Ovarian Diathermy Research Articles

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.

Transvaginal ultrasound ovarian diathermy: sheep as an experimental model

BackgroundSome techniques of transvaginal ovarian drilling have been previously described. Nevertheless a monopolar transvaginal ovarian cauterization, that use the expertise and safety of transvaginal puncture for oocyte captation seems to be an easier and feasible approach. The aim of this study was to develop a minimally invasive ovarian cauterization technique under transvaginal ultrasound control, and to evaluate the safety of the transvaginal ovarian monopolar cauterization, female sheep at reproductive age were used as an experimental model.FindingsAn experimental study was performed in a university research center. Seventeen female sheep (15 Corriedale e 2 Suffolk) in reproductive age were submitted to transvaginal ovarian cauterization with a monopolar Valleylab Force 2 electrocautery. Macroscopic and microscopic lesions were assessed. Ovarian size were 1.31 cm2 ± 0,43 (Corriedale) and 3.41 cm2 ± 0,64 (Suffolk). From 30 ovaries from Corriedale sheep punctured, only 3 were cauterized, presenting macroscopic and typical microscopic lesion. In the Suffolk sheep group, only one ovary was cauterized. No lesion could be found in the needle path.ConclusionsThis is the first experimental animal model described for ovarian cauterization needle guided by transvaginal ultrasound. The sheep does not seem to be the ideal animal model to study this technique. Another animal model, whose ovaries are better identified by transvaginal ultrasound should be sought for this technique, theoretically less invasive, before it could be offered safely to women with polycystic ovary syndrome.

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.

Visuospatial ability correlates with performance in simulated gynecological laparoscopy

Objective To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN). Study design This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10–100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability. Results Visuospatial ability correlated with Total Time ( r = −0.62; p = 0.03) and Score ( r = 0.57; p = 0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time ( r = −0.64; p = 0.02), Ovarian Diathermy Damage ( r = −0.65; p = 0.02) and with overall Score ( r = 0.64; p = 0.02). Conclusions Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs.

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.

Running into spring

Running into spring

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.

Combined metformin and clomiphene citrate versus laparoscopic ovarian diathermy for ovulation induction in clomiphene‐resistant women with polycystic ovary syndrome: A randomized controlled trial

To compare the effect of combined metformin and clomiphene citrate (CC) with laparoscopic ovarian diathermy (LOD) meant for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS). Two-hundred and eighty-two anovulatory women with CC-resistant PCOS were selected in this randomized controlled trial. Patients (n = 138) received combined metformin-CC for up to six cycles or underwent LOD (n = 144) with six months follow up. The outcome measures were: ovulation rate, midcycle endometrial thickness, pregnancy and miscarriage rates. Ovulation occurred in 386/576 cycles (67%) in the combined metformin-CC group and 381/558 cycles (68.2%) in LOD group without a significant difference between the groups. Resumption of regular menstruation was similar in both groups. A significant increase in midcycle endometrial thickness was observed in the combined metformin-CC group (9.2 ± 1.2 mm vs 7.6 ± 1.1 mm) (P < 0.05). The pregnancy rate was similar in both groups (15.4% vs 17%), and there were no statistically significant differences regarding the miscarriage rate between both groups. Four twin pregnancies occurred in the metformin-CC group. No ovarian hyperstimulation occurred in either group. Combined metformin-CC and LOD are equally effective for inducing ovulation and achieving pregnancy in CC-resistant PCOS patients.

Laparoscopic ovarian diathermy vs clomiphene citrate plus metformin as second-line strategy for infertile anovulatory patients with polycystic ovary syndrome: a randomized controlled trial

The purpose of this study was to compare the effectiveness of laparoscopic ovarian diathermy (LOD) vs clomiphene citrate (CC) plus metformin in infertile patients with CC-resistant polycystic ovary syndrome (PCOS). Fifty primary infertile patients with CC-resistant PCOS were assigned randomly to receive LOD followed by a 6-month observation (group A) or 6-cycle course of CC plus metformin (group B). Reproductive and safety outcomes were analyzed. No significant difference between 2 groups in pregnancy (15/92 women [16.3%] vs 14/107 women [13.1%]; P = .521) and live-birth (13/92 women [14.1%] vs 12/107 women [11.2%]; P = .536) rates per cycle was observed. With the use of a Cox regression analysis, patients under medical treatment, compared with patients who received surgical treatment, had a relative risk of pregnancy of 1.2 (95% confidence interval, 0.61-2.44; P = .582) and a relative risk of live-birth of 1.4 (95% confidence interval, 0.63-2.96; P = .425). LOD and CC plus metformin seem to be 2 effective approaches to treat infertility in patients with CC-resistant PCOS.

