Abstract
Background: Polycystic ovarian syndrome is a common endocrine disorder affecting 6-10% of women of reproductive age and the most common cause of anovulatory infertility.
 Objective: The aim of the study was to compare the effectiveness, side effects and outcomes of step-up gonadotrophin protocol versus laparoscopic ovarian diathermy (LOD) in infertile patients with clomiphene citrate resistant polycystic ovary syndrome.
 Methods: The sample included women who attended our infertility clinic at Al-Elwiya Maternity Teaching Hospital and Kamal Al-Samarraee for Infertility and IVF Hospital in Baghdad/ Iraq from November 2013 to November 2014. Eighty cases of infertile women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate for six months where collected, forty women treated with step-up protocol with low dose recombinant FSH gonadotrophin which increased gradually according to ovulation response, another forty women treated with LOD. Ovulation monitoring in each group was done with transvaginal ultrasound to exclude monofollicullar, bifollicular ovulation, ovarian hyperstimulation syndrome, multiple pregnancy and pregnancy rate in each cycle for 6 cycles.
 Results: Higher unifollicular ovulation and pregnancy rate in LOD than step-up protocol (91.4% & 25% versus 75% & 10%) respectively, while multifollicular and hyperstimulation rate were higher in gonadotrophin group (24.3% & 0.1% versus 8.50% & nil) respectively.
 Conclusion: Ovulation induction and pregnancy rate per cycle was higher with LOD group, not time consuming, also there was no risk of hyperstimulation of the ovary or twin pregnancy as compared to the step-up protocol with gonadotrophin
Highlights
Polycystic ovary syndrome (PCOS), called hyper androgenic anovulation or SteinLeventhal syndrome,(1) is one of the most common endocrine disorders among women.According to the Rotterdam criteria, PCOS is characterized by a combination of oligo/amenorrhoea, clinical or endocrine signs of hyperandrogenism and polycystic ovaries. [2] Women withPCOS have normogonadotrophic and normo-oestrogenic anovulation (WHO group II) and constitute the largest group of anovulatory women encountered in clinical practice (60-85%). [3]The heterogeneity of PCOS is reflected in the varying response exhibited to ovulation induction regimens. [4]Not all women with PCOS have difficulty becoming pregnant, for those who do; anovulation is a common cause
Ovulation induction and pregnancy rate diathermy (LOD) in infertile patients with per cycle was higher with laparoscopic ovarian drilling (LOD) group, not time clomiphene citrate resistant polycystic ovary consuming, there was no risk of syndrome
Thikra N Abdulla ..et al treatment for ovulation induction (OI) in PCOS patients. [10,11,12,13,14] Clomiphene citrate (CC)-resistance (CCR) refers to the failure to ovulate with 150 mg of CC for at least 3 cycles, while CC-failure is defined as failure to conceive with CC despite successful regular ovulation for 6-9 cycles
Summary
Polycystic ovary syndrome (PCOS), called hyper androgenic anovulation or SteinLeventhal syndrome,(1) is one of the most common endocrine disorders among women. Not all women with PCOS have difficulty becoming pregnant, for those who do; anovulation is a common cause. The mechanism of this anovulation is uncertain, but there is evidence of arrested antral follicle development, which in turn, may be caused by abnormal interaction of insulin and luteinizing hormone on granulosa cells. [15] Gonadotrophin stimulation is usually administered to women who are CCR as an effective second-line treatment, but can be used as first line [16] and pregnancy rates are higher in low-dose recombinant FSH cycles compared with clomiphene citrate cycles.
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