Laparoscopic Ovarian Diathermy 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.

Retraction Note: Does laparoscopic ovarian diathermy change clomiphene-resistant PCOS into clomiphene-sensitive?

Retraction Note: Does laparoscopic ovarian diathermy change clomiphene-resistant PCOS into clomiphene-sensitive?

Retraction Note: Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.

Retraction Note: Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.

Rehabilitation Care of Women with PCOS: A Case Study

Background: The most widely recognized endocrine problem is Polycystic Ovary Syndrome (PCOS) that shows during puberty with menstrual irregularities, acne and hirsutism. The fundamental imperfections in PCOS are still unclear, so insulin resistance and metabolic syndrome are most common in both healthy weight and as well as in obese patients. Numerous treatments are offered for women related to PCOS including weight loss, gonadotropins, metformin, DASH diet, letrozole and laparoscopic ovarian diathermy. Case presentation: This case report 35-years-old female presented for evaluation of obesity, menstrual irregularity and amenorrhea, and had no received any kind of hormonal treatment. Luteinizing hormone and serum testosterone level were elevated, while follicle stimulating hormone and estradiol level was normal. Conclusion and Outcome: Metformin and DASH diet was best treatment choice for PCOS patient that requires further examination before to being suggested on a long term basis and successful treatment outcome.

Step-up protocol gonadotrophin versus laparoscopic ovarian drilling in clomiphene citrate resistant PCOS infertile women in two Iraqi hospitals

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

Evaluation of Ultrasonographic and Anti-Müllerian Hormone (AMH) Changes as Predictors for Ovarian Reserve after Laparoscopic Ovarian Drilling Versus Conservative Treatment for Women with Polycystic Ovarian Syndrome

Background: Until recently, there was no international consensus either on the definition of polycystic ovarian syndrome (PCOS) or on what constitutes a polycystic ovary. At a recent consensus of The European Society of Human Reproductive and Embryology/American Society of Reproductive Medicine (ESHRE/ASRM), a refined definition of the PCOS was agreed: namely two out of the following three criteria; Oligo- and/or anovulation, Hyperandrogenism (clinical and/or biochemical) and Ultrasonographic features of PCOS. Aim of the Work: evaluation of ovarian volume, antral follicles count and anti mullerian hormones as predictors of ovarian reserve after conservative treatment versus laparoscopic ovarian drilling in women with polycystic ovarian syndrome. Patients and Methods: This prospective controlled study was conducted on 20 women attending Outpatient Clinics of Al Hussein University Hospital & Aswan University Hospital for infertility treatment. It was conducted between January 2016 and February 2018. Results: No significant difference was found between clomiphene citrate (CC) and laparoscopic ovarian diathermy (LOD) groups regarding to AFC and summed ovarian volume in follow up periods, (P= 0.645,P=0.401//P=0.238, P=0.301) respectively. There was a highly significant difference between CC, LOD and control groups regarding to AMH (P < 0.001) after 6 months of treatment. The study revealed that there was no statistically significant difference between groups according to clinical & reproductive outcomes. Conclusion: The relative contribution of each individual measure of the ovarian reserve is clearer and most authors agree that antral follicle counts and serum anti-mullerian hormone levels had the most discriminative. Antral follicle counts are easy to perform and cheap in comparison as all units had access to ultrasound facilities. Follicle counts, as a quantitative measure of the ovarian reserve, are also subject to ‘assay’ variation due to intra- and inter-observer differences and require additional time and manpower to perform.

Ovarian stromal blood flow changes after laparoscopic ovarian drilling (LOD) in women with polycystic ovary s)

Is to compare the changes in the ovarian stromal blood flow &amp; some hormonal profile (LH,T,FSH &amp; LH/FSH ratio) after laparoscopic ovarian diathermy in women with PCOS. In the ovarian stromal blood flow with serum concentrations of follicle stimulating hormones, luteinizing hormone and testosterone were measured at early follicular phase of menstrual cycle before and first cycle after laparoscopic ovarian diathermy. The ovulation was also evaluated by folliculometry at the first menstrual cycle after operation.After laparoscopic ovarian drilling, there was statistically significant reduction in ovarian stromal blood flow (peak systolic velocity significantly decreased,while resistance index and pulsatiltyindex significantly increased) as well as serum levels of testosterone,luteinizing hormones and LH/ FSH ratio all significantly decreased. These changes were significantly more in those who ovulated after laparoscopic ovarian diathermy. The measurement of ovarian stromal blood flow by 2D power Doppler for women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian drilling may provide a useful tool in evaluating the outcome of laparoscopic ovarian diathermy.

