Clomiphene-resistant Women Research Articles

Retraction Note: Letrozole versus laparoscopic ovarian diathermy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a randomized controlled trial.

Retraction Note: Letrozole versus laparoscopic ovarian diathermy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a randomized controlled trial.

Title: OVULATION INDUCTION WITH LETROZOLE AND DEXAMETHASONE IN INFERTILE PATIENTS WITH LETROZOLE-RESISTANT POLYCYSTIC OVARIAN SYNDROME

A common cause of infertility is polycystic ovarian syndrome (PCOS). Guidelines suggest Letrozole should be considered the first-line ovulation induction therapy to improve fertility outcomes(1). However, approximately 15% of patients may fail to ovulate after receiving letrozole and are considered resistant(2). Previous studies have evaluated the efficacy of adjuvant dexamethasone in clomiphene-resistant women and have found the combination can successfully induce ovulation in many who fail to respond to clomiphene alone(3-5).

Effect of Laparoscopic Ovarian Drilling on Outcomes of In-Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome

Effect of Laparoscopic Ovarian Drilling on Outcomes of In-Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome

Retraction Note: Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women.

Retraction Note: Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women.

CLINICO-PHARMACOLOGICAL ASPECTS OF OVARIAN-MENSTRUAL CYCLE SUPPORT. Review

Relevance. It is known that 12.5% of women suffer from infertility. Correction of menstrual disorders is an important way to maintain a woman's reproductive health.
 Objective is to consider current data on the physiology, etiopathogenesis and pharmacotherapy of women with ovarian-menstrual disorders.
 Methods. Analysis of the data presented in PubMed, by keywords "ovarian-menstrual cycle", "pharmacological support".
 Results. Modern data on physiology, humoral regulation of the ovarian-menstrual cycle are presented. The role of positive and negative feedback between estradiol and progesterone levels and the activity of anterior pituitary gonadotropic hormones and insulin regulatory pathways is emphasized. The main changes of the central nervous system and behavioral features depending on the phase of the menstrual cycle are described. The directions of pharmacological support and stimulation of ovulation are described. The mechanisms of action and indications for the use of oral hypoglycemic and gonadotropic drugs, the benefits and place of each in the maintenance and stimulation of the ovarian-menstrual cycle are presented. Metformin is effective in clomiphene-resistant women and may be combined with clomiphene, particularly in the treatment of polycystic ovary syndrome (PCOS). Sitagliptin improves ovulation in PCOS, is more effective in combination with metformin. Gonadotropins stimulate the ovaries, promoting the production and maturation of eggs, progesterone prepares the inner layer of the uterus to fix the embryo and helps to bear fruit. They are mainly used in women with PCOS in whom other drugs are ineffective.Some results of pharmacogenetic researches, efficiency, in particular, use of follicle-stimulating hormone depending on genetic polymorphisms of its receptor are noted.
 Conclusions. In modern conditions, the use of pharmacological agents is an important area of support and stimulation of the ovarian-menstrual cycle to improve female reproductive function.

Optimization of treatment for women with infertility

Annotation. Up to 20-25% of women with PCOS are resistant to clomiphene citrate. The aim of the study is to optimize the baseline ovarian response in clomiphene-resistant women to ovulation induction with minimal drug costs. Materials and methods of research: the study included 40 clomiphene-resistant women with PCOS. For women in group I, we used clomiphene citrate 100mg + human menopausal gonadotropin (HMG)37.5 IU / day. Group II received only HMG 37.5 using a low dose escalating protocol. The use of this protocol enables monofollicular growth and a decrease in the risk of multiple pregnancies and, in turn, is the prevention of ovarian hyperstimulation. The results of the study showed that in group I compared with group II, the frequency of ovulation was significantly higher (60% versus 35%). Conclusions. The combined administration of CC + HMG in clomiphene-resistant women with PCOS compared to the use of HMG alone, gives higher ovulation rates and lower financial costs.

