P-623 Outcomes of Ovarian Drilling

Abstract

Abstract Study question Is it cost-effective performing laparoscopic ovarian drilling in patients with polycystic ovarian syndrome? Summary answer Laparoscopic ovarian drilling (LOD) is a cost-effective procedure and can potentially reduce the risk of ovarian hyperstimulation syndrome (OHSS) in subsequent IVF treatment What is known already LOD increases the chances of resumed regular menstruation as well as an increase in spontaneous ovulation when compared to patients treated with clomiphene citrate. An increase in spontaneous conception of pregnancy can be seen in LOD patients however this can be affected by the age of the patient but not necessarily by the BMI. In the 1980’s wedge resection was shown to be successful in ovulation induction, however this was abandoned with the emergence of urinary gonadotrophins and oral anti-oestrogens. Study design, size, duration This is a retrospective observational study performed in a single UK district general hospital. A total of 84 patients underwent laparoscopic ovarian drilling over a six-year period were identified from the hospital discharge code. All patients with a confirmed PCOS diagnosis according to the Rotterdam Criteria were included. Demographic details included age, body mass index, follicle-stimulating and luteinising hormone levels, Anti-Mullerian hormone (AMH) and antral follicle count and patient’s subsequent treatment details were analysed. Participants/materials, setting, methods We analysed the biochemical pregnancy, clinical pregnancy and livebirth rates of all patients who underwent LOD. We further evaluated the prognosis of the patients who did not achieve a live birth following LOD with subsequent fertility treatment such as ovulation induction treatment or in-vitro fertilisation (IVF). We also explored the rate OHSS after LOD. All data were obtained from the local hospital database system where patient’s demographic, treatment details and birth outcomes are recorded. Main results and the role of chance 38 out of the 84 (45%) patients had receive other forms of fertility treatment prior to the laparoscopic ovarian drilling, namely clomiphene or letrozole but failed to achieve a successful pregnancy. 26 (31%) of the patients ovulated spontaneously after the operation and conceived with 22 of them achieving a livebirth (26%). For patients who did not ovulate spontaneously or did not achieve a pregnancy after 6 months from the drilling, 28 patients then undergone further ovulation induction, with a 43% (13/28) clinical pregnancy and 29% (9/28) of livebirth rate. Further 35 patients went for IVF treatment with 21/35 (60%) achieving a livebirth. 6 out of the 35 (17%) had a ‘freeze all’ cycle due to high risk of development of moderate to severe OHSS. The OHSS rate in this high risk group of population was 8% (3/35). In conclusion, 61% (52/84) patients achieved a live birth of which, 26% was following laparoscopic drilling without any further treatment fertility treatment. For patients who underwent drilling and subsequently had IVF treatment, the development of OHSS is similar to the background rate quoted in literature rather than the much higher 20% in PCOS population (Delvigne et al, 2002) Limitations, reasons for caution The retrospective nature of the study with a relatively small sample size limited the generalisability of the results. There was a lack of strict inclusion criteria for patients who were offered drilling reflected by the wide range of AMH (18.9-176 pmol/l) and LH (0.8-33.4 iu/l) levels in our sample. Wider implications of the findings The response to treatment can also be dependent on the energy modality used. LOD has been shown to be cost effective when compared Gonadotrophin treatment which can lead to ovarian hyperstimulation. Some studies have reported similar pregnancy outcomes with both treatment options, however LOD has shown to be cost effective. Trial registration number not applicable