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Slouha E, Segal J, White C, Pallotta T, Ghosh S, Clunes LA, Kollias TF. Ovarian Reserve and Hormone Alteration Following Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: A Systematic Review. Cureus 2024; 16:e62092. [PMID: 38989366 PMCID: PMC11236422 DOI: 10.7759/cureus.62092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2024] [Indexed: 07/12/2024] Open
Abstract
We aimed to conduct a systematic review of the data in the literature on ovarian reserve and ovarian hormone following laparoscopic ovarian drilling (LOD). The PubMed, ScienceDirect, and ProQuest databases were comprehensively searched using a combination of keywords such as "ovarian reserve", "laparoscopic ovarian drilling", "luteinizing hormone", "follicle-stimulating hormone", "inhibin", "LH/FSH ratio", "ovulation", and "testosterone". All studies involving females of reproductive age who were officially diagnosed with polycystic ovarian syndrome (PCOS) and had undergone LOD with reported data concerning at least one of the following parameters were considered for inclusion: ovarian reserve, anti-Mullerian hormone (AMH), inhibin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH ratio, and testosterone. All the included studies were evaluated by the GRADE scale for bias and their findings were synthesized by four independent coauthors. A total of 38 studies involving 3118 female patients were included. Based on our findings, a significant number of participants experienced spontaneous ovulation along with a significant decrease in ovarian reserve, and a significant decrease in AMH, LH, and testosterone, with no significant changes in FSH and inhibin B. With the end goal of LOD being to improve fertility and pregnancy rates among females with PCOS, it is important to look at the first few steps that enable this. As expected, there was a significant improvement in ovulation while the ovarian reserve decreased. Along with the decrease in ovarian reserve, there was a significant normalization in AMH, LH, and testosterone levels. LOD may exert its main effects through the manipulation of the ovarian reserves.
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Affiliation(s)
- Ethan Slouha
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Jeremy Segal
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Colton White
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Theresa Pallotta
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Shanalyn Ghosh
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, True Blue, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology, and Pharmacology, St. George's University School of Medicine, True Blue, GRD
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Javedani Masroor M, Sheybani H, Sheybani S, Abolghasem N. Anti-mullerian hormone levels before and after ovarian drilling in polycystic ovary syndrome: has this an effect on fertility? Reprod Biol Endocrinol 2022; 20:129. [PMID: 36042475 PMCID: PMC9426279 DOI: 10.1186/s12958-022-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrine, metabolic, and multi-causal disorder in the reproductive period with a possible genetic origin. Women with PCOS are characterized by oligo-ovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries. Women with PCOS have an increased number of antral follicles. Anti-Mullerian hormone (AMH), a dimeric glycoprotein produced from the granulosa cells of the pre-antral and antral follicles, is elevated in PCOS. AMH has been implicated in two stages of follicle dysfunction that lead to the development of PCOS. The level of AMH decreases following ovarian drilling in patients with PCOS. The present study compared the level of AMH before and after Laparoscopic ovarian drilling (LOD) in patients with PCOS and its effect on fertility. MATERIALS AND METHODS This cohort study was carried out on 84 women with PCOS who underwent LOD in Akbarabadi Hospital in Tehran in 2020. Demographic characteristics, AMH, and estradiol levels were determined before surgery and compared with the amount one week after surgery. The effect of AMH level on pregnancy rate was also evaluated. RESULTS The mean age of the patients was 29.01 ± 4.01 years. The mean Body Mass Index (BMI) of the patients was 26.33 ± 4.14 kg/m2. The results showed that the mean AMH level decreased significantly after ovarian drilling (P-value < 0.001). Menstrual cycle distribution was significantly different before and after LOD (P < 0.001). None of the variables had an effect on the pregnancy (P-value > 0.05). Oligomenorrhea in the previous menstrual period might cause AMH levels to increase by 3.826 units after LOD (P-value < 0.001). CONCLUSION Measuring serum AMH concentration before treatment can be a useful tool to predict LOD outcomes. This can help in selecting the patient for treatment. TRIAL REGISTRATION The project was found to be under the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and issue date of IR.IUMS.FMD.REC.1397.206 and 2018.08.26 respectively, which has been registered with the research project number 2766 in the Vice-Chancellor for Research and Technology Development of Iran University of Medical Sciences, School of Medicine, Tehran, Iran. URL: https://ethics. RESEARCH ac.ir/EthicsProposalView.php?id=34791 .
