Pregnancy rates after laparoscopic ovarian drilling in polycystic ovary syndrome patients following unsuccessful ovulation induction

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine pathologies and is a frequent cause of anovulatory infertility affecting 5-20% of reproductive age women1. Medical induction of ovulation is considered the first-line treatment option for infertile PCOS women. Laparoscopic ovarian drilling (LOD) is currently accepted as a successful second-line treatment in drug-resistant PCOS2. Many authors have reported high ovulation (∼80%) and pregnancy (∼60%) rates following LOD3. The aim of this study was to evaluate the efficacy of laparoscopic ovarian drilling (LOD) on the reproductive outcome of anovulatory PCOS women. The results of our study were compared to historical controls from literature. Retrospective cohort study. Women unable to achieve pregnancy with ovulation drugs who underwent LOD from 2013-2018 were included. One physician followed a standard technique for LOD and performed all surgeries. Age, BMI, years of infertility, tobacco or alcohol use, pre and post surgery ovulation rates, pre and post surgery pregnancy rate, time until ovulation and pregnancy after surgery were documented. 136 patients who underwent LOD were included in this study. Demographics were divided as follows: mean age 28.9; mean BMI 22.2 kg/m2, and mean duration of infertility 2.9 years. Race was divided as follows: 58.8% Caucasian, 22.8% Hispanic, 14% African American, 3.7% Asian, 0.7% other. Tobacco use was reported by 4.4% and social alcohol use was reported by 37.5%. 39.0% reported successful ovulation with drugs prior to surgery but were unable to achieve a pregnancy. Ovulation after LOD was reported by 77.2% with a live birth rate of 47.1% and mean time until ovulation of 79.0 days. Statistical analysis showed a woman was 2.27% (95% CI 1.83 - 2.82) more likely to ovulate following LOD. This was considered significant on a Chi Square test (X2 = 69.8, P<0.05). Furthermore, a patient was 1.95% (95% CI 1.48 - 2.58) more likely to achieve a live birth following LOD with a mean time of 241.1 days until pregnancy. This was also considered significant on a Chi Square test (X2=22.9, P<0.05). (Table 1). Our study demonstrates significantly improved ovulation and pregnancy rates in drug resistant PCOS women after LOD. Although our rates are lower than those reported in previous published studies, this may be attributed to 37 out of 136 patients (27.2%) being lost to follow up. Some patients also did not achieve desirable results after the surgery due to other factors like male infertility, marital issues and diagnosis of cancer.Table 1ResultsYesNoUnknownOvulation prior to LOD39.0%58.1%2.9%Ovulation after LOD77.2%7.4%15.4%Pregnancy rate prior to LOD33.1%66.9%n/aPregnancy rate after LOD47.1%25.7%27.2% Open table in a new tab