Effect Of Laparoscopic Ovarian Drilling Research Articles

Retraction.

Retraction: El Behery, M. M., Diab, A. E., Mowafy, H., Ebrahiem, M. A., Shehata, A. E. (2010) Effect of laparoscopic ovarian drilling on vascular endothelial growth factor and ovarian stromal blood flow using 3-dimensional power Doppler. International Journal of Gynecology & Obstetrics, 112: 119-121. https://doi.org/10.1016/j.ijgo.2010.08.018. The above article, published online on 08 December 2010 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Professor Michael Geary, the International Federation of Gynecology and Obstetrics, and John Wiley and Sons Ltd. The retraction has been agreed due to major overlap between this article and the following article: Amin, A.F., Abd El Aal, D.E.M., Darwish, A.M, Meki, A.-R.M.A. (2003). Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stromal blood flow, serum vascular endothelial growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome. Fertility and Sterility, 79: 938-941. https://doi.org/10.1016/S0015-0282(02)04849-5. Following a complaint from a third party, an investigation by the editorial office and Wiley concluded that there are extensive duplications in the study design, sample sizes, tables, and results between the two articles. The authors did not respond to a request for an explanation and original data by the publisher. Representatives at Zagazig University did not respond to requests to begin an investigation.

Laparoscopic Ovarian Drilling in Women with Anovulatory Infertility

Background: Polycystic ovaries are common condition mostly found in reproductive aged women. Conventionally clomiphene is used instead of letrozole as first line drug in patients presenting with infertility as later is off label. 20% women are clomiphene resistant, those can be treated with gonadotrophins, other ovulation induction drugs or laparoscopic ovarian drilling. Objective: As PCOS is one of the leading cause of anovulatory infertility among women of reproductive age group. We study different factors to speculate the effect of laparoscopic ovarian drilling. Study Design: Quasi experimental study. Setting: Department of Gynecology & Obstetrics, Faisalabad Medical University, Faisalabad Pakistan. Duration: One year from August 2021 to August 2022. Methods: Our study includes 100 anovulatory PCOS patients resistant to conceive by medical treatment like clomiphene, later selected for LOD. Various clinical and biochemical parameters of PCOS were examined. Outcome was measured between different categories by using SPSS V 25 system. Results: Polycystic anovulatory women with BMI >35kg/m2, serum testosterone concentration > 4.5 and span of infertility > 3 years showed lack of response to LOD. Whereas response was seen in patients with less BMI and testosterone concentration along with decrease span of infertility. Conclusion: Ovarian drilling by laparoscopy is an efficient second choice for infertile anovulatory patients resistant to clomiphene citrate, main benefits are single time treatment, as opposed to several trials of ovulation induction, cost effective and a method to replace gonadotrophins effectively for ovulation induction while maintaining pregnancy rate.

The effect of laparoscopic ovarian drilling on pregnancy outcomes in polycystic ovary syndrome women with more than 2 in-vitro fertilization cycle failures: A pilot RCT.

Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject. Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures. Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups. Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups. Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

Effect of laparoscopic ovarian drilling on ovulation rate in women with clomiphene resistant polycystic ovarian syndrome

Effect of laparoscopic ovarian drilling on ovulation rate in women with clomiphene resistant polycystic ovarian syndrome

The effect of laparoscopic ovarian drilling in patients with anovulatory polycystic ovary syndrome and high serum levels of anti-Müllerian hormone.