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.

Pregnancy in an Infertile Woman with Polycystic Ovary Syndrome

Introduction: The most common cause of anovulatory infertility is polycystic ovary syndrome (PCOS). It is a syndrome of ovarian dysfunction associated with hyperandrogenism and polycystic ovary morphology. Several treatment options are available for women with infertility related to PCOS including weight reduction, clomiphene citrate, gonadotropins, laparoscopic ovarian diathermy, metformin and letrozole.Case Presentation: This is a case report of 32-year-old infertile female who was married for 12 years and tried ovulation induction drugs several times but failed to conceive. She was overweight, hirsute, oligomenorrheic and lastly amenorrheic. Investigations revealed altered ratio of FSH and LH, and polycystic ovaries on ultrasound. Patient was adviced to do regular physical exercise and prescribed metformin and combined oral contraceptive pill. After treatment restoration of regular menstruation occurred, weight reduced and patient became pregnant.Conclusion: Before choosing any treatment option for an infertile woman with PCOS proper control of abnormal metabolic conditions are necessary for a successful treatment outcome.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 656-659

Polycystic ovary syndrome (PCOS)

Key content The symptoms of polycystic ovary syndrome (PCOS) include menstrual cycle disturbance and features of hyperandrogenism (hirsutism, acne and alopecia), with associated fertility problems, obesity and psychological issues. There are ethnic variations in expression of PCOS related to differences in insulin metabolism and this may impact upon treatment algorithms. Obesity has a major impact on the expression of PCOS and the efficacy of the management of all aspects of the syndrome, in particular infertility. The management of anovulatory infertility involves lifestyle modification and therapies to induce ovulation, namely clomifene citrate, gonadotrophin therapy and laparoscopic ovarian diathermy. For those who do not wish to conceive the management of menstrual problems requires prevention of endometrial hyperplasia and adenocarcinoma and consideration of the long term metabolic risks. Learning objectives To understand the full spectrum of the syndrome that is PCOS to include how to make the diagnosis and differentiate from other causes of menstrual irregularity and androgen excess. To appreciate the role of insulin resistance and the long‐term health implications for women with PCOS. To understand how to manage the issues that may affect a woman in different ways at different times in her life, namely menstrual cycle irregularity, hyperandrogenism and infertility. Ethical issues A contentious issue is the appropriateness to deny fertility treatment based upon a cut‐off for body mass index (BMI), when BMI is a crude measure of metabolic risk and the risks of conception at a high BMI are not absolute. This also has to be balanced against the decline in fertility with age which may have an additional impact. To what extent should young women who are found to have polycystic ovaries on ultrasound scan but without any features of the syndrome be advised about the potential for developing problems in the future? Should relatives of individuals with PCOS be screened for either PCOS or metabolic syndrome (the latter may apply to male relatives too)?

Short and Long-Term Efficacy of Laparoscopic Ovarian Diathermy in Women with Polycystic Ovary Syndrome.

Polycystic ovary syndrome is the most frequent cause of anovulatory infertility and management involves a multistep approach. Laparoscopic ovarian diathermy is accepted as a second-line treatment of patients who failed to respond to clomiphene citrate. The aims of this study were to determine the efficacy of this technique at short and long-term and to perform an analysis of predictive factors of spontaneous pregnancy. This retrospective study involved 76 women who underwent laparoscopic ovarian diathermy between 2004 and 2013 in a university hospital. Main outcomes were cycle regularity and pregnancy. Short-term outcomes recorded during followup in our centre were reviewed and long-term outcomes were evaluated by a telephone interview to all women whose surgery was undertaken more than three years ago. Clinical and biochemical data were analysed as predictive factors of spontaneous conceptionin patients without other infertility factors. Menstrual cycle regularity was initially achieved in 53 (70%) women and in the long-term follow-up subgroup, 52% (12/23) had regular periods. In general, 53 (70%) women conceived and 77 pregnancies were achieved, 60% of which were spontaneous. The only prognostic factor found to be significantly associated with spontaneous conception was a shorter duration of infertility (< 3 years) (p < 0.05). Laparoscopic ovarian diathermy showed pregnancy rates comparable to other ovulation induction treatments with the advantage of having a long lasting beneficial effect in menstrual regularity and fertility. Laparoscopic ovarian diathermy is a safe and effective treatment option for anovulatory infertility in women with polycystic ovary syndrome.

