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

2017 ◽  
Vol 9 (4) ◽  
pp. 336-340 ◽  
Author(s):  
Richa Singh ◽  
Meenal Jain ◽  
Poonam Yadav ◽  
Sarvesh Awasthi ◽  
Pallavi Raj
Keyword(s):  
Statistical Analysis ◽  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Polycystic Ovary ◽  
Clomiphene Citrate ◽  
Reproductive Age ◽  
Multiple Pregnancies ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
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.

scholarly journals Laparoscopic ovarian drilling in clomiphene citrate resistant polycystic ovarian syndrome patients

2018 ◽  
Vol 5 (10) ◽  
pp. 3230
Author(s):  
M. Sridhar ◽  
Chillamherla Susmitha
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Ovarian Function ◽  
Surgical Intervention ◽  
Clomiphene Citrate ◽  
Reproductive Age ◽  
Transvaginal Sonography ◽  
Polycystic Ovarian Disease ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome

Background: Polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) is a common endocrine disorder which commonly affects women in their reproductive age, often leading to anovulatory infertility. There has been a resurgence of surgical intervention with the advent of ovarian drilling. This study was performed to assess the surgical management for patients with PCOS resistant to hormonal therapy.Methods: A thorough history and demographic details were taken from all the patients. A detailed clinical examination, along with transvaginal sonography was done. Laparoscopic ovarian drilling was performed on the patients under general anesthesia.Results: Most of the women were in the 3rd decade of their life and majority of the women had attained menarche at 13 years. The chief complaint of the patients was irregular periods experienced by 80%. 44.4% of the patents had normal BMI, while 31.5% were underweight. Most of the patients (6.7%) showed no evidence of hyperandrogenism, while 20% had hirsutism, 11% had acne.Conclusions: Polycystic ovarian syndrome is quite prevalent among the women of reproductive age. The effective treatment for PCOS which are resistant to hormonal therapy is laparoscopic drilling of the ovaries which results in ovarian function.

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

2019 ◽  
Vol 15 (1) ◽  
pp. 103-109
Author(s):  
Thikra N Abdull
Keyword(s):  
Pregnancy Rate ◽  
Polycystic Ovarian Syndrome ◽  
Polycystic Ovary ◽  
Transvaginal Ultrasound ◽  
Clomiphene Citrate ◽  
Multiple Pregnancy ◽  
Reproductive Age ◽  
Infertile Women ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Syndrome

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

scholarly journals Effect of laparoscopic ovarian drilling on serum anti-Mullerian hormone in clomiphene citrate resistant polycystic ovarian syndrome patients

2021 ◽  
Author(s):  
Ambika Shankar ◽  
Oby Nagar ◽  
Shakuntla . ◽  
Suman Meghwal
Keyword(s):  
Ovarian Reserve ◽  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Interventional Study ◽  
Ovarian Insufficiency ◽  
Common Cause ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome ◽  
Anovulatory Infertility

Background: PCOS (polycystic ovarian syndrome) is the most common cause of anovulatory infertility, the purpose of our study was to see the effect of laparoscopic ovarian drilling on the ovarian reserve (with AMH as an indicator of ovarian reserve) and its safety as 2nd line of treatment in patients resistant to clomiphene citrate.Methods: This was a prospective interventional study conducted on 40 clomiphene citrate resistant PCOS women attending the infertility OPD. This study was conducted over a period of 1 year May 2019 to May 2020. Laparoscopic ovarian drilling (LOD) was done and these subjects were studied preoperatively and postoperatively on day 7 and day 30 for change in AMH (anti-Mullerian hormone) levels.Results: There is a significant change in the AMH level post LOD day 7 and 30 but not so severe that it will lead to premature ovarian failure. The amount of drop in AMH (day 30) increases till 20 ng/ml beyond which it shows a decrease.Conclusions: If LOD is done in a proper manner in women with sufficient ovarian reserve (high AMH), it will not adversely affect the ovarian reserve (the fall is not enough to cause premature ovarian insufficiency). 

scholarly journals Clomiphene citrate for ovulation induction in patients with polycystic ovarian syndrome

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Muhammad Arshad Chohan ◽  
Fauzia Butt ◽  
Humaira Mansoor ◽  
Tanzeela Falak
Keyword(s):  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Obstetrics And Gynecology ◽  
Ovarian Hyperstimulation ◽  
Follicular Growth ◽  
Miscarriage Rate ◽  
Ovarian Drilling ◽  
Hormonal Milieu ◽  
Ovarian Syndrome