Peculiarities of carbohydrate and lipid metabolism in infertile patients with clomifen-resistant form of polycystic ovarian syndrome and obesity

Medical ovulation induction with clomiphene citrate is currently the first line treatment for anovulatory women with PCOS. Clomiphene resistance (failure to ovulate after taking clomiphene) is common, occurring in approximately 15% to 40% of women with PCOS. Resistance is associated with an increased body mass index. The aim of the study was to elucidate the characteristics of carbohydrate and lipid metabolism in patients with clomiphene-resistant PCOS and obesity. Material and methods. A comprehensive examination of 97 infertile patients with PCOS with obesity and clomiphene-resistant PCOS and 46 conditionally healthy normoovulatory women of control group K with 18.5 ≤ body mass index (BMI) < 25 kg/m2, without clinical or biochemical signs of hyperandrogenism, with ovarian volume less than 9 cm3 and without previously known endocrine disease. Clinical-anamnestic, anthropometric, sonographic, immunochemical, enzyme-linked immunosorbent assay, colorimetric, statistical research methods are used. Results and discussion. It was found that the most characteristic features of carbohydrate metabolism disorders in clomiphene-resistant women with PCOS and obesity are increased levels of hypoglycemic index, C-peptide, glucose levels after 2 h in oral glucose tolerance test, HOMA index; and of lipid metabolism - an increase in atherogenic factor, triglycerides, total cholesterol on the background of increased production of leptin and vaspin and decreased secretion of adiponectin, omentin and visfatin.. Conclusions. Visceral obesity plays an important role in the development of insulin resistance and hyperinsulinemia in infertile patients with clomiphene-resistant PCOS and obesity. This category of women in preconception training, before carrying out ovarian drilling or controlled ovarian stimulation, it is necessary to correct disorders of carbohydrate and lipid metabolism.

Letrozole versus clomiphene and tamoxifen in ovulation induction in clomiphene-resistant polycystic ovary syndrome cases

Objective The aim of this study was to make a comparison between the effects of letrozole and a combination of clomiphene citrate and tamoxifen in ovulation induction in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). Background PCOS is the most common endocrine disorder affecting ~ 6–15% of women of reproductive age causing several medical problems mainly infertility. Ovulation induction can be achieved by administration of an oral drug or a combination of drugs such as clomiphene citrate, tamoxifen, and letrozole, which are considered the first-line treatment for anovulatory PCOS. Patients and methods This prospective comparative study has been performed at the outpatient clinic of Obstetrics and Gynecology of both Menoufia University Hospital and Quesna Central Hospital during the period from December 2018 to March 2020. A total of 100 patients with PCOS (resistant to clomiphene citrate) were selected according to 'Rotterdam criteria,' including biochemical hyperandrogenism. Results There were no statistically significant differences between group A (40 cases) and group B (39 cases) regarding age, BMI, and duration of infertility. The results of both groups regarding ovulation rate were comparable, with no significant difference between the two groups. Conclusion The results of the present study are comparable to previous reported studies, revealing that clomiphene citrate, tamoxifen, and letrozole are effective in the treatment of infertility in patients with PCOS. Addition of tamoxifen to clomiphene citrate enhances its effect and gives better results.

The effectiveness of two different doses letrozole in ovulation induction – a comparative study

Introduction: Letrozole is a third-generation selective aromatase inhibitor and an effective agent for ovulation induction. Even though it was used in Clomiphene Citrate failure cases, Clomiphene Citrate resistant women, for Intra-Uterine insemination, and also for mild stimulation for IVF/ICSI cases it has not gained its importance as a first-line drug for ovulation induction. Objective: To study the effectiveness of two different doses of Letrozole in ovulation induction and pregnancy rates and to calculate the proportion of Letrozole resistant and failure cases. Materials and Methods: One year Prospective, observational study was conducted on 120 study participants who were divided into two groups and were given either 2.5 or 5 mg of Letrozole respectively. Serial Ultrasound scans were done from day 10 to assess response to two doses of Letrozole. Results: It was observed that 28 (46.67%) of 60 study participants in group I and 38 (63.33%) of 60 study participants in group II had ovulated. Conclusion: It is observed that there was no significant statistical difference in ovulation rates, Letrozole failure, and resistance rates in both groups. Though the endometrial growth was comparable in both study groups, it was observed that there was better follicular growth in study group II. The study group also showed a statistically significant difference in the pregnancy rates compared to group I. Therefore 5mg dosage of Letrozole could be recommended for ovulation induction.