Female infertility is often associated with anovulatory polycystic ovary syndrome (PCOS), characterized by high serum levels of anti-Müllerian hormone (AMH). Laparoscopic ovarian drilling (LOD) is commonly used to treat PCOS, especially when drug interventions have failed. This study aimed to evaluate the response to LOD intervention in women with PCOS by assessing AMH serum levels and their ability to restore normal physiological menstrual cycle and achieve conception. Seventy-five infertile women (24-41 years old) with body mass index (BMI) ranging from 19.6-35kg/m2 were included in the study. Among them, 57 had primary infertility, and 18 from secondary infertility, with an average duration of 8.6±4.4 years. Baseline levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and AMH were measured, and post-LOD levels of LH and AMH were evaluated. Menstrual cycle regularity was evaluated before and after LOD. Baseline FSH serum level before LOD was 5.2-1.6IU/L. Following LOD, the serum levels of LH and AMH significantly decreased from 14.3±4.1 to 7.8±2.8 IU/L and from 13.7±5.9 to 7.7±3.9 IU/L, respectively (p<0.05). LOD significantly (p<0.05) decreased the menstrual cycles irregularity, such as oligomenorrhea and amenorrhea, from 55 (73.3%) to 22 (29.3%) women and from 2 (2.7%) to 0 (0%) women respectively. Moreover, regular menstrual cycles significantly (p<0.05) increased from 18 (24%) to 53 (70.7%) women. Importantly, 68% of LOD-treated women showed a significant increase in pregnancy rates, with 52.9%, 35.3%, and 11.8% achieving pregnancy within 3, 6, and 9 months after LOD, respectively (p<0.05). Moreover, spontaneous ovulation was observed in 7/75 (9.3%) women within 90 days after LOD, and 71.4% achieved pregnancy. These findings highlight the success of laparoscopic ovarian drilling as an intervention for PCOS, with AMH serving as a reliable test to assess the response to LOD treatment.

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

Ovarian Reserve Assessment after Laparoscopic Ovarian Drilling in women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endo-crinopathy, affecting 4-8% of women in their reproductive age. Menstrual disturbances commonly observed in PCOS include oligomenorrhea, amenorrhea and erratic menstrual bleeding. Objective: To evaluate the effect of laparoscopic ovarian drilling on ovarian reserve in patients with polycystic ovarian syndrome before and after LOD measured by serum anti-mullerian hormone levels, FSH, ovarian volume and AFC. Patients and methods: This study was conducted at Al-Hussein Maternity University Hospital and Ministry of Health Hospitals including 38 patients of polycystic ovarian syndrome candidate for laparoscopic ovarian drilling (clomiphene citrate resistant patients). Polycystic ovarian syndrome was diagnosed according to the Rotterdam criteria. Patients with age 19-35 years, presence of ovarian pathology detected by transvaginal ultrasound were excluded from the study. Results: There was a significant negative correlation between age and difference between pre- and post-LOD serum AMH. There no significant association between obesity or clinical hyperandrogenism (hirsutism and/or acne vulgaris) and any of the differences between pre- and post-LOD values for sonographic or biochemical markers of ovarian reserve. Presence of amenorrhea was significantly associated with higher difference between pre- and post-LOD AFC of the right ovary. The anti-mullerian hormone, AFC & Ovarian Volume after LOD decreased significantly (P<0.001), While the FSH after LOD increased significantly (P<0.001). Conclusion: It could be concluded that PCOS women after LOD these occurs: Anti-mullerian hormone decreased significantly. The FSH increased significantly. AFC & Ovarian Volume decreased significantly.

The effect of laparoscopic ovarian drilling on timing of menopause in patients with polycystic ovary syndrome: 29 years of follow-up data

Background: Despite significantly improved rates of ovulation and pregnancy after laparoscopic ovarian drilling (LOD) in patients with polycystic ovary syndrome (PCOS), one should remain cautious of this procedure due to the associated risk of post-operative adhesions and a significant decrease in ovarian reserve markers. In this longitudinal follow-up study, we aimed to evaluate the long-term effects of LOD on the timing of menopause. Methods: A total of 83 patients were identified who had undergone LOD between December 1991 and December 1996. Of the 13 patients that we were able to reach, two had undergone unilateral LOD and were excluded, leaving 11 patients to be analysed. Results: The median age at the time of LOD was 25 (range 19–35) years. The median age at the time of the current analysis was 52 (range 46–64) years. Whereas two of these patients had surgical menopause at the age of 35 and 47 due to leiomyoma, four patients had natural menopause between the ages of 45 to 52 years. Although five patients were still having regular cycles at the age of 46 to 54 years at the time of the study, we do not have any biochemical data to evaluate their ovulatory status. With respect to fecundity, whereas nine out of 11 patients conceived spontaneously, two required assisted reproduction treatment. Discussion: According to the findings from a limited number of patients, LOD does not appear to have any negative effect on the timing of menopause.

The effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, LH/FSH ratio &amp; Inhibin B

Background: Where laparoscopic ovarian surgery is to be recommended, there may be a small associated risk of lower ovarian reserve or loss of ovarian function. Based on its activities, Anti-Mullerian hormone (AMH) has been proposed to be involved in the pathophysiology of polycystic ovary syndrome (PCOS). AMH has become a useful clinical marker of ovarian reserve (OR) and reproductive disease in women. Its clinical utility has been expanding in scope for use in monitoring ovarian reserve, response to in vitro fertilization protocols, and diagnosis of ovarian diseases such as primary ovarian insufficiency and polycystic ovary syndrome (PCOS). Aim: Comparing AMH to other parameters of ovarian reserve (OR) in evaluating the effect of laparoscopic ovarian drilling (LOD) on OR in treatment of PCO. Patients and Methods: It is a prospective comparative clinical trial study. Serum AMH along with other parameters of OR measurement (LH/FSH ratio and Inhibin B) were done before and after LOD in forty eight PCO women. This study was conducted in Ain Shams University Maternity Hospital. The patients were recruited from the gynecologic outpatient clinic of Ain-Shams University Hospital from January 2014 to December 2017 (about four years). Results: Eight cases of our studied patients got pregnant within the first three months postoperative after LOD and six cases got pregnant after three months. The total number of cases that got pregnant was 14 out of 48 cases before excluding the 8 cases that got pregnant before 3 months (29.16⁒). The mean AMH level before the operation was 6.9 ± 1.4 ng/ml and 8.2 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. While the mean AMH level after 3 months of the operation was 5.1 ± 1.1 ng/ml and 6.3 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. The mean LH/FSH ratio before the operation was 2.04 ± 0.5 and 3.02 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. While the mean LH/FSH ratio after 3 months of the operation was 1.15 ± 0.2 and 1.93 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. The mean inhibin B level before the operation was 52.5 ± 2.2 pg/ml and 52.6 ± 3.9 pg/ml for the patients who got pregnant and those who did not get pregnant ,respectively. While the mean inhibin B level after 3 months of the operation was 48.3 ± 2.1 pg/ml and 49.1 ± 3.6 pg/ml for the patients who got pregnant and those who did not get pregnant, respectively.Lower preoperative AMH levels and LH/FSH ratio and after 3 months postoperatively were associated with increased pregnancy rates in patients who conceived compared to those who did not conceive (p=0.004) and (p=0.002) preoperative versus (p=0.003) and (p=0.004) postoperative, respectively. On the other hand, preoperative and 3 month’s postoperative levels of Inhibin B had no effect on pregnancy rates (p=0.954) and (p=0.582).Conclusion: Pregnancy rates were significantly related to the preoperative LH/FSH ratio and AMH levels when comparing the cases that got pregnant with the cases who did not conceive postoperatively in patients of polycystic ovary syndrome (PCOS), whereas preoperative Inhibin B level had no relation to pregnancy rates . Therefore, AMH measurement could be a useful tool in assessing and predicting the results of LOD on PCOS patients concerning the pregnancy results after the operation.

Effects of Laparoscopic Ovarian Drilling on Restoration of Menstrual Cycles, Hormonal Profiles and Pregnancy Rate in Women with Polycystic Ovary Syndrome

One of the major cause of an ovulatory infertility is polycystic ovary syndrome with a multifactorial etiology.Laparoscopic ovarian drilling (LOD) is regarded as the method of choice for inducing ovulation in those notresponding to oral ovulation induction with PCOS.A prospective study was carried out for assessment of effects of LOD on menstruation, serum levels ofhormones, and reproductive outcome including ovulation and pregnancy rate.A total of 169 patients with an ovulatory infertility underwent LOD over a period of about two years. Allpatients assessed three times for clinical characteristics and serum hormone levels LH, FSH, testosterone,SHBG, prolactin and AMH. FAI and LH/FSH ratio calculated, first before the procedure, second within oneweek after and the last one after three months with the ovulation and pregnancy outcome follow up until sixmonth.The prevalence of irregular menstrual pattern was 89.3%, significantly (P&lt; 0.001) decreased to 19.5%after the procedure with improvement of hirsutism, acne and scalp hair loss, there was a highly significantdecrease in the serum levels of LH, testosterone, AMH, FAI and LH/FSH ratio (P ? 0.001) and a highlysignificant elevation of serum SHBG and prolactin post-operatively, resumption of spontaneous ovulationof 56.2%, and the pregnancy rate of all the study group was 26%. In conclusion, LOD regarded as a methodfor improvement of the hormones, restoration of menstruation and increasing ovulation and pregnancy rate.

The effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, LH/FSH ratio and inhibin B

The effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, LH/FSH ratio and inhibin B

The effect of laparoscopic ovarian drilling on the serum levels of AMH, FSH, LH and Testosterone hormones, in patients with PCOS

Objective: This study was performed to evaluate the effect of laparoscopic ovarian drilling on the serum levels of anti-Müllerian hormone(AMH), Follicle Stimulating hormone(FSH), Lutenizing hormone(LH) and testosterone hormones, in patients with PCOS. Methods: A prospective observational study carried out on 50 patients with PCOS who underwent LOD, as a treatment for anovulatory infertility between June 2015 and June 2016. This study was conducted in AL Basrah Hospital for maternity and children. We assessed the serum levels of anti-Müllerian hormone(AMH), Follicle Stimulating hormone(FSH), Lutenizing hormone(LH) and testosterone hormone (test.) one month before laparoscopic surgery, one day after and 3 months after the surgery. Results: Among 50 patients (2 patients were lost from follow up and they were excluded from the study), 31(64.6%) started to menstruate regularly and 26 (54.2%) ovulated spontaneously and 9(18.8%) of them conceive spontaneously after LOD within 3 months of doing the operation. The serum levels of hormons, before, one day after and 3 months after surgery, for AMH were 8.9 ± 3.5 ng/ml, 7.3 ± 2.9 ng/ml and 7.4 ± 2.1 ng/ml, (P value =0,000), respectively. For the FSH were 5.2 ± 1.8 IU/L, 6.5 ± 2.0 IU/L and 7.1 ± 1.9 IU/L, (p value = 0.000), respectively. For the LH were 10.2 ± 21 IU/L, 10.7 ± 4.5 IU/L and 7.2 ± 2.2 IU/L, (p value=0.000), respectively. For the testosterone levels were 1.16 ± 0.7 ng/ml, 0.44 ± 0.2 ng/ml and 0.34 ± 0.1ng/ml, (P value= 0.000), respectively. Conclusion: LOD operation is an effective treatment for infertile PCOS patient who are not responding to medical treatment (clomiphene citrate and gonadotrophine resistant cases or cases who can't offer the gonadotrophines). If it is done properly it will not affect the ovarian reserve. The resultant hormonal changes after the operation (decrease LH and testosterone) infavoure the continuation of pregnancy and lower the miscarriage rate. In our locality it represents a cost-effective and offered able alternative to medical treatment of PCOS.

Effect of laparoscopic ovarian drilling on serum vascular endothelial growth factor and ovarian stromal blood flow in patients with polycystic ovarian syndrome

Background Women with polycystic ovary syndrome have significant difference in their ovarian stromal blood flow indices when compared with women with normal ovaries. Aim To determine the serum level of vascular endothelial growth factor (VEGF) and ovarian stromal blood flow changes in anovulatory women with polycystic ovarian syndrome before and after laparoscopic ovarian drilling (LOD). Patients and methods This is a prospective, controlled study conducted at the Department of Obstetrics and Gynecology at Al Zahraa University Hospital. Thirty-eight women with polycystic ovarian syndrome (PCOS) according to Rotterdam Criteria, 2003, aged 25–40 years, BMI between 20 and 30 kg/m2, having normal hysterosalpingography (HSG), resistant to clomifene citrate treatment, and partners having normal semen analysis according to WHO criteria were included. Thirty-eight women with polycystic ovarian syndrome resistant to clomifene citrate treatment and 18 healthy fertile women served as the control group. Ovarian Doppler and serum levels of VEGF, luteinizing hormone (LH), follicular stimulating hormone (FSH), and total testosterone were measured in the early follicular phase of PCOS (before LOD) and control cases, then PCOS women undergo LOD, then ovarian Doppler and serum levels of VEGF, LH, FSH, and total testosterone were measured in the early follicular phase within 3 months after LOD Results After LOD, serum level of VEGF concentrations in women with PCOS significantly decrease in its level after LOD; LH decreased significantly from 11.1±1.4 mIU/ml before LOD to 5.8±0.8 mIU/ml after LOD. FSH increased significantly from 4.5±0.6 mIU/ml before LOD to 7±0.1 mIU/ml after LOD and total testosterone decreased significantly from 0.9±0.2 ng/ml before LOD to 0.5±0.1 ng/ml after LOD. Ovarian stromal blood flow velocity declined significantly after LOD in women with PCOS. There is significant increase in the resistance index, pulsatility index after LOD when compared with its value before LOD levels. Conclusion LOD reduced serum levels of VEGF, in addition to ovarian blood flow indices, in women with PCOS. LOD is a good second choice to induce ovulation in patients with PCOS who are clomifene citrate resistant, as it improves ovulation in infertile anovulatory PCOS women.

