Outcome of Laparoscopic Ovarian Drilling (LOD) for Women with Polycystic
Ovary Syndrome.
Abstract
Objective: To evaluate the effectivity of laparoscopic ovarian drilling
procedures at the East Sussex Healthcare Trust, UK, over the past decade
on sub-fertile women with polycystic ovary syndrome, regardless of
clomiphene resistance. Design: Retrospective case note review of LOD
procedures Methods: •Study 1: Evaluating a systematic literature review
investigating ovulation and pregnancy rates following LOD. •Study 2: An
audit of 58 women with LOD treated for ovulation induction at the ESHT
fertility clinic between 2005-2014. Main outcome measures: Ovulation,
pregnancy, live birth, miscarriage rates; tubal patency; associated
pathologies; previous treatments compared with Cochrane Review 2012.
Results: •Study 1: From the literature review, 71% achieved ovulation,
whereas the pregnancy, live birth and miscarriage rates were 25-51%,
24-44% and 4-9% respectively. •Study 2: Of the 58 patients studied,
ovulation rate was 69%, pregnancy rate was 39.4% and live birth rate
was 30.3%. The miscarriage rate was 15.4%. Pregnancy outcome after
LOD, irrespective of further treatment, showed 34 pregnancies. Including
17 spontaneous pregnancies and 17 pregnancies after further treatment.
Of the 34 pregnancies, 85.3% were live birth, 11.7% miscarriages and 1
ectopic pregnancy. Conclusion: No significant difference in ovulation
rates post-LOD in ESHT, which is comparable to published studies. The
low pregnancy and live birth rates indicate that additional factors
affect the success of LOD. Co-existing pathology is associated with
lower pregnancy rate post-LOD. Novel theories are postulated to explain
underlying pathologies, thus PCOS treatment may change and open a
fascinating area of research. Keywords: polycystic ovary syndrome,
laparoscopic ovarian drilling, clomiphene citrate