Laparoscopic Ovarian Drilling by Diathermy for Ovulation Induction in Infertile Women with Polycystic Ovarian Syndrome

Abstract

Background:  Polycystic ovarian syndrome (PCOS) is the commonest cause of secondary infertility. Lapa-roscopic ovarian drilling has widely been used for in-duction of ovulation in polycystic ovarian syndrome patients resistant to clomiphene citrate. 80% patients ovulated after treatment and 60% patient conceived either spontaneously or after treatment with medi-cation to which they are previously resistant.

Purpose:  The aim of the present study was to see the effectiveness of laparoscopic ovarian drilling (LOD) with monopolar diathermy on pregnancy outcome in infertile women with polycystic ovarian syndrome (PCOS).

Design:  Descriptive cross sectional study.

Intervention:  Laparoscopic ovarian drilling.

Main Outcome Measures: Pregnancy, ovulation rate.

Material and Methods:  This study was carried out in the department of Gynae and Obstetrics in Sharif Medical City Hospital from January, 2007 to January, 2009. The inclusion criteria for laparoscopy ovarian drilling (LOD) were those infertile women between the age group of 25 - 38 years who meet the criteria for PCOS and who are resistant to clomiphene citrate and injectable gonadotrophins. A total of 30 women were booked for laparoscopic ovarian drilling after having informed consent for procedure. Response to therapy was assessed in term of pregnancy outcome and ovulation rate for 1 year after therapy.

Results:  A total of 30 patients were booked for lapa-roscopic ovarian drilling from January, 2007 to Jan-uary, 2009. The mean age of study group was 30 years ± SD 4.7791. Cumulative ovulation rate was observed in 22 patients (73%), out of which spontaneous ovula-tion occurred in 18 patients (80%), and after ovulation induction therapy in 4 patients (18%). Eleven patients (37%) conceived in two year duration. Spontaneous conception without any treatment was observed in 7 patients (63%); however 4 patients (37%) require fur-ther assistance with combined therapy of clomiphene citrate and injectable gonadotrophins after failure of ovulation induction. Miscarriage occurred in none of our patients. Mean age of conceived group was 29.36 ± SD 5.07 years; with mean duration of infertility 5.136 ± SD 4.605 years. Most of the patients concei-ved in first 4 months of LOD i.e 8 patients (72%), two patients (18%) in further 8 months, and 1 patient in 1 year duration. Mean interval of conception was 3.95 ± SD 4.14 months after laparoscopic ovarian drilling. None of our patient lost follow up.

Conclusion:  Laparoscopic ovarian drilling is safe, cost effective treatment in patients with polycystic ovarian syndrome. Spontaneous ovulations were ob-served within 2 - 3 months, and maximum conception occurred in 6 to 9 months of treatment with LOD.

Key Words:  PCOS, Laparoscopy.