Objective: To provide fertility assistance and to determine the response of clomiphene citrate in polycystic ovarian syndrome. Design: Observational study. Place and duration of study: Department of Obstetrics and Gynecology Lady Willingdon Hospital Lahore. Eighty-four patients of polycystic ovarian syndrome who required fertility assistance were subjected to clomiphene citrate therapy for duration of 12 months from February 2005 to January 2006. Intervention: Clomiphene citrate (50-150mg) was administered from second to sixth day of menstrual cycle and TVS performed on 12th and 16th day of cycle for follicular growth, ovulation, endometerial thickness and echogenic pattern. Main outcome measures: Ovulation, conception rate, miscarriage rate and ovarian hyperstimulation rate were assessed. In addition the thickness and echogenic pattern of the endometrium was observed in conceived group. Results: Forty-six patients (54.76%) ovulated in six cycles while twenty-seven (32.14%) remained anovulatory. Sixteen women (34.79%) conceived during the study period. Out of which ten women (62.5%) miscarried. Endometerial thickness did not differ (P>.50) between the conceived and non-conceived group but echogenic grade A pattern (75%) was observed during the conceived cycles (P<. 001). Conclusion: Clomiphene citrate (CC) is a successful drug for ovulation induction in patients with polycystic ovarian syndrome. But the discrepancy in ovulation and pregnancy rate s upport that clomiphene citrate therapy has antiestrogenic effect at the endometrium, which interferes with implantation of pregnancy. The high miscarriage rate in these patients demand some other forms of therapies. These include weight reduction, use of insulin sensitizing drugs, gonadotrophin therapy and ovarian drilling to reduce high LH levels, thus correcting disturbed hormonal milieu, ovulation resumption and pregnancy outcome.

scholarly journals Ovulation rates in a stair-step protocol with Letrozole vs clomiphene citrate in patients with polycystic ovarian syndrome

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
S. Thomas ◽  
I. Woo ◽  
J. Ho ◽  
T. Jones ◽  
R. Paulson ◽  
...  
Keyword(s):  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Step Cycle ◽  
Treatment Groups ◽  
Predominantly Hispanic ◽  
Ovarian Syndrome

Abstract Purpose To compare ovulation rates between Letrozole and Clomiphene Citrate (CC) using a stair-step protocol to achieve ovulation induction in women with Polycystic Ovarian Syndrome (PCOS). Methods This is a retrospective cohort of predominantly Hispanic PCOS women of reproductive age who completed ovulation induction (OI) comparing women who underwent Letrozole stair-step protocol to those who underwent OI with CC stair-step. All women had a diagnosis of PCOS based on the 2003 Rotterdam criteria. For both protocols, sequentially higher doses of Letrozole or CC were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. The primary outcome was ovulation rate (determined by presence of a dominant follicle) between the two treatment groups. Secondary outcomes included time to ovulation, clinical pregnancy rates and side effects. Results 49 PCOS patients completed a Letrozole stair-step cycle and 43 completed a CC stair-step cycle for OI. Overall, demographics were comparable between both groups. Ovulation rates with the Letrozole stair-step protocol were equivalent to CC stair-step protocol (96% vs 88%, p = 0.17). Although the mean time (days) to ovulation was shorter in the Letrozole group (19.5 vs 23.1, p = 0.027), the pregnancy rates were similar for both groups. Conclusions This is the first study to date that has compared the efficacy of the stair-step protocol in PCOS patients using Letrozole and CC. Both Letrozole and CC can be prescribed in a stair-step fashion. Letrozole stair-step was as efficacious as CC stair-step; patients achieved comparable rates of ovulation and clinical pregnancy. Time to ovulation was shorter in the Letrozole protocol.

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

2017 ◽  
Vol 8 (3) ◽  
pp. 93-96
Author(s):  
Mohan S Kamath ◽  
Sumi Thomas ◽  
Vivek P Vithayathil ◽  
Achamma Chandy ◽  
Thaiparambil K Aleyamma
Keyword(s):  
Retrospective Analysis ◽  
Treatment Option ◽  
Ovulation Induction ◽  
Polycystic Ovarian Syndrome ◽  
Line Treatment ◽  
Clinical Factors ◽  
Laparoscopic Ovarian Drilling ◽  
Ovarian Drilling ◽  
Ovarian Syndrome

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

scholarly journals Effectiveness of Laparoscopic Ovarian Drilling (LOD) on restoration of menstrual cycles, ovulation and pregnancy in clomiphene citrate resistant women with PCOS

2017 ◽  
Vol 6 (12) ◽  
pp. 5425
Author(s):  
Rama Singh Chundawat ◽  
Arun Gupta
Keyword(s):  
Polycystic Ovarian Syndrome ◽  
Clomiphene Citrate ◽  
Signs And Symptoms ◽  
Menstrual Cycles ◽  
Laparoscopic Ovarian Drilling ◽  
Gynecology And Obstetrics ◽  
Ovarian Drilling ◽  
Ovarian Syndrome ◽  
Anovulatory Infertility

Background: Anovulatory infertility is present in 75% of patients with polycystic ovarian syndrome (PCOS), in addition to oligomenorrhoea and signs and symptoms of hyperandrogenism. This study was performed to evaluate the role of laparoscopic ovarian drilling (LOD) on ovulation, restoring menstrual cycles and pregnancy in clomiphene resistant women with PCOS.Methods: This prospective cohort study included 50 women who were diagnosed with PCOS and anovulatory infertility. These patients had already tried Clomiphene citrate for conception and did not ovulate, underwent LOD between 1st September 2009 until February 2011 in the Department of Gynecology and Obstetrics, at the Panna Dhay Mahila Chikitasalya, Udaipur. The major outcome measures include spontaneous ovulation, menstrual regularity after LOD and pregnancy rates.Results: Among 50 patients 33 (66%) started to menstruate regularly and 60% ovulated spontaneously, of them 24 (48%) conceived.Conclusions: Women with PCOS respond favourably to LOD.

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