Evaluation of Ultrasonographic and Anti-Müllerian Hormone (AMH) Changes as Predictors for Ovarian Reserve after Laparoscopic Ovarian Drilling Versus Conservative Treatment for Women with Polycystic Ovarian Syndrome

Abstract

Background: Until recently, there was no international consensus either on the definition of polycystic ovarian syndrome (PCOS) or on what constitutes a polycystic ovary. At a recent consensus of The European Society of Human Reproductive and Embryology/American Society of Reproductive Medicine (ESHRE/ASRM), a refined definition of the PCOS was agreed: namely two out of the following three criteria; Oligo- and/or anovulation, Hyperandrogenism (clinical and/or biochemical) and Ultrasonographic features of PCOS. Aim of the Work: evaluation of ovarian volume, antral follicles count and anti mullerian hormones as predictors of ovarian reserve after conservative treatment versus laparoscopic ovarian drilling in women with polycystic ovarian syndrome. Patients and Methods: This prospective controlled study was conducted on 20 women attending Outpatient Clinics of Al Hussein University Hospital & Aswan University Hospital for infertility treatment. It was conducted between January 2016 and February 2018. Results: No significant difference was found between clomiphene citrate (CC) and laparoscopic ovarian diathermy (LOD) groups regarding to AFC and summed ovarian volume in follow up periods, (P= 0.645,P=0.401//P=0.238, P=0.301) respectively. There was a highly significant difference between CC, LOD and control groups regarding to AMH (P < 0.001) after 6 months of treatment. The study revealed that there was no statistically significant difference between groups according to clinical & reproductive outcomes. Conclusion: The relative contribution of each individual measure of the ovarian reserve is clearer and most authors agree that antral follicle counts and serum anti-mullerian hormone levels had the most discriminative. Antral follicle counts are easy to perform and cheap in comparison as all units had access to ultrasound facilities. Follicle counts, as a quantitative measure of the ovarian reserve, are also subject to ‘assay’ variation due to intra- and inter-observer differences and require additional time and manpower to perform.