AN INITIAL STUDY TO EVALUATE THE ROLE OF LAPAROSCOPIC OVARIAN DRILLING (LOD) IN AN OVULATORY WOMAN WITH POLYCYSTIC OVARIAN SYNDROM (PCOS)

Abstract

The aim of this study was to evaluate the role of laparoscopic ovarian drilling (LOD) in correcting anovulation and failure of conception in women with polycystic ovarian syndrome (PCOS). An initial study to evaluate the role of laparoscopic ovarian drilling (LOD) in an ovulatory woman with polycystic ovarian syndrome (PCOS) [1]. Laparoscopic ovarian drilling (LOD) has evolved into a safe and effective surgical treatment for an ovulatory, infertile women with polycystic ovary syndrome (PCOS), unresponsive to clomiphene citrate [2]. The investigation was undertaken at a tertiary referral unit in K.S.A, Saudi German Hospital, Aseer (Laparoscopic unit). The participants comprised of 150 women between 20-30 years old and BMIbetween 20-30, treated with clomiphene citrate but failed to ovulate or get pregnant.  During the period from November 2015 to July 2017, 150 patients of PCOS who underwent LOD were included in this study. The diagnosis of PCO was based on Rotter-dam criteria which necessitate two of the following three features to be present for diagnosis one of them was Oligomenorrhea and / or amenorrhea, second one was Clinical and/ or biochemical signs of hyperandrogenism and the third and the last one was Ultrasonic confirmation of polycystic ovaries. Using the role of 4, four punctures for 4 seconds at 40 Watts for each ovary using the diathermy needle (4mm diameter and 4 mm depth), per ovary were applied during laparoscopy as standard technique for LOD. Follow- up of the patient was 1 year. A total of 150 patients with an ovulatory infertility associated with PCOS who underwent LOD were included in this study. Among the 150 patient included in these study 78 (52%) ovulates spontaneously after LOD & a further 31 patients ovulated after giving them clomiphene citrate in a dose of 100mg/day for 5 days starting from the 3rd day of their menses, giving an overall ovulation rate of 109 out of 150 (72%). One patient conceived with twins and 6 ended in early first trimester miscarriage & two were ectopic pregnancies. LOD is successful in PCOS patients who failed to ovulate on clomiphene citrate. LOD is more cost-effective than gonadotropins as a single treatment results in several mono-ovulatory cycles, thus allowing multiple attempts at conception whereas one course of gonadotropin therapy yields a single ovulatory cycle with the inherent need for intensive monitoring. LOD is currently recommended as a safe, efficacious & cost-effective alternative to gonadotropins for induction of ovulation in infertile, an ovulatory clomiphene citrate - resistant PCOS women without the risk of ovarian hyper stimulation syndrome or multiple gestation. It improves ovarian responsiveness to successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long.