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Affiliation(s)
- Mojgan Javedani Masroor
- Shahid Akbar-Abadi Clinical Research and Development Unit, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Sheybani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shiva Sheybani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Abolghasem
- Firooz-Abadi Hospital, Department of Gynecology, Iran University of Medical Sciences, Tehran, Iran
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Seow KM, Chang YW, Chen KH, Juan CC, Huang CY, Lin LT, Tsui KH, Chen YJ, Lee WL, Wang PH. Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome. Int J Mol Sci 2020; 21:ijms21218147. [PMID: 33142702 PMCID: PMC7663012 DOI: 10.3390/ijms21218147] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy, characterized by chronic anovulation, hyperandrogenism, and multiple small subcapsular cystic follicles in the ovary during ultrasonography, and affects 5–10% of women of reproductive age. PCOS is frequently associated with insulin resistance (IR) accompanied by compensatory hyperinsulinemia and, therefore, presents an increased risk of type 2 diabetes mellitus (DM). The pathophysiology of PCOS is unclear, and many hypotheses have been proposed. Among these hypotheses, IR and hyperandrogenism may be the two key factors. The first line of treatment in PCOS includes lifestyle changes and body weight reduction. Achieving a 5–15% body weight reduction may improve IR and PCOS-associated hormonal abnormalities. For women who desire pregnancy, clomiphene citrate (CC) is the front-line treatment for ovulation induction. Twenty five percent of women may fail to ovulate spontaneously after three cycles of CC treatment, which is called CC-resistant PCOS. For CC-resistant PCOS women, there are many strategies to improve ovulation rate, including medical treatment and surgical approaches. Among the various surgical approaches, one particular surgical method, called laparoscopic ovarian drilling (LOD), has been proposed as an alternative treatment. LOD results in an overall spontaneous ovulation rate of 30–90% and final pregnancy rates of 13–88%. These benefits are more significant for women with CC-resistant PCOS. Although the intra- and post-operative complications and sequelae are always important, we believe that a better understanding of the pathophysiological changes and/or molecular mechanisms after LOD may provide a rationale for this procedure. LOD, mediated mainly by thermal effects, produces a series of morphological and biochemical changes. These changes include the formation of artificial holes in the very thick cortical wall, loosening of the dense and hard cortical wall, destruction of ovarian follicles with a subsequently decreased amount of theca and/or granulosa cells, destruction of ovarian stromal tissue with the subsequent development of transient but purulent and acute inflammatory reactions to initiate the immune response, and the continuing leakage or drainage of “toxic” follicular fluid in these immature and growth-ceased pre-antral follicles. All these factors contribute to decreasing local and systemic androgen levels, the following apoptosis process with these pre-antral follicles to atresia; the re-starting of normal follicular recruitment, development, and maturation, and finally, the normalization of the “hypothalamus–pituitary–ovary” axis and subsequent spontaneous ovulation. The detailed local and systematic changes in PCOS women after LOD are comprehensively reviewed in the current article.
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Affiliation(s)
- Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Institute of Physiology, National Yang-Ming University, Taipei 112, Taiwan;
| | - Yi-Wen Chang
- Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei 112, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 108, Taiwan;
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
| | - Chi-Chang Juan
- Institute of Physiology, National Yang-Ming University, Taipei 112, Taiwan;
| | - Chen-Yu Huang
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Institute of BioPharmaceutical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Medicine, Cheng-Hsin General Hospital, Taipei 112, Taiwan
- Correspondence: (W.-L.L.); (P.-H.W.); Tel.: +886-2-28757566 (P.-H.W.)
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan; (C.-Y.H.); (L.-T.L.); (K.-H.T.); (Y.-J.C.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Female Cancer Foundation, Taipei 104, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
- Correspondence: (W.-L.L.); (P.-H.W.); Tel.: +886-2-28757566 (P.-H.W.)
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Nankali A, Kazeminia M, Jamshidi PK, Shohaimi S, Salari N, Mohammadi M, Hosseinian-Far A. The effect of unilateral and bilateral laparoscopic surgery for endometriosis on Anti-Mullerian Hormone (AMH) level after 3 and 6 months: a systematic review and meta-analysis. Health Qual Life Outcomes 2020; 18:314. [PMID: 32972380 PMCID: PMC7513290 DOI: 10.1186/s12955-020-01561-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. METHODS In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. RESULTS In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). CONCLUSION The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.