Comparison of metformin treatment and laparoscopic ovarian diathermy in patients with polycystic ovary syndrome

Objective To compare hormone levels and clinical outcomes in patients with polycystic ovary syndrome (PCOS) after metformin therapy or laparoscopic ovarian diathermy (LOD) at 6 months follow-up. Methods A randomized trial was conducted in 126 patients with PCOS who had a history of infertility for at least 1 year and resistance to clomiphene citrate (CC). Patients (n = 63) received metformin treatment or underwent LOD (n = 63). Results Levels of follicle-stimulating hormone did not change in either group after the intervention ( P > 0.05). Serum levels of testosterone ( P < 0.001) and luteinizing hormone ( P < 0.001) were significantly lower after the treatment in both groups. The proportion of women with regular menstrual cycles increased significantly to 35% ( P < 0.001) in the LOD group and to 49% ( P < 0.001) in metformin group compared with before the intervention. Although proportion was higher in the metformin group compared with the LOD group, the difference was not significant (odds ratio 1.81; 95% CI, 0.88–3.69, P = 0.1). Hirsutism decreased significantly from 100% to 79.37% ( P < 0.001) in both groups. Conclusion CC-resistant patients with PCOS were treated effectively by both metformin and LOD.

The value of measuring anti-Mullerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy

Anti-Müllerian hormone (AMH) has been implicated in the pathogenesis of polycystic ovary syndrome (PCOS). The aim of this study was to measure circulating AMH before laparoscopic ovarian diathermy (LOD) to evaluate its prognostic value for an ovulatory response and to investigate AMH changes after LOD to further explore the effects of LOD. This prospective study included anovulatory women with PCOS undergoing LOD (n = 29) or receiving clomiphene citrate (n = 18). Plasma AMH concentrations were measured before and 1 week after treatment. Further measurements of AMH were made at 3- and 6-month follow-up. The pretreatment median (range) plasma AMH concentrations were 6.1 (1.0-21.0) and 5.7 (1.3-9.5) ng/ml in women having LOD and clomiphene citrate treatment, respectively. Women who ovulated after LOD (n = 24) had a significantly (P = 0.032) lower pre-operative AMH [5.6 (1.0-21.0) ng/ml] compared with the non-responders [9.0 (6.1-17.1) ng/ml]. Using receiver-operating characteristic curve analysis, AMH was found to be a useful predictor of no ovulation after LOD with area under the curve of 0.804 (P = 0.025). Using a cut-off of 7.7 ng/ml, AMH had a sensitivity of 78% and a specificity of 76% in the prediction of no ovulation after LOD. For all patients (n = 47, clomiphene citrate or LOD), plasma AMH >or=7.7 ng/ml was associated with a reduced chance of ovulation after treatment (P = 0.004). Following LOD, the median AMH concentration significantly (P = 0.003) decreased to 4.7 (0.3-15.1) ng/ml and remained low at 3- and 6-month follow-up. Pretreatment circulating AMH level seems to be a good predictor of the ovarian response to LOD.

Is ovarian reserve diminished after laparoscopic ovarian drilling?

Background. Surgical therapy with laparoscopic ovarian ‘drilling’ (LOD) may avoid or reduce the need for gonadotrophins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve (DOR).Objective. To review the available literature, whether the LOD is harmful on the ovarian reserve markers.Search strategy. A literature search was conducted using the keywords LOD, laparoscopic ovarian diathermy, PCOS, ovarian reserve, premature ovarian failure (POF). The MEDLINE and EMBASE databases and the Cochrane Database of Systematic Reviews were searched.Selection criteria. All trials, case reports and letters to the editor in the PubMed database were included.Data collection and analysis. Along with the long-term clinical follow-up research articles, four that were specifically identifying the ovarian reserve tests were included in this review. Among these, three of them compared before and after LOD values, and one of them compared ovarian reserve markers among different groups of subjects; those with LOD, those with PCOS without LOD and those with normal ovulatory controls.Results. There were statistically significant differences between Day 3 FSH, inhibin B levels, ovarian volume and antral follicle count before and after LOD in some of the reports. Although the after LOD values were found to be lower than the before LOD values by means of ovarian reserve markers, the after values stayed higher than normal when compared with normal women without PCOS.Conclusion. Although the available data in the literature is limited, there was no concrete evidence of a DOR or POF associated with LOD in women with PCOS. Most of the changes in the ovarian reserve markers observed after LOD could be interpreted as normalisation of ovarian function rather than a reduction of ovarian reserve. LOD, if applied properly, normalises the exaggerated ovarian morphologic and endocrinologic properties.

Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome

Laparoscopic ovarian diathermy (LOD) is currently accepted as a successful second-line treatment for ovulation induction (OI) in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). The aim of this study was to test the hypothesis that LOD may be superior to CC as a first-line treatment. The study included 72 anovulatory women with PCOS who were randomized to LOD (n = 36) or CC (n = 36). Women who remained anovulatory after LOD were offered CC. Similarly, women receiving CC who failed to ovulate or conceive were offered LOD. Pregnancy rates were compared between the two groups using chi(2) and odds ratio with 95% confidence interval (OR, 95% CI). After randomization, six women conceived before starting treatment and another patient postponed treatment. The remaining 65 women received the treatment (33 underwent LOD and 32 received CC). After the primary treatment, more pregnancies (44%) occurred in women receiving CC than in those undergoing LOD (27%), although the difference did not reach statistical significance [P = 0.13, OR 2.1 (0.7 - 5.8)]. After adding the second treatment, the pregnancy rate was still higher, but to a less extent, in the CC group [63% versus 52%, P = 0.2, OR 1.6 (0.6 - 4.2)]. LOD is not superior to CC as a first-line method of OI in women with PCOS. The trial is registered with ClinicalTrials.gov with an identifier number NCT00220545.

ANTI-MULLERIAN HORMONE AS A MARKER FOR DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME AND ITS FUNCTION AFTER LAPAROSCOPIC OVARIAN DIATHERMY

Background: Although the polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder in women of reproductive age, its diagnosis remains one of the most challenging issues in endocrinology, gynecology, and reproductive medicine. The elevated levels of Anti-mullcrian hormone (AMH) in the women of PCOS strongly suggested that serum AMH levels may be used in the diagnosis of this condition. Laparoscopic ovarian diathermy (LOD) frequently induces ovulalion in patients with polycystic ovary syndrome (PCOS). The mechanism by which this effect occurs remains largely unexplained.The aim of this study is to assess whether AMH could play a role in the diagnosis of PCOS and to measure changes in (AMH) production in response to (LOD) to sec whether this could explain the mechanism of action of (LOD). Methods: This prospective study included 30 anovulatory women with PCOS and 10 ovulatory women as a control. All PCOS women underwent LOD. Blood samples were collected before and after LOD to measure plasma concentrations of Anti-Mullerian Hormone (AMH), cstradiol (E2), gonadotrophins (FSH and LH), and testosterone. The number of early (at day 3 of the cycle) antral follicles (2-9mm in diameter) were estimated by ultrasound scanning. Results: The mean serum AMH level was about 3-folds higher in PCOS patients than in controls (P < 0.001). Likewise, the 2- to 9-mm follicular numbers per ovary (FNPO) at U/S were 3-fold higher in PCOS patients than in controls (P < 0.001). It was significantly related to the serum AMH levels, both in controls (r = 0.370; P< 0.022) and in patients (r = 0.670; P < 0.0001). AMH was also positively related to the serum testosterone level in cases in comparison to controls (r = 0.454 and P < 0.0004 in cases; versus r = 0.163 and P = 0.288 in controls). No significant correlation was observed between FSH, E2, BMI and AMH levels in PCOS patients and controls. In PCOS patients, the mean scrum level of AMH differed significantly by ANOVA (P < 0.05) between those presenting either with amenorrhea (n = 10), oligoamenorrhea (n = 10) or regular cycles (n = 10); the former and the latter having the highest and the lowest values, respectivcly(8.17ng/ml andl6.8 ng/ml). As expected, the 2- to 9mm follicular number per ovary (FNPO )followed the same trend in these three subgroups ( P < 0.05), whereas age did not exert a statistically significant effect. Our data suggest that, high androgen (HA) is associated with higher serum AMH levels in PCOS patients with irregular cycles. Following LOD, there was a statistically significant reduction of mean plasma concentrations of AMH from the pre-operative values in the overall group of 30 women with PCOS [8.2ng/ml versus 12.2ng /ml]. Women who ovulalcd after LOD (n = 10) had a higher mean pre-LOD AMH level [15.5 ng/ml] compared with that [10.5 ng/ml] of patients (n = 20) who did not respond. After LOD there was a statistically significant reduction in LH: FSH ratio and the plasma concentrations of LH and testosterone. Plasma concentrations of FSH did not change after LOD.Conclusions: Anti-Mullerian Hormone could be a valuable marker for diagnosis of polycystic ovary syndrome and improvement of its function after laparoscopic ovarian diathermy. The dramatic and significant reduction of Anti-Mullerian hormone after LOD especially in responders makes it likely that this hormone has a role to play in the mechanism of action of LOD.