Impact of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone Levels and Ovarian Stromal Blood Flow Using 2D Power Doppler in Women with Anovulatory Polycystic Ovary Syndrome

Aim of the work: this study aimed to evaluate the effect of laparoscopic ovarian drilling (LOD) on plasma levels of anti-Mullerian hormone (AMH) and ovarian stromal blood flow changes, by using 2D power Doppler ultrasonography, in polycystic ovary syndrome (PCOS), previously described as being clomiphene citrate resistant and to evaluate the value of these parameters in predicting the clinical outcome of this line of treatment. Patients and methods: this prospective controlled was conducted in Al-Hussien University Hospital, Al-Azhar University and Police Authority Hospitals. This study was included twenty-three anovulatory clomiphene citrate (CC)-resistant women with PCOS and 20 fertile women as a control group. Laparoscopic ovarian drilling was done. Serum levels of hormonal profile were measured (AMH, LH, FSH, LH/FSH ratio and total testosterone), ovarian stromal blood flow Doppler indices (RI and PI) and occurrence of ovulation or pregnancy. Result: in this study we reported our findings regarding the effects of LOD on AMH, hormonal profile and ovarian stromal blood flow in women with PCOS with Clomiphene resistance. These results suggested that the measurement of AMH, LH, LH/FSH ratio, total testosterone, ovarian volume and ovarian stromal blood flow by color Doppler were in discrimination of PCOS from potentially normal women. The data in our study also suggested that there were no significant differences as regard AMH, hormonal profile except total testosterone, ultrasound ovarian findings and ovarian stromal blood flow before and after LOD, but there were significant differences as regard total testosterone before and after LOD. Also, there was good predictive value for AMH after LOD for ovulation and clinical pregnancy. Conclusion: measuring AMH for women with anovulatory PCOS undergoing LOD may provide a useful tool in evaluating the outcome of LOD, but ovarian stromal blood flow 2D Doppler indices did not show significant changes predicting ovulation or pregnancy rate after LOD.

Studying the Effect of Laparoscopic Ovarian Drilling on Ovarian Reserve via Measurement of Anti-Mullerian Hormone in Polycystic Ovarian Syndrome Patients

Background: Polycystic ovarian syndrome (PCOS) is the most common cause of anovulation and it also causes other metabolic and endocrinal disorders. Lines of management of PCOS include several medical options in addition to laparoscopic ovarian diathermy (LOD). However, the effect of LOD on ovarian reserve has always been a concern. Advocates to LOD claimed that the decrease in ovarian reserve following LOD is merit not a drawback. Study Design: A case series study aimed at investigating the effect of LOD on Anti-Mullerian hormone (AMH) and trying to find the relation between AMH levels and success of LOD. Patients and Methods: The study was carried out on 30 clomiphene citrate resistant PCOS patients from EL Shatby maternity hospital. Hormonal profile including; FSH, LH, free testosterone, AMH and progesterone was done preoperatively and 3 months after LOD. Results: After LOD 19/30 cases (63.3%) had spontaneous ovulation. After LOD the mean AMH decreased significantly from 9.12 ng/ml to 7.66 ng/ml (p = 0.006*). Responders had significantly lower preoperative AMH as compared to non-responders (8.01 ng/ml Vs 10.01 ng/ml). Responders had a highly significant (p Conclusion: Measurement of serum AMH concentration before LOD may be a useful tool in predicting responders to LOD and help in patient selection.

