Transvaginal needle versus laparoscopic ovarian drilling in drug-resistant polycystic ovary syndrome: a randomized, controlled study

Abstract

Objective The aim of this study was to evaluate the outcome of ovarian needle drilling using transvaginal ultrasound guidance as an alternative to the traditional laparoscopic electrosurgical drilling for patients with polycystic ovary syndrome (PCOS). Background Ovarian drilling has been established as a treatment for drug-resistant PCOS. Patients and methods The study comprised 84 patients with PCOS who are resistant to ovulation induction using clomiphene citrate. The patients were randomly divided into two groups; in the first group of 42 patients ovarian needle drilling was done using transvaginal ultrasound guidance, whereas in the other group of 42 patients laparoscopic electrosurgery ovarian drilling was done. Results No significant differences were found between the two groups with regard to age, parity, BMI, and ultrasound finding of PCOS. The duration of ultrasound-guided transvaginal ovarian drilling was 15.59 ± 2.83 min, whereas it was 38.45 ± 5.46 min for laparoscopic drilling, with a statistically significant difference between the two groups. There were significant improvements after intervention in both groups without differences regarding resumption of regular menstruation, improvement of hyperandrogenic symptoms such as acne and hirsutism, occurrence of ovulation, and pregnancy. As regards hormonal profiles; serum luteinizing hormone, and luteinizing hormone/follicle stimulating hormone levels, were found to be markedly decreased after intervention in both groups. Conclusion The results of this study have shown that the outcome of a simple rapid technique such as ultrasound-guided transvaginal ovarian drilling was comparable to the standard laparoscopic monopolar drilling in resumption of regular menstruation, improvement of hyperandrogenic symptoms, occurrence of ovulation and pregnancy in patients with PCOS resistant to ovulation induction using clomiphene citrate without all the risks expected from the later.