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Affiliation(s)
- Anisodowleh Nankali
- School of Medicine, Department of Obstetrics and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parnian Kord Jamshidi
- School of Medicine, Department of Obstetrics and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
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Umehara T, Urabe N, Obata T, Yamaguchi T, Tanaka A, Shimada M. Cutting the ovarian surface improves the responsiveness to exogenous hormonal treatment in aged mice. Reprod Med Biol 2020; 19:415-424. [PMID: 33071644 PMCID: PMC7542011 DOI: 10.1002/rmb2.12345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Ovarian vascular abnormality and ovarian fibrosis are observed in the low responder patients and aging mice. Vascularization and fibrosis are regulated by injury‐repair system, such as wound. Thus, in this study, the authors tried to investigate the effect of the surgical treatment to ovarian surface with cutting on the functions of ovary in aging mouse model, gcNrg1KO. Method The ovarian surface of gcNrg1KO was surgically cut, and then the ovary was returned inside of bursa ovarica. To assess the effect of cutting on fertility, mating test, smear analysis, and exogenous hormonal treatment were done. Additionally, the histological analysis was used for observing the remodeling of ovarian stroma after the surgical approach. Result Ovarian fibrosis disappeared at 7 days after surgery. With the abrogation of fibrosis, the blood vessels were fluently observed around the follicles, and the follicular development was re‐started. The responses against exogenous hormone were recovered at 21 days after the surgery, and estrous cycle and delivery were also recovered by the surgery and the fertility was maintained for 3 months. Conclusion This cutting method of ovarian surface becomes a good option against low responder patients.
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Affiliation(s)
- Takashi Umehara
- Graduate School of Integrated Sciences for Life Hiroshima University Higashi-Hiroshima Japan
| | - Nao Urabe
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Toshiki Obata
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Takashi Yamaguchi
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Masayuki Shimada
- Graduate School of Integrated Sciences for Life Hiroshima University Higashi-Hiroshima Japan
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Hafizi L, Amirian M, Davoudi Y, Jaafari M, Ghasemi GH. Comparison of Laparoscopic Ovarian Drilling Success between Two Standard and Dose-Adjusted Methods in Polycystic Ovary Syndrome: A Randomized Clinical Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2019; 13:282-288. [PMID: 31710188 PMCID: PMC6875852 DOI: 10.22074/ijfs.2020.5628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 04/23/2019] [Indexed: 01/16/2023]
Abstract
Background One of the treatment methods for increasing the ovarian response to ovulation induction in polycystic
ovary syndrome (PCOS) is laparoscopic ovarian drilling (LOD). The optimal amount of the electrosurgical energy
discharged in the ovaries to achieve maximum treatment response with minimal follicle injury is unknown. This study
was performed to compare the success level of LOD by means of standard and dose-adjusted treatment methods
among infertile clomiphene-resistant PCOS women. Materials and Methods This randomized clinical trial was conducted on infertile clomiphene citrate-resistant PCOS
women in the Gynaecology Department of Imam Reza Hospital between 2016 and 2017. The patients were randomly di-
vided into two groups based on the ovarian cautery method. The two groups were examined and compared regarding the
antral follicles, the serum levels of anti-Müllerian hormone (AMH), androgens, and mid-luteal progesterone one month
after surgery. The regularity of cycles, ovulation, and pregnancy were examined monthly up to six months after surgery. Results In total, 60 women received bilateral LOD (n=30 per group). The level of AMH (P=0.73), testosterone
(P=0.91), and dehydroepiandrosterone sulphate (DHEAS, P=0.16) did not differ at study entrance and one month after
ovarian cautery [P=0.94 (AMH), P=0.46 (testosterone), and P=0.12 (DHEAS)] and for postoperative mid-luteal pro-
gesterone (P=0.31). Intragroup comparisons showed a statistically significant difference in the decrease in the number
of antral follicles and testosterone in the standard group (P=0.02) and AMH level in the cautionary dose-adjusted
group (P=0.04). We observed no difference in cycle regularity (P=0.22), ovulation (P=0.11), and pregnancy (P=0.40)
between the two groups after six months. Conclusion The results indicated that there was no difference between the two methods of ovarian cautery with re-
gards to establishing cycle regularity and ovulation. The standard treatment was effective in decreasing the numbers of
antral follicles and testosterone levels, whereas the dose-adjusted method significantly affected the decrease in AMH
levels (Registration Number: IRTC20171210037820N1).
