. Giving an overall ovulation rate of 109 out of 150 (72%). One patient conceived with twins and six ended in early fi rst trimester miscarriage and two were

ectopic pregnancies.

Conclusion: LOD is successful in PCOS patients who failed to ovulate on Clomiphene Citrate. LOD is more cost-effective than

gonadotropin’s as a single treatment results in several mono ovulatory cycles, thus allowing multiple attempts at conception whereas one course of gonadotrophic therapy yields a single ovulatory cycle with the inherent need for intensive monitoring. LOD is currently recommended as a safe, efficacious and cost-effective alternative to gonadotropins for induction of ovulation in infertile, anovulatory Clomiphene Citrate: Resistant PCOS women without the risk of ovarian hyperstimulation syndrome or multiple gestations.