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Broker Resources. Individuals and Families. Health and Wellness. Wellness Library. Surgery Overview Laparoscopic ovarian drilling is a surgical treatment for polycystic ovary syndrome PCOS that can help with ovulation. How Well It Works How Well It Works Ovarian drilling can help restore ovulation and improve the chances of becoming pregnant for some people who don't respond to other treatments.
Risks Risks Risks of the procedure include: Infection of the incision. Bleeding from the incision. Internal bleeding. The ovarian volume was calculated using the formula for a prolate ellipsoid: 0.
The mean volume of the right and left ovary was calculated for each subject. The techniques of LOD used in our centre have been described previously Li et al. In most cases, a three-puncture laparoscopy was performed. A specially designed diathermy probe Rocket of London, Watford, UK was used to penetrate the ovarian capsule at a number of points with the aid of a short burst of diathermy.
The electrosurgical unit used was the Force 2 Valleylab electrosurgical generator Valleylab Inc. Following ovarian drilling, women were asked to keep a record of their menstrual cycle. If the patient started a menstrual period within 6 weeks of the surgery, a blood sample was taken on day 2 of that cycle for measurement of serum concentrations of LH, FSH, testosterone, androstenedione and SHBG.
Another blood sample was taken on day 21 of the same cycle for measurement of serum concentration of progesterone. If spontaneous menstruation did not occur, a random blood sample was taken to measure all the above hormones at 6 weeks following surgery. If the patient did not ovulate as evidenced by the low progesterone levels or lack of menstruation, CC would be started 6—8 weeks after surgery. If ovulation was achieved either spontaneously or with the help of CC, patients were followed-up until they conceived or for up to 12 months after LOD.
Ovulation and pregnancy rates after LOD were compared between the different categories of each factor. Multiple logistic regression analysis for categorical data was used to identify independent predictors of success of LOD. Backward stepwise elimination was used for the multivariate logistic analysis of prediction of patients being responders to LOD. The Cox and Snell square measure of goodness of fit was used to check for lack of fit of the final model.
Student's t -test test was used for this comparison. The characteristics of this group of women are shown in Table II. Of the women in the study, seven had not yet completed their 12 months follow-up after treatment at the time of writing. Multiple logistic regression analysis showed the duration of infertility to be the most important independent predictor of ovulation after LOD, followed by FAI and then BMI.
The final logistic regression model had an R 2 Cox and Snell of 0. As far as conception is concerned, duration of infertility then FAI were the most important predictors of success. The final model had an R 2 of 0. There was a trend towards higher conception rates with increasing levels of LH, although statistical significance was not reached Tables III.
Table IV shows the impact of various clinical and biochemical factors on the duration of the regular menstrual cycles after LOD. In addition, we have also reported on the factors affecting the duration of the beneficial effects of LOD.
Furthermore, many anovulatory PCOS patients ovulate occasionally and some may resume regular menstrual cycles for variable periods of time. This explains why some anovulatory PCOS patients conceive spontaneously while being investigated for infertility or waiting for treatment.
Our data showed three main factors to have a significant impact on the efficacy of LOD, namely BMI, hyperandrogenism and duration of infertility. With regards to LH levels, there was no impact on the ovulation rate but, once ovulation was achieved, LH levels had a significant impact on the pregnancy rates.
Furthermore, we found that once ovulation was achieved, the BMI had no impact on the pregnancy rate. These findings are consistent with our earlier report Li et al. Gjonnaess also found that once ovulation was established, BMI has no impact on conception rates. More recently, in accordance with our observations, Duleba et al. Several previous studies have shown an inverse relationship between BMI and the response to medical methods of ovulation induction including CC Lobo et al.
This is in disagreement with our earlier report Li et al. This disagreement could be due to the relatively smaller sizes of the groups studied in the earlier reports compared with the current one.
The results of the present study were consistent with those of Gjonnaess who found that women with low levels of SHBG i.
It is difficult to explain the relative resistance of hyperandrogenic PCOS patients to LOD since the exact mechanism of action of this treatment is yet to be determined. A possible explanation could be that the amount of destruction of androgen-producing ovarian tissue during LOD is relatively insufficient in women with marked hyperandrogenism.
This may result in persistence of the androgenic intraovarian microenvironment characteristic of PCOS which could explain the persistence of anovulation after LOD. It remains to be elucidated whether an increased number of punctures or increased total power used during LOD in women with marked hyperandrogenism could result in reduction of the androgen levels, which may in turn result in an improvement of the outcome.
There was an inverse relationship between the duration of infertility and the chances of success of LOD. Indeed the duration of infertility has been found to be the most important independent predictor of success of LOD. A possible explanation for this is that women with longer duration of infertility are more likely to have other subtle subfertility factors.
However, once ovulation is achieved, LH levels appear to have a significant impact on pregnancy rate. This is in agreement with our earlier report Li et al. Interestingly, some recent studies have reported that patients receiving CC had a significantly higher probability of conception once ovulation had been achieved by CC if their pre-treatment LH levels were elevated Kousta et al.
These observations seem to contradict in vivo evidence of the detrimental effects of elevated LH levels on oocyte maturation and capacity for fertilization. This may explain the finding that increased BMI, a long history of infertility and hyperandrogenism were not predictive of recurrence of anovulation, despite the fact that these factors were associated with an immediate resistance to LOD. We therefore recommend the consideration of alternative methods of treatment for this group of patients such as weight reduction, metformin, gonadotrophin therapy or IVF.
In addition, our observation may help in selecting and counselling patients concerning their chances of a successful outcome after LOD. Student t -test was used to compare between the two groups. Abbreviations as in Table II. Clin Endocrinol 33 , — Gynaecol Endocrinol 7 , 43 — Ovarian drilling is a one-time treatment unlike fertility medicines that have to be taken every month.
Having twins or triplets is not as likely with ovarian drilling as with fertility medicines. However, the benefits of ovarian drilling are not permanent. Ovulation and menstrual cycles may become irregular again over time. For some women with PCOS, ovarian drilling will not fix the problems with irregular periods and ovulation, even temporarily.
However, ovarian drilling can help a woman respond better to fertility medicines. The decision to do ovarian drilling should not be made lightly. While problems from ovarian drilling are rare, some can be serious. Some of the risks are related to surgery. As with all surgical procedures, there are risks of bleeding, anesthesia, and infection. Also, laparoscopy can cause injury to the bowel, bladder, and blood vessels.
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