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Affiliation(s)
- Leili Hafizi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Amirian
- Department of IVF and Infertility, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasmin Davoudi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Jaafari
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - G Hazal Ghasemi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.Electronic Address:
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Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100093. [PMID: 31497757 PMCID: PMC6722221 DOI: 10.1016/j.eurox.2019.100093] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 07/22/2019] [Accepted: 08/09/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To report long term pregnancy rate in polycystic ovary syndrome (PCOS) treated by ovarian drilling. To evaluate predictive factors of pregnancy and possibility of a second drilling. Design Retrospective, observational, multicenter study. Setting Gynecologic departments of two teaching's hospitals. Patients All infertile women with PCOS who were treated by ovarian drilling from 2004 to 2013. The Rotterdam criteria were applied to define PCOS. Interventions Surgical ovarian drilling by laparoscopy and trans vaginal hydro laparoscopy. Main Outcome Measures The primary endpoint was pregnancy rate after ovarian drilling. The secondary endpoints were the predictive factors of pregnancy and the possibility of a second ovarian drilling. Results 289 women were included in the study. The mean follow-up period was 28.4 months (25.3-31.5). A pregnancy was obtained in at least 137 (47.4%) women after a drilling, and 71 (51.8%) of these pregnancies were spontaneous, 48 (16.6%) women achieved at least two pregnancies after drilling, and 27 (56.3%) of these were spontaneous. The predictive factors for effectiveness were a normal body mass index (BMI), an infertility period of less than three years, an AFC of less than 50, and an age of less than 35. Second drillings were performed on 33 women. Among them, 19 (57.6%) achieved at least one pregnancy, and 10 (52.6%) of these were spontaneous. It appeared that a second drilling was effective either when the first drilling had been successful (pregnancy achieved after drilling) or when it had failed in cases of high AFC (greater than 55). Conclusion Ovarian drilling permitted to obtain spontaneous pregnancy for women with PCOS. This surgery could have durably effect permitted to obtain more than one pregnancy.
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Kamal N, Sanad Z, Elkelani O, Rezk M, Shawky M, Sharaf AE. Changes in ovarian reserve and ovarian blood flow in patients with polycystic ovary syndrome following laparoscopic ovarian drilling. Gynecol Endocrinol 2018; 34:789-792. [PMID: 29633882 DOI: 10.1080/09513590.2018.1459549] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
This prospective cohort study was conducted on 80 patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome undergoing laparoscopic ovarian drilling (LOD). Pre- and post-LOD ovarian reserve parameters (anti-Mullerian hormone: AMH, ovarian volume: OV, and antral follicle count: AFC) and ovarian stromal blood flow indices (Vascularization index: VI, flow index: FI, and vascularization flow index: VFI) were measured to explore the effect of LOD and to find out the correlation between serum AMH and different clinical, hormonal, and ultrasonic variables. There was a highly significant reduction of the serum AMH (p < .001) after LOD with significant reduction in OV, AFC and vascular indices (VI, FI and VFI) of the right and left ovaries (p < .05). LOD significantly reduced ovarian reserve parameters (AMH, OV and AFC) and ovarian stromal blood flow indices (VI, FI and VFI) with no observed correlation between AMH levels and Doppler indices.