Association between Letrozole Dose and Pregnancy Rate in Clomiphene-Resistant Women with Polycystic Ovary Syndrome Randomized Controlled Trial

Abstract Background Among couples experiencing difficulty conceiving, unexplained infertility is a fairly common diagnosis, occurring in approximately 10–20% of cases. One of the options available to women with unexplained infertility is ovulation induction, which is most commonly achieved using clomiphene citrate. Aim of the Work To evaluate the effect of high dose letrozole protocol (7.5 mg, 10 mg for 5 days compared with standard letrozole protocol 5 mg for 5 days) in the management of clomiphene-resistant women with polycystic ovary syndrome. Patients and Methods Randomized controlled clinical trial. The current study was conducted in Ain Shams University Maternity Hospital. The study included a total of 120 women. The study population was randomized using a Computer generated randomization system into 3 groups: Group A: standard letrozole regimen (5mg /day starting from day 2 to for 5 days). Group B received letrozole (7.5 mg/day from day 2 for 5 days). Group C received letrozole (10 mg/day from day 2for 5 days). Results We found that there were insignificant differences between study groups as regard age, BMI and Duration of infertility p-value 0.997,0.873,0.927 respectively, there was insignificant differences between study groups as regard parity and Ovulation status p-value 0.575,0.897 respectively, there was insignificant differences between study groups as regard serum level of FSH,LH, E2 and Testosterone p-value 0.911, 0.821, 0.811, 0.954 respectively. Conclusion It seems that the use of higher doses of letrozole improve endometrial thickness and follicle number but it offers no advantage in terms of pregnancy rates over the lower (2.5 mg) dose.

Ultrasound-guided transvaginal ovarian needle drilling for clomiphene-resistant polycystic ovarian syndrome in subfertile women.

Ovulatory disturbance is a key diagnostic feature of polycystic ovarian syndrome (PCOS), leading to infertility and correspondingly heavy disease burden. Many therapeutic strategies have been used to induce ovulation for women with PCOS who are infertile. Ultrasound-guided transvaginal ovarian needle drilling (UTND) is a novel surgical method used to induce ovulation for women with clomiphene-resistant PCOS at the outpatients clinic. Nevertheless, the quality in most of the studies seemed low, and the safety and efficacy of UTND is still uncertain. To evaluate the efficacy and safety of UTND for subfertile women with clomiphene-resistant PCOS. We searched the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, and six other databases to November 2018. We checked conference abstracts from the 2018 ESHRE, reference lists, and clinical trials registries. We contacted experts and specialists in the field. We included randomised controlled trials (RCTs) comparing UTND to laparoscopic ovarian drilling (LOD), and UTND combined with gonadotropins to gonadotropins alone for women of reproductive age with clomiphene-resistant PCOS and infertility. Two review authors independently screened appropriate trials for inclusion, assessed methodological quality and risk of bias, and extracted data. The primary outcomes were live birth rate and incidence of surgical complications (bleeding and infection). We included ovarian hyperstimulation syndrome (OHSS) as a secondary outcome. Meta-analyses could only be conducted for the secondary outcomes pregnancy rate and ovulation rate in the comparison of UTND versus LOD using a random-effect model. We calculated odds ratios (OR) with 95% confidence intervals (CI) for dichotomous data. We assessed the overall quality of the evidence by applying GRADE criteria. We included five trials involving 639 clomiphene-resistant women with PCOS. Three studies compared UTND with LOD, and two compared UTND combined with gonadotropins with gonadotropins alone. The evidence was of low to very low quality. The main limitations were serious risk of bias due to poor reporting of methods, inconsistency resulting from heterogeneity, imprecision induced by limited sample size, and lack of reporting of clinically relevant outcomes such as live birth and surgical complications.UTND versus LODNo studies reported on the main outcome live birth. One study reported on surgical complications; however, the evidence for this outcome was of very low quality because it was based on one study with small sample size and there were no events in either arm. Thus, we are uncertain whether there is any difference in surgical complications between UTND and LOD.We are also uncertain whether there is any difference in pregnancy rate when comparing UTND with LOD (OR 0.54, 95% CI 0.28 to 1.03; I2 = 56%; 3 RCTs, n = 473; very-low quality evidence). UTND may lead to a slight decrease in ovulation rate when compared to LOD (OR 0.66, 95% CI 0.45 to 0.97; I2 = 0%; 3 RCTs, n = 473; low-quality evidence). This suggests that among clomiphene-resistant women with PCOS using LOD with an expected ovulation rate of 69.5%, the ovulation rate among women using UTND may be between 50.6% and 68.8%No studies reported on the outcomes OHSS and multiple pregnancy. There was also insufficient evidence to reach a conclusion regarding miscarriage as there was only one study of very low quality.UTND combined with gonadotropins versus gonadotropins aloneNo studies reported on the main outcomes live birth and incidence of surgical complications. The evidence for the outcomes OHSS, pregnancy, ovulation, miscarriage, and multiple pregnancy in this comparison was of very low quality. Thus, we are uncertain whether there is any difference in these outcomes for women with clomiphene-resistant PCOS using UTND combined with gonadotropins as compared with gonadotropins. Based on very low-quality evidence, It is uncertain whether there is any difference in pregnancy rate, incidence of surgical complications, and miscarriage rate between UTND and LOD in women with clomiphene-resistant PCOS. UTND may lead to a slight decrease in ovulation rate when compared to LOD. No studies reported on the outcomes live birth rate, incidence of OHSS, and multiple pregnancy rate. No studies reported on the main outcomes live birth and surgical complications for the comparison UTND combined with gonadotrophins versus gonadotrophins alone. The evidence for the outcomes OHSS, pregnancy, ovulation, miscarriage, and multiple pregnancy in this comparison was of very low quality. Thus, it is unclear if there is a difference in any of the outcomes between UTND combined with gonadotrophins versus gonadotrophins alone.