Laparoscopic ovarian drilling reduces serum homocysteine levels in women with Polycystic Ovary Syndrome

ObjectiveTo investigate the effect of laparoscopic ovarian drilling (LOD) on homocysteine levels and clinical outcomes in women with Polycystic Ovary Syndrome (PCOS). Study designThe study was conducted in JIPMER, Puducherry. Fifty PCOS subjects who were admitted for LOD were enrolled in the study. Serum homocysteine levels were estimated in all the subjects before and after LOD. Paired t-test was used to compare the homocysteine levels before and after LOD. ResultsLOD reduces homocysteine levels (p < .001), improves the rate of ovulation (38/50) and clinical pregnancy (21/50) in PCOS. When subgroup analysis was done, LOD significantly reduced homocysteine levels in ovulatory and conceived groups. Between the conceived and non conceived groups, the reduction was more significant (p = 0.001) in conceived group, when compared with non conceived group. ConclusionsLOD reduces homocysteine levels and improves clinical outcome in PCOS.

Effect of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone Level among Women with Polycystic Ovary Syndrome : A Retrospective Study

Background: Thyroid dysfunction is associated with increased cardiovascular morbidity and mortality. Hyperthyroidism increases the susceptibility of the heart to ischemia reperfusion injury. Moreover, myocardial ischemia can be further worsened by increased cardiac workload and oxygen demand elicited by the excess thyroid hormones. Objectives: Investigating the cardiac dysfunction induced by ischemia-reperfusion (IR) in rats exposed to excess thyroid hormones and role of somatostatin analogue against ischemia/reperfusion injury in hyperthyroid rats. Patients and Methods: This study was performed on 24 adult male albino rats of a local strain weighing 140-200 g, allocated into three equal groups: Group I (Control IR group): Euthyroid control group exposed to ischemia-reperfusion. Hearts of this group were isolated and perfused in a Langendorff apparatus. Isolated hearts were subjected to 15 min of stabilization, 20 min of zero-flow global ischemia and 30 min of reperfusion. Group II (Hyperthyroid IR group) were subjected to the same protocol of ischemia reperfusion. Group III (Hyperthyroid IR-OCT group): Hyperthyroid rats were supplemented with the somatostatin analogue, octreotide (OCT), 35 µg/kg subcutaneously, 20 minutes before sacrifice, followed by in-vitro study of cardiac responses to ischemia reperfusion. Blood samples were collected for measurement of plasma free T3, T4 and TSH. Coronary efflux lactate dehydrogenase levels were measured. Also, cardiac tissue malondialdehyde (MDA) levels and tumor necrosis factor alpha (TNF-α) levels were estimated. Results: Hyperthyroid (IR) rats revealed significant elevation in plasma free T3 and T4 with concomitant decrease in TSH levels. A significant reduction in final BW and BW gain were observed with higher absolute weights of left ventricle (LV) and cardiac index compared to the euthyroid controls. Systolic blood pressure (SBP) and mean arterial pressure (MAP) significantly elevated in non-treated hyperthyroid rats with a significant increase in their baseline chronotropic and inotropic activity compared to euthyroid control rats. But after ischemia those rats exhibited significantly higher degree of bradycardia (∆HR) and % change in heart rate (HR) compared to control rats. Moreover, significantly deteriorated post-ischemic recovery of inotropic parameters and significantly higher ∆ changes of these parameters were observed compared to euthyroid controls. These changes were accompanied by significant elevation in coronary efflux LDH levels and both cardiac tissue MDA and TNFα. Meanwhile, octreotide administration to hyperthyroid rats showed improvement of their baseline chronotropic and inotropic parameters as evidenced by the significantly reduced degree of bradycardia as well as significantly lower ∆ change of PT and PT/LV parameters compared to non-treated hyperthyroid rats. Such findings could be ascribed partly to the reduction of oxidative and inflammatory responses to IR as determined by the significantly decreased cardiac tissue MDA and TNFα respectively. Conclusion: Hyperthyroid hearts are less tolerant to ischemia/reperfusion injury with higher susceptibility to oxidative stress as well as overproduction of pro-inflammatory mediators. Thus, pharmacological targets that defend oxidative challenge and confer anti-inflammatory properties, namely octreotide (somatotstatin analogue) are considered to have potential therapeutic effect and may protect against myocardial ischemic damage in hyperthyroidism.