Combined metformin‐clomiphene in clomiphene‐resistant polycystic ovary syndrome: a systematic review and meta‐analysis of randomized controlled trials

Our objective was to compare the effectiveness of metformin plus clomiphene citrate vs. gonadotrophins, laparoscopic ovarian diathermy, aromatase inhibitors, N-acetyl-cysteine and other insulin sensitizers+clomiphene for improving fertility outcomes in women with clomiphene-resistant polycystic ovary syndrome. PubMed, SCOPUS and CENTRAL databases were searched until April 2014 with the key words: PCOS, polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction and pregnancy. The search was limited to articles conducted with humans and published in English. The PRISMA statement was followed. Twelve randomized controlled trials (n = 1411 women) were included. Ovulation and clinical pregnancy rates per woman randomized. Compared with gonadotrophins, the metformin+clomiphene combination resulted in significantly fewer ovulations (odds ratio 0.25; 95% confidence interval 0.15-0.41; p < 0.00001, 3 trials, I(2) = 85%, n = 323) and pregnancies (odds ratio 0.45; 95% confidence interval 0.27-0.75; p = 0.002, 3 trials, I(2) = 0%, n = 323). No significant differences were found when metformin+clomiphene was compared with laparoscopic ovarian diathermy (odds ratio 0.88; 95% confidence interval 0.53-1.47; p = 0.62, 1 trial, n = 282; odds ratio 0.96; 95% confidence interval 0.60-1.54; p = 0.88, 2 trials, I(2) = 0%, n = 332, for ovulation and pregnancy rates, respectively). Likewise, no differences were observed in comparison with aromatase inhibitors (odds ratio 0.88; 95% confidence interval 0.58-1.34; p = 0.55, 3 trials, I(2) = 3%, n = 409; odds ratio 0.85; 95% confidence interval 0.53-1.36; p = 0.50, 2 trials, n = 309, for ovulation and pregnancy rates, respectively). There is evidence for the superiority of gonadotrophins, but the metformin+clomiphene combination is mainly relevant for clomiphene-resistant polycystic ovary syndrome patients and, if not effective, a next step could be gonadotrophins. More attempts with metformin+clomiphene are only relevant if there is limited access to gonadotrophins.

Improved cycle outcomes after laparoscopic ovarian diathermy in hyper-responder patients with previous ART failure

Excessive response to ovarian stimulation is common among hyper-responder patients undergoing assisted reproductive technology (ART). Cycle cancellations and severe ovarian hyperstimulation syndrome (OHSS) are all detrimental consequences observed within this cohort and several approaches have been proposed to enhance outcomes. The current study is designed to evaluate whether laparoscopic ovarian diathermy (LOD) improves ART outcomes and pregnancy rates by reducing Anti-mullerian hormone (AMH) levels in a group of patients who had a history of recurrent ART failure and high response. A total of 40 hyper-responder patients with history of previous ART failure were included. Group I consisted of 22 patients that underwent LOD prior to ART. Group II consisted of 18 patients that underwent only ART. Cycle outcomes of groups were compared. Following LOD, significant reduction in AMH levels were detected in group I (4.75 ng/mL to 2.25 ng/mL). Clinical pregnancies were similar among groups (40% versus 27.8% p = 0.65). There was no cycle cancellation in Group I, whereas there were three cycle cancellations observed due to OHSS in Group II. Our results indicate that LOD might offer enhanced fertility outcomes and may reduce the likelihood of cycle cancellations in hyper-responders with previous ART failures.