Combined Letrozole and Clomiphene versus Letrozole with low dose gonadotropin protocol for ovulation induction in infertile clomiphene-resistant women with polycystic ovary syndrome: Comparative study

Objectives: To compare the effect of combined clomiphene citrate (100mg) and Letrozole (5mg) versus Letrozole (5mg) followed by gonadotropin injection for one cycle in CC resistant PCOs patients.Design: Prospective randomized trial.Setting: Infertility Outpatient Clinic and Cytogenetic and Endoscopy Unit of Obstetrics and Gynecology Department of Zagazig University Hospitals.Study group: About 212 PCOs patients with CC resistance (anovulatory response with CC at a dose of 100-150 mg for 3 cycles) were divided into two groups (106 in each group).Intervention: A studied group was randomly divided into two groups. Group A received combined Letrozole 5mg (2 tablets) in the morning and clomid 100 mg (2 tablets) in the evening from the 3rd day of menses for 5 days, group B received Letrozole 5 mg (2 tablets) from the 3rd day of menses for 5 days followed by human menopausal gonadotropin (hMG) injection every other day from cycle day 7. Moreover, ultrasound folliculometry started on cycle day 10 then the dose was adjusted according to follicular size. Both groups received treatment regimen for only one cycle.Results: There was higher ovulation rate (85.8%) in letrozole plus hmG group than in the other group receiving letrozole and CC (80.2%), but with no statistical significant difference (P -value =0.65). But, there was statistical significant difference between both groups regarding stimulation characters including total number of mature follicles (≥18 mm) 2.1 ± 1.01 in combined letrozole and CC was greater in group A than in group B (1.66 ± 0.98) with (P - value = 0.009). Stimulation days were longer in group B (18.2 ± 2.5) than in group A (16.2 ± 2.1). Mean total E2 on the day of hCG administration was significantly higher among patients in the clomiphene-letrozole group as compared with that in the other group of letrozole with hmG ( 650 ± 190.3 and 540 ± 180.5, respectively). Also, higher day 21 serum progesterone in group A (11 ± 1.1) than (9.5 ± 0.9) in group B. But, there was no statistical significant difference in mean endometrial thickness in both groups (A and B) (9.6 ± 1.7 versus 9.8 ± 1.5mm, respectively) (P-value = 0.41). The pregnancy rate did not show any statistical significant difference in both groups (P-value = 0.45) ; 32 patients out of 106 (30.1%) in group A compared with 27 patients (25.4%) in group B. Four cases were aborted in group A compared with 3 cases in group B. Four cases had twin pregnancy in group A with only 3 cases in group B. Also, there was no significant difference between both groups regarding ovarian hyperstimulation ; as there were 2 cases with combined clomid and letrozole group and one case only in letrozole plus hmG group.Conclusion: This study showed that lerozole is an effective medication when combined with CC or sequentially with hmG injection in improving the ovulation and pregnancy rate in CC-resistant PCOs patients with higher results when combined with hmG injection, but did not reach statistical significance.