Short term effects of laparoscopic ovarian drilling in clomiphene citrate resistant patients with polycystic ovary syndrome

Abstract Objective The study aims to assess the effect of laparoscopic ovarian drilling (LOD) in clomiphene citrate resistant patients with polycystic ovary syndrome (PCO) on the changes occurred in ovarian reserve. Study design A prospective cohort study. Setting Sohag University Hospital, Sohag, Egypt. Materials and methods Thirty-seven patients with PCO were enrolled in the study. We evaluated the effect of LOD on the ovarian reserve using hormonal assay (measuring FSH, LH, AMH, Testosterone, SHBG, E2 and FAI) and sonographic markers (including ovarian volume, antral follicle count (AFC) and ovarian stromal blood flow). Results Amongst the 37 patients underwent LOD, regulation of the cycle occurred in 20 patients after 6 months (54.06%) (p = 0.001). Occurrence of pregnancy occurred in 4 patients after three months and in 18 patients after 6 months. As regard the hormonal profile, LOD has reducing effect on the serum levels of FSH, LH, AMH, SHBG, Testosterone and free androgen index. This reduction is of statistically significance in case of LH, AMH, testosterone and FAI especially after 6 months (p = 0.01, 0.001, 0.05, 0.05 respectively). The deleterious effect of LOD was statistically significant in the AFC which was reduced from 18.1 ± 2.7 to 11.5 ± 1.8 after 6 months (p = 0.05). Also, the ovarian blood flow indices were reduced with p = 0.01 for all indices. Conclusions Using the AMH and AFC as reliable markers of the ovarian reserve and measuring them for women with anovulatory PCO undergoing LOD may provide a useful tool in evaluating the outcome of LOD as the gold standard treatment for CC resistant PCO women.

To Study the Effect on Fertility Outcome by Gonadotropins vs Laparoscopic Ovarian Drilling in Clomiphene-resistant Cases of Polycystic Ovarian Syndrome

ABSTRACT Introduction The polycystic ovary syndrome (PCOS) is the most common condition associated with chronic anovulation affecting 4 to 6% of reproductive age women. Aim To compare the effectiveness of laparoscopic ovarian drilling (LOD) for ovulation induction with gonadotropins in clomiphene-resistant PCOS in terms of ovulation, pregnancy, live birth, abortion, multiple pregnancies, and complication like ovarian hyperstimulation syndrome (OHSS). Setting and design A prospective hospital-based randomized trial. Materials and methods It was a prospective study, which was carried out from January 2012 to May 2015. Totally, 89 women were evaluated in the study, out of which 44 women were in gonadotropin group and 45 were in LOD group. Statistical analysis Standard statistical analysis was done and significance of difference in results was tested by chi-square test. Results Ovulation rate in gonadotropin group was 75.0% at 6 months, whereas in LOD group, it was 20% at 3 months and was increased up to 66.66% after addition of clomiphene citrate and gonadotropin. The primary outcome in terms of pregnancy in gonadotropin group was 45.45% after 6 cycles and in LOD group was 11.11% after 3 cycles and 40.00% after 6 cycles with supplementation of clomiphene citrate and gonadotropin. Conclusion The ongoing pregnancy rate from ovulation induction with LOD alone was significantly less but if supplemented by clomiphene citrate and gonadotropin, it seems equivalent to ovulation induction with gonadotropin, but the former procedure carries a lower risk of multiple pregnancies. How to cite this article Yadav P, Singh S, Singh R, Jain M, Awasthi S, Raj P. To Study the Effect on Fertility Outcome by Gonadotropins vs Laparoscopic Ovarian Drilling in Clomiphene-resistant Cases of Polycystic Ovarian Syndrome. J South Asian Feder Obst Gynae 2017;9(4):336-340.

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.