Long‐term follow up of women with laparoscopic ovarian diathermy for women with clomiphene‐resistant polycystic ovarian syndrome

Laparoscopic ovarian diathermy (LOD) is one of the options for managing women with anovulation secondary to polycystic ovarian syndrome. The long-term benefits and harms of LOD are unknown. The aim of this report was to establish the long-term benefits and harms of LOD in the group of women who took part in a randomised controlled trial (RCT) six to ten years earlier. Women who took part in the fertility PLUS RCT comparing laparoscopic ovarian diathermy and gonadotrophins were contacted six to ten years following the end of the study. A postal questionnaire of clinical symptoms and pregnancy outcomes was collected, and follicle-stimulating hormone (FSH) levels were measured. Of the 33 women who completed the postal questionnaire, 29 had subsequently undergone LOD. The mean FSH level of these women was 5.7 IU/L (SD 3.7) ranging from <0.1 to 18.4 IU/L. The number of periods per year increased from 3.5 at study entry to 7.8 in the follow-up period in women not on the oral contraceptive. At the follow up, 15 of 29 women undergoing LOD (52%) reported symptoms of hirsutism and 14.0% reported acne. After undergoing laparoscopic ovarian diathermy, 79.0% (23 of 29) of the women delivered live infants, and over the follow-up period, 35 babies were delivered. Further fertility treatment was needed by 14 of 29 women who underwent LOD. There are the benefits of ongoing fertility and regular menstrual cycles in more than half of the women who underwent LOD.

INFERTILE FEMALE

Objective: To highlight the role of laparoscopy in the diagnosis andmanagement of problems related to infertility. Design: Retrospective, descriptive study. Place &amp; Duration: Departmentof Obstetrics &amp; Gynaecology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore between 1stJanuary 2003 to December 2003. Patients &amp; Methods: Forty three women were selected for laparoscopy, 25 havingprimary infertility and 18 having secondary infertility. Results: Laparoscopy diagnosed significant number of previouslyundiagnosed (unexplained) cases. In laparoscopy multiple procedures like laparoscopic ovarian diathermy,adhesiolysis, cauterization of endometriotic spots, and removal of endometriomas, salpingostomy and cauterizationof fibroids can be performed in women with primary as well as secondary infertility while having minimal complications,short hospital stay and no mortality. Conclusion: Laparoscopy is a valuable diagnostic tool for female infertility.Laparoscopy is less invasive and more convenient.

Reply: Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome

Reply: Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome

The position of diagnostic laparoscopy in current fertility practice

In everyday clinical practice, it is not always clear if and when exactly in the fertility work-up a diagnostic laparoscopy should be offered. The aim of this review is to analyse the available evidence with respect to alternative diagnostic methods for detecting tuboperitoneal infertility and with respect to the position of diagnostic laparoscopy in women with infertility. A literature search of the National Library of Medicine and the National Institutes of Health (PubMed) was performed using the key words 'diagnostic laparoscopy and infertility'. The study methodology was carefully considered in an effort to present conclusions preferably based on randomized controlled trials (RCTs). The routine use of diagnostic laparoscopy for the evaluation of all cases of female infertility is currently under debate. According to data published in retrospective non-controlled studies, diagnostic laparoscopy after several failed cycles of ovulation induction enables the detection of a significant proportion of pelvic pathology amenable to treatment. A Cochrane review has shown that laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovarian syndrome is at least as effective as gonadotrophin treatment, and results in a lower multiple pregnancy rate. The role of laparoscopy before the start of treatment with intrauterine insemination is controversial, according to one RCT. In women with bilateral ultrasonically visible hydrosalpinges, two RCTs have demonstrated increased implantation and pregnancy rates in IVF cycles after salpingectomy. Although RCTs which have studied the benefit of laparoscopic surgery in moderate or severe endometriosis are still lacking, its value has generally been accepted. In conclusion, some specific clinical settings, solid evidence is available to recommend the use of diagnostic laparoscopy in current fertility practice. There is however a need for more RCTs to answer remaining questions regarding its value in the diagnosis and treatment of some patients with infertility.