Extended Letrozole Therapy for Ovulation Induction in clomiphene resistant Women with Polycystic Ovary Syndrome

Objective: This study aimed to evaluate the efficacy of short and extended long course of letrozole therapy for ovulation induction in clomiphene resistant women with polycystic ovary syndrome. Patients: One hundred infertile women were selected from the patients attending the outpatient clinic of Manshiet El-Bakry general hospital. All patients were diagnosed as having anovulation due to polycystic ovary syndrome (PCOS). Interventions: Patients were randomly allocated to treatment with either long letrozole group took 2.5 mg of letrozole daily starting day 1 of spontaneous or progesterone inducing menstrual bleeding for 10 days (50 patients, up to 3 cycles) or short letrozole group took 5 mg of letrozole daily starting day 1 of spontaneous or progesterone inducing menstrual bleeding for 5 days (50 patients, up to 3 cycles). Results:The number of ovulating patients was greater in the long letrozole group (74% vs. 56%), but without statistical differences. The total number of follicles during stimulation was insignificantly greater in the long letrozole group (8.2 vs. 8.17). The numbers of follicles ≥18 mm were significantly greater in the long letrozole group. Pregnancy occurred in 7 in the short group (14%) and 12 of (24%) in the long letrozole group, and the difference was statistically insignificant. Conclusion: The long letrozole protocol (10 days) can produce more mature follicles and subsequently more pregnancies than the short letrozole therapy (5 days).

Extended Letrozole Therapy for Ovulation Induction in clomiphene resistant Women with Polycystic Ovary Syndrome

Extended Letrozole Therapy for Ovulation Induction in clomiphene resistant Women with Polycystic Ovary Syndrome

Low-dose gonadotropin induction of ovulation in anovulatory women: still needed in the age of IVF.

Low-dose, step-up gonadotropin is the treatment of choice for women with polycystic ovary syndrome (PCOS) who have not conceived after anti-oestrogen treatment and as an effective alternative to pulsatile GnRH in women with hypogonadotropic hypogonadism (HH). There has been, however, no large-scale, comparative study between the two groups using low-dose gonadotropins. Here, we performed a retrospective, comparative analysis, in a single clinic database, of efficacy and safety of induction of ovulation using low-dose gonadotropins in 364 women with PCOS and 80 women with HH. The rate of ovulation was high in both PCOS (83%) and HH (84%) but mono-follicular, ovulatory cycles were more prevalent in PCOS than in HH (77% vs 53%, P < 0.0001) and the proportion of cycles that were abandoned was higher in HH than in PCOS (25% vs 15%, P < 0.0001). The median threshold dose of gonadotropin required to induce ovulation was 75 IU/day in PCOS and 113 IU/day in HH (P < 0.001) and the range of doses was greater in HH women. Forty-nine percent of women with PCOS and 65% of those with HH conceived (more than 90% within 6 cycles of treatment) and had at least one pregnancy. Multiple pregnancies (all twins) occurred in only 4% of women with PCOS and 5% of those with HH. These findings emphasise the efficacy and safety of low-dose gonadotropin treatment for both clomiphene-resistant women with PCOS and those with HH. These results highlight the importance of choosing the more physiological approach of gonadotropin induction of ovulation in both groups as the most appropriate treatment, in preference to IVF.