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Affiliation(s)
- Nasser Kamal
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Zakaria Sanad
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Osama Elkelani
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Mohamed Rezk
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Mohamed Shawky
- b Department of Radiology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Abd-Elbar Sharaf
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Menoufia University , Shebin El-Kom , Egypt
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Seyam E, Hefzy E. Tumor necrosis factor alpha versus LH and androstendione as a reliable predictor of spontaneous ovulation after laparoscopic ovarian drilling for women with clomiphene citrate resistance polycystic ovarian disease. Eur J Obstet Gynecol Reprod Biol 2018; 222:126-133. [PMID: 29408743 DOI: 10.1016/j.ejogrb.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 11/05/2017] [Accepted: 01/10/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Laparoscopic ovarian drilling (LOD) is still a controversial decision; due to the long term hazards; so short and long term predictors after the procedure should be taken in consideration. The aim of this work was to investigate the role of the serum level of tumor necrosis factor alpha (TNF-α) and other polycystic ovarian disease (PCOD) relevant clinical and biochemical factors as a predictor of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD). METHODS It was a prospective research work, where 150 infertile women with CCR-PCOD had been recruited. TNF-α serum level, which is an inflammatory biomarker, was investigated in addition to other PCOD relevant clinical and biochemical parameters as possible predictors of successful spontaneous ovulation and subsequent pregnancy after LOD. RESULTS Recruited women with higher preoperative levels of TNF-α, LH, and androstenedione had significantly higher rates of spontaneous ovulation within the first three months follow up after LOD, in contrast to obese women with BMI ≥ 25 kg/m2, long duration of infertility ≥3 years, marked biochemical hyperandrogenism (testosterone levels ≥4.5 nmol/L, free androgen index ≥15), and high insulin resistance (IR). Ninty five (95 = 63.3%) women in between women regularly menstruated (105 = 70%) had spontaneous ovulation, and of those spontaneously ovulated, 35(36.8%) women got pregnant spontaneously during the first 3 months follow up. Extended follow up for 12 months period revealed that 61 women got pregnant, with cumulative pregnancy rate of 58%. Logistic regression showed that the best cut-off values for spontaneous ovulation after LOD were 65.1 pg/ml, 11.5 IU/l, and 3.1 ng/ml and with a sensitivity of 91%, 88%, 55%, and with a specificity of 85%, 79%, 78%, for TNF-α, LH, androstenedione serum level respectively. CONCLUSION TNF-α, LH, and Androstenedione could be considered as reliable predictors to depend on for recruiting the ideal women candidates with CCR-PCOD; to have the maximum benefits after LOD treatment option.
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Affiliation(s)
- Emaduldin Seyam
- Obstetrics and Gynecology Department, Minia University College of Medicine, Minia, Egypt.
| | - Enas Hefzy
- Microbiology and Immunology Department, Fayoum University College of Medicine, Fayoum, Egypt.
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Garg N, Khaira HK, Kaur M, Sinha S. A Comparative Study on Quantitative Assessment of Blood Flow and Vascularization in Polycystic Ovary Syndrome Patients and Normal Women Using Three-Dimensional Power Doppler Ultrasonography. J Obstet Gynaecol India 2017; 68:136-141. [PMID: 29662284 DOI: 10.1007/s13224-017-1082-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose of the Study To compare the quantitative assessment of blood flow and vascularization of ovaries in polycystic ovary syndrome patients and normal women using three-dimensional power Doppler ultrasonography. Methods This cross-sectional quantitative study was conducted on women of reproductive age group (15-45 years) attending Gynaecology OPD AIMSR, Bathinda, Punjab. Thirty women were enrolled in polycystic ovarian syndrome (PCOS) group and 30 healthy women in control group. Women were categorized as polycystic ovary syndrome according to Rotterdam's criteria. The women with PCOS underwent transvaginal USG Doppler on day 6 of the cycle using 3D power Doppler USG equipment (GE Voluson E8), and vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were measured. Results The mean values of VI, FI and VFI measured by power Doppler ultrasonography were significantly increased (P value = 0.000) in women with PCOS when compared with healthy women. Conclusion This study suggests that blood flow and vascularization measured by 3D power Doppler ultrasonography in ovaries of polycystic ovary syndrome patients were significantly more than the ovaries of normal women.