Evidence-Based Management of Infertility in Women with Polycystic Ovary Syndrome Using Surgery or Assisted Reproductive Technology

Polycystic ovary syndrome (PCOS) has been managed surgically since the development of wedge resection in the 1930s. Second-line surgical interventions for anovulation associated with PCOS include laparoscopic ovarian diathermy, which is as effective as medical induction of ovulation with gonadotropins, with a much reduced risk of multiple pregnancy. Bariatric surgery may be considered for morbidly obese patients with PCOS, although further research assessing such surgery specifically in PCOS patients is needed. Assisted reproduction, in the form of IVF with or without intracytoplasmic sperm injection, is usually indicated as third-line medical treatment or in the presence of other infertility factors. There is an ongoing debate concerning the relative merits of IVF and ovulation induction in PCOS, comparing the higher multiple pregnancy rate of ovulation induction with the greater cost and psychological stress of IVF.

The Role of Obesity in the Development of Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is one of the common endocrine diseases that affects women in their reproductive age. PCOS has diverse clinical implications that include reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, cardiovascular diseases) and psychological features (increased anxiety, depression and worsened quality of life). The exact patho-physiology of PCOS is complex and remains largely unclear. The prevalence of PCOS is estimated at 4-18%, depending on diverse factors discussed ahead. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and body weight. During the last decades, obesity and excess weight are major chronic diseases all around the word. Obesity increases some features of PCOS such as hyperandrogenism, hirsutism, infertility and pregnancy complications. Both obesity and insulin resistance increase diabetes mellitus type 2 and cardiovascular diseases. Moreover, obesity impairs insulin resistance and exacerbates reproductive and metabolic features of PCOS. It is well known that obesity is associated with anovulation, pregnancy loss and late pregnancy complications (pre-eclampsia, gestational diabetes). Obesity in PCOS is also linked to failure or delayed response to the various treatments including clomiphene citrate, gonadotropins and laparoscopic ovarian diathermy. It has been reported that, after losing as little as 5 % of initial body weight obese women with PCOS improved spontaneous ovulation rates and spontaneous pregnancy. Therefore, the weight loss prior to conception improves live birth rate in obese women with or without PCOS. The treatment of obesity may include lifestyle therapy (diet and exercise), pharmacological treatment and bariatric surgery. In summary, weight loss is considered the first-line therapy in obese women with PCOS. In the present review, the consequence and treatment of obesity in women with PCOS are discussed.

The Optimal Number of Ovarian Punctures to Be Applied During Laparoscopic Ovarian Diathermy in Women with Polycystic Ovarian Syndrome

Abstract Objective: The purpose of this study was to determine the amount of thermal energy required during laparoscopic ovarian diathermy (LOD) for polycystic ovary syndrome (PCOS) to produce an optimal success rates without excessive ovarian damage. Design: This study was designed as a prospective comparative study. Setting: The study took place in a fertility unit in a specialized hospital. Participants: The participants were women with clomiphene-resistant PCOS. Intervention: Subjects underwent LOD and were divided into five groups by number of punctures per ovary. Main outcome measure(s): The outcome measures were reproductive performance and endocrine assays. Results: The subjects' reproductive performance significantly improved after three or more punctures per ovary; in each group, the rates of restoration of menstrual regularity were 30, 73, 82, 82, and 50%; the rates of spontaneous ovulation were 23, 60, 64, 58, and 42%; and the rates of conception were 15, 40, 53, 47, and 28%, respectively, aft...

Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.

Laparoscopic ovarian diathermy (LOD) represents a successful treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). However, in case of CC failure PCOS, LOD offers several theoretical advantages. This study was conducted to compare the efficacy of LOD versus continuation of CC up to six further cycles in PCOS patients who failed to achieve pregnancy despite the previous successful CC induced ovulation. One hundred and seventy six infertile women with CC failure PCOS were selected in this randomized controlled trial. Patients (n = 87) underwent LOD with 6 months follow-up or received CC (n = 89) up to six cycles. Outcome measures were; clinical pregnancy rate, midcycle endometrial thickness, cycle length, miscarriage and live birth rates. The clinical pregnancy rate per patient and the cumulative pregnancy rate after six cycles were comparable in both groups (39 vs. 33.7% and 47 vs. 39.2%, respectively). Four twin pregnancies occurred in CC group and none in LOD group and the difference was statistically significant (p < 0.05). No significant difference in midcycle endometrial thickness was observed (8.8 ± 1.2 mm vs. 7.7 ± 1.1 mm). Improvement in cycle length, miscarriage and live birth rates were comparable in both groups. No cases of ovarian hyperstimulation syndrome occurred in either group. LOD during the 6 months follow-up period and CC for up to six further cycles are equally effective for achieving pregnancy in CC failure PCOS patients.