Clinical Evaluation of Antihyperglycemic Activity of Metformin in Treatment of Insulin Sensitivity in Polycystic Ovary Syndrome: A double Blind Placebo-Controlled Study

Polycystic ovary syndrome is the most common endocrinological disorder affecting 4–12% of women and also the most controversial. Metformin was logically introduced to establish the extent to which hyperinsulinaemia influences the pathogenesis of the condition. Early studies were very encouraging. Randomized controlled studies and several metaanalyses have changed the picture and put the drug that was once heralded as magic in a much contracted place. Metformin is one of the longest established oral insulin sensitising agents. For decades its use was restricted to management of type 2 diabetes. However, in the past two decades, its properties as an insulin sensitising agent have been explored in relation to its applicability for women with PCOS. Metformin is an effective ovulation induction agent for non-obese women with PCOS and offers some advantages over other first line treatments for anovulatory infertility such as clomiphene. For clomiphene-resistant women, metformin alone or in combination with clomiphene is an effective next step. Women with PCOS undergoing in vitro fertilisation should be offered metformin to reduce their risk of ovarian hyperstimulation syndrome. Limited evidence suggests that metformin may be a suitable alternative to the oral contraceptive pill (OCP) for treating hyperandrogenic symptoms of PCOS including hirsutism and acne. More research is required to define whether metformin has a role in improving long term health outcomes for women with PCOS, including the prevention of diabetes, cardiovascular disease and endometrial cancer.

Comparison of metformin and N-acetyl cysteine, as an adjuvant to clomiphene citrate, in clomiphene-resistant women with polycystic ovary syndrome

ObjectiveTo evaluate the effects of short- and long-term treatment with metformin and NAC, in an adjuvant to clomiphene citrate (CC), on the improvement of hormonal profile (SHBG, total testosterone, FBS, and fasting insulin) and fertility status in CC-resistant women with PCOS. Materials and methodsOne hundred and eight CC-resistant PCOS patients participated in the study and received either metformin (1500mg/day) or NAC (1800mg/day) with 100mg/day of CC for 8 and 12 weeks. Mean BMI, hirsutism score, LH/FSH ratio, endometrial thickness, mature follicle number, and serum concentrations of LH, FSH, E2, fasting insulin, total testosterone and FBS were evaluated before and after short- and long-term treatment. Furthermore, ovulation and pregnancy rates in the first and second cycles were also determined in treated patients. ResultsThere was no significant difference in all variables before and 8 weeks after treatment with metformin and NAC. The BMI- and insulin-lowering effects of metformin were significantly higher than NAC after long-term treatment. However, the reducing-effect of NAC on hirsutism score and FBS levels was significantly more than metformin after 12 weeks. Treatment with metformin and NAC significantly increased ovulation and pregnancy rates in CC-resistant PCOS patients. In the first and second cycles, ovulation and pregnancy rates in patients treated with NAC were slightly higher than those received metformin. ConclusionsCompared with metformin, administration of NAC in an adjuvant to CC is recommended for improving of hormonal profile and treatment of anovulatory infertility in hyperinsulinemic patients especially women with PCOS who are CC-resistant.

Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis

ABSTRACTIntroductionOvulation induction in women with polycystic ovarian syndrome (PCOS) can be carried out with drugs, such as clomiphene citrate (CC), which remains the first-line treatment option, and surgery, such as laparoscopic ovarian drilling (LOD), which is usually recommended as one of the second-line treatment options. Laparoscopic ovarian drilling may avoid or reduce the need for gonadotropins and at the same time reduce ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy.AimWe aimed to evaluate the effectiveness of LOD in clomiphene-resistant women and to identify the clinical factors that might predict its success.Study designRetrospective analysis in a tertiary level infertility unit.Materials and methodsAll CC-resistant PCOS women who underwent LOD over a 10-year period were included. Polycystic ovarian syndrome was defined as per the Rotterdam criteria. The follow-up period was up to 3 years post-LOD. Outcomes, such as onset of regular cycles, spontaneous pregnancies, and live births were recorded.ResultsA total of 59 PCOS women who underwent LOD and were available for follow-up were included in the study. Majority of the patients were less than 30 years of age with a body mass index (BMI) &gt; 24 kg/m2. Out of those, 12 conceived (20.3%) spontaneously and 14 (23.7%) had regular menstrual cycles after the procedure. The live birth rate was 16.9% (10/59). We did not find any association of clinical factors, such as age, BMI, type of infertility, and history of irregular cycles with LOD success.ConclusionLaparoscopic ovarian drilling can be offered as a treatment option in select group of CC-resistant women with reasonable success. Post-LOD, for those who do not have resumption of regular cycles, alternate method of ovulation induction can be initiated.How to cite this articleThomas S, Vithayathil VP, Chandy A, Aleyamma TK, Kamath MS. Laparoscopic Ovarian Drilling in Clomiphene-resistant Polycystic Ovarian Syndrome Women: A Retrospective Analysis. Int J Infertil Fetal Med 2017;8(3):93-96.

