Office microlaparoscopic ovarian drilling (OMLOD) versus conventional laparoscopic ovarian drilling (LOD) for women with
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REPRODUCTIVE MEDICINE
Office microlaparoscopic ovarian drilling (OMLOD) versus conventional laparoscopic ovarian drilling (LOD) for women with polycystic ovary syndrome Imaduldin M. Salah
Received: 18 April 2012 / Accepted: 13 August 2012 / Published online: 1 September 2012 Ó Springer-Verlag 2012
Abstract Objective and design This was a prospective controlled study to compare the beneficial effects of office microlaparoscopic ovarian drilling (OMLOD) under augmented local anesthesia, as a new modality treatment option, compared to those following ovarian drilling with the conventional traditional 10-mm laparoscope (laparoscopic ovarian drilling, LOD) under general anesthesia. Methods The study included 60 anovulatory women with polycystic ovary syndrome (PCOS) who underwent OMLOD (study group) and 60 anovulatory PCOS women, in whom conventional LOD using 10-mm laparoscope under general anesthesia was performed (comparison group). Transvaginal ultrasound scan and blood sampling to measure the serum concentrations of LH, FSH, testosterone and androstenedione were performed before and after the procedure. Intraoperative and postoperative pain scores in candidate women were evaluated during the office microlaparoscopic procedure, in addition to the number of candidates who needed extra analgesia. Results Women undergoing OMLOD showed good intraoperative and postoperative pain scores. The number of patients discharged within 2 h after the office procedure was significantly higher, without the need for postoperative analgesia in most patients. The LH:FSH ratio, mean serum concentrations of LH and testosterone and free androgen index decreased significantly after both OMLOD and LOD.
The research work had been done in a private fertility care center. I. M. Salah (&) Department of Obstetrics and Gynecology, College of Medicine, El-Minya University, El-Minya, Egypt e-mail: [email protected]
The mean ovarian volume decreased significantly (P \ 0.05) a year after both OMLOD and LOD. There were no significant differences in those results after both procedures. Conclusion Intra- and postoperatively augmented local anesthesia allows outpatient bilateral ovarian drilling by microlaparoscopy without general anesthesia. The high pregnancy rate, the simplicity of the method and the faster discharge time offer a new option for patients with PCOS who are resistant to clomiphene citrate. Moreover, ovarian drilling could be performed simultaneously during the routine diagnostic microlaparoscopy and integrated into the fertility workup of these patients. Keywords Endocrine effects Office microlaparoscopic ovarian drilling Long-term follow-up Polycystic ovary syndrome Polycystic ovaries
Introduction Polycystic ovary syndrome (PCOS) is a relatively frequent disease observed in approximately 75 % of infertile women with ovulation disorder. Patients with PCOS have various clinical symptoms and laboratory findings. PCOS presents mainly as a menstrual abnormality and infertility associated with ovulation disorder. A variety o
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