Does laparoscopic ovarian diathermy change clomiphene-resistant PCOS into clomiphene-sensitive?

To test the role of laparoscopic ovarian diathermy (LOD) in improving the ovarian response to clomiphene citrate (CC) in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. The study comprised of 234 CC-resistant PCOS women who were treated with LOD. Eighty-four patients that remained anovulatory after LOD received 100-150 mg CC for 5 days starting from day 3 of induced menstruation for 1-3 cycles. Outcome measures were; ovulation, pregnancy, miscarriage and live birth rates. Ovulation occurred in 80/162 cycles (49.4%) and in 30/84 patients (35.7%). Pregnancy occurred in 13/84 patients (15.5%) and in 13/80 cycles (16.2%). Miscarriage and live birth rates were 23.1 and 76.9%, respectively. Ovulatory women showed significantly lower baseline BMI (P < 0.001), Ferriman-Gallwey score (P = 0.02), testosterone (P = 0.03), higher sex hormone binding globulin and lower free androgen index (P < 0.001) compared with anovulatory women. The baseline fasting insulin was statistically significantly lower and fasting glucose:insulin ratio was statistically significantly higher (P = 0.003, 0.002) in ovulatory compared with anovulatory patients. LOD improves the ovarian response to CC in at least one-third of CC-resistant patients who remained anovulatory following LOD especially in women who are less hyperandrogenic and less insulin resistant.

Incomplete and inconsistent reporting of maternal and fetal outcomes in infertility treatment trials

Pregnancy outcomes and adverse outcomes in infertility trials are reported to varying extents; for example, 35% of clinical trials reported no information on pregnancy loss, only 43% reported adverse events during the preconception treatment period, and only 7% reported any serious adverse events. Incomplete reporting limits the value of these studies in counseling patients on the risk-benefit ratio of treatment to themselves and their infants.

The impact of insulin resistance on the outcome of laparoscopic ovarian diathermy in women with polycystic ovarian syndrome

Insulin resistance (IR), which is common in women with polycystic ovarian syndrome (PCOS), may adversely affect the outcome of ovulation induction due to its detrimental effect on ovarian function. The aim of this study was to evaluate the impact of IR on the outcome of laparoscopic ovarian diathermy (LOD). Prospective observational study. Tertiary fertility centre. Forty-four anovulatory women with PCOS undergoing LOD. Fasting serum concentrations of insulin and glucose were measured before and after LOD. Insulin sensitivity was determined using the homeostasis model assessment (HOMA) index. Values of HOMA index ≥2.1 were considered abnormal, indicating IR. Ovulation and pregnancy rates were compared between women with and without IR using χ(2) test and odds ratio (OR) with 95% confidence interval (CI). Eighteen women (41%) had elevated HOMA index (≥2.1). There was no change of HOMA index after LOD (median 1.89, range 0.53-8.48 vs. 1.92, range 0.53-8.46). The ovulation rate in women with IR (12 of 18, 67%) was significantly (p=0.013, OR 0.08; 95% CI 0.01-0.74) lower than that (25 of 26, 96%) of women without IR. Likewise, the pregnancy rate (six of 18, 33%) was significantly (p=0.037, OR 0.26; 95% CI 0.07-0.94) lower in women with IR than that of women without IR (17 of 26, 65%). Using a receiver operating characteristics curve, the HOMA index was useful in predicting no ovulation after LOD (area under the curve 0.826). Insulin resistance appears to have an adverse effect on the outcome of LOD and seems to be a useful prognostic factor.