Impact of laparoscopic ovarian drilling on serum anti-mullerian hormone levels in patients with anovulatory Polycystic Ovarian syndrome.

Objectives:Anti-mullerian hormone (AMH) is a marker of the activity of recruitable ovarian follicles. It is useful in the prediction of ovarian reserve. Women with polycystic ovarian syndrome (PCOS) have elevated circulating and intrafollicular AMH levels. Laparoscopic ovarian drilling (LOD) in patients with PCOS destroys ovarian androgen-producing tissue and reduces their peripheral conversion to estrogens. Identifying factors that determine the response of patients with PCOS to LOD will help in selecting the patients who would likely benefit from this treatment. AMH is one such marker that can predict the response to LOD. To evaluate the effect of LOD on serum AMH levels among PCOS responders and non-responders and the usefulness of AMH as a tool in predicting the response to LOD, and to whether there was loss of ovarian function after LOD.Materials and Methods:This is a prospective cohort study including 30 clomiphene-resistant women with anovulatory PCOS undergoing LOD. Statistical analysis was performed to evaluate the effect of LOD on serum levels of AMH on these women.Results:A significant fall in the levels of AMH was observed after LOD in both responders and non-responders (p<0.001). Women with AMH >8.3 ng/mL showed a significantly lower ovulation rate (33.3%). LOD was not associated with a risk of diminished ovarian reserve.Conclusion:LOD is an effective first-line treatment for women with PCOS who are clomiphene resistant. LOD has no negative effect on ovarian reserve. AMH is a useful marker in predicting the outcome of LOD.

Effect of Laparoscopic Ovarian Drilling on Outcomes of In Vitro Fertilization in Clomiphene-Resistant Women with Polycystic Ovary Syndrome.

Recently the laparoscopic ovarian drilling (LOD) has been used as a surgical treatment for ovulation in women with polycystic ovarian syndrome (PCOS), although its mechanism and outcomes are still unclear. This study was undertaken to evaluate the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcomes in clomiphene-resistant women with PCOS who were treated with LOD. In this retrospective study, we reviewed the medical records of 300 women between 20 to 35 years old with clomiphene-resistant PCOS who had an ovulatory infertility and who were nominated for IVF/ICSI. Based on their treatment history, they were located into the following two groups: group I (n=150) including PCOS women who had history of LOD at least 6 months to 3 years before IVF/ICSI, and group II (n=150) including PCOS patients without history of drilling. Both groups were treated with antagonist protocol in the assisted reproductive technology (ART) process. The duration of treatment cycles, number of oocytes and embryos obtained, chemical and clinical pregnancy rate, the number of embryos transferred, and presence of ovarian hyper stimulation syndrome (OHSS) were measured. To compare means and frequencies, Student's t test, Mann-whitney and chi-square tests were used. Our results showed that ovarian cauterization before IVF/ICSI in patients with PCOS reduced the risk of OHSS (P=0.025). Despite the same pregnancy rate in both groups (P=0.604), more obtained oocytes and embryos were seen on women without ovarian drilling than women with LOD (P˂0.001 and P=0.033, respectively). There is no difference between the pregnancy rate in both groups. Due to significant reduction in OHSS in women undergoing LOD, this surgical treatment may be considered as a useful technique in the management of patients who have previously developed OHSS. However, there are ongoing concerns about long-term effects of LOD on ovarian function.