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Affiliation(s)
- Nitasha Garg
- 1Department of Obstetrics and Gynecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab India
| | - Harkiran Kaur Khaira
- 1Department of Obstetrics and Gynecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab India
| | - Manjot Kaur
- 2Department of Radiodiagnosis, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab India
| | - Smita Sinha
- 1Department of Obstetrics and Gynecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab India
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Salem MN, Ahmed SR, Abbas AM, Salem AN, Sabala AERM. Short term effects of laparoscopic ovarian drilling in clomiphene citrate resistant patients with polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Lepine S, Jo J, Metwally M, Cheong YC. Ovarian surgery for symptom relief in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2017; 11:CD009526. [PMID: 29125183 PMCID: PMC6486107 DOI: 10.1002/14651858.cd009526.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a common endocrine condition, affecting approximately one in 10 women. PCOS is defined by two of three features: oligo- or anovulation, clinical or biochemical hyperandrogenism or both, or polycystic ovaries.Women with PCOS can have a wide range of health problems, including infrequent and irregular periods, unwanted hair growth and acne, and subnormal fertility. Long-term health concerns include an increased risk of heart disease, diabetes and the development of precancerous disease of the womb. OBJECTIVES To assess the effectiveness and harms of ovarian surgery as a treatment for symptomatic relief of hirsutism, acne and menstrual irregularity in PCOS. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group specialized register, CENTRAL, MEDLINE, Embase and PsycINFO (from inception to 17 October 2016). We handsearched citation lists, registers of ongoing trials and conference proceedings. SELECTION CRITERIA We included randomized controlled trials (RCTs) of women undergoing ovarian drilling in comparison to no treatment, medical treatment, or other forms of surgical treatment for the symptoms of PCOS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary outcome measures were improvement in menstrual regularity and androgenic symptoms of PCOS (hirsutism, acne); the secondary outcome measures included harms, change of body mass index (BMI), waist circumference, androgen levels, metabolic measures and quality of life. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS We included 22 RCTs (2278 women analyzed) of participants with PCOS and symptoms of acne, hirsutism or irregular menstrual cycles, all of which included laparoscopic ovarian drilling (LOD) as an intervention.Two studies reported their funding source (Farquhar 2002 - supported in part by the Auckland Medical Research Foundation; Sarouri 2015 - the authors thank the Vice Chancellor for Research of Guilan University of Medical Sciences for funding this project).The quality of the evidence ranged from very low to moderate quality. The main limitations were imprecision associated with the low number of studies, inconsistency and risk of bias associated with the inability to blind participants. There were too few studies to assess risk of publication bias. Menstrual RegularityTwo studies compared LOD versus metformin (n=226) but no conclusions could be drawn with regard to menstrual regularity, as their findings were inconsistent and they were unsuitable for pooling. There appeared to be little or no difference in the rate of women reporting improvement in menstrual regularity when LOD was compared with medical treatment including metformin + clomiphene (OR 1.02, 95% CI 0.64 to 1.64, 2 studies, 332 women, I2 = 13%, low-quality evidence), letrozole (OR 1.08, 95% CI 0.64 to 1.84, 1 study, 260 women, low-quality evidence), or metformin + letrozole (OR 0.95, 95% CI 0.49 to 1.81, 1 study, 146 women, low-quality evidence). However, one study reported that LOD was superior to gonadotrophin (OR 19.2, 95% CI 3.17 to 116.45, 1 study, 35 women, very low-quality evidence).There appeared to be little or no difference in the rate of women reporting improvement in menstrual regularity when bilateral unipolar LOD was compared to unilateral LOD (OR 1.51, 95% CI 0.62 to 3.71, 2 studies, 104 women, I2 = 0%, moderate-quality evidence), transvaginal ultrasound-guided LOD (OR 1.23, 95% CI 0.64 to 2.37, 1 study, 147 women, low-quality evidence), LOD using adjusted thermal dose in accordance with the ovarian volume (OR 0.42, 95% CI 0.16 to 1.14, 1 study, 115 women, low-quality evidence) or bipolar LOD (OR 1.00, 95% CI 0.05 to 18.57, 1 study, 18 women, low-quality evidence).Four to five punctures per ovary may improve the rate of women reporting menstrual regularity compared with two or fewer (OR 16.04, 95% CI 4.19 to 61.34, 2 studies, 73 women, I2 = 0%, low-quality evidence). Androgenic SymptomsThere was probably little or no difference in improvement in androgenic symptoms when LOD was compared to metformin (OR 1.00, 95% CI 0.42 to 2.37, 1 study, 126 women, moderate-quality evidence) or gonadotrophins; acne (OR 3.20, 95% CI 0.33 to 30.94, 1 study, 25 women, low-quality evidence), hirsutism (OR 2.31, 95% CI 0.22 to 23.89, 1 study, 25 women, low-quality evidence).There appeared to be little or no difference in improvement of androgenic symptoms when LOD was compared to transvaginal ultrasound-guided LOD, with respect to hirsutism (OR 1.09, 95% CI 0.30 to 3.91, 1 study, 39 women, low-quality evidence) or acne (OR 0.84, 95% CI 0.20 to 3.50, 1 study, 31 women, low-quality evidence). HarmsLOD was associated with fewer gastrointestinal side effects than metformin plus clomiphene (OR 0.05, 95% CI 0.01 to 0.36, 2 studies, 332 women, I2 = 0%, moderate-quality evidence). One study suggested little or no difference in rates of ovarian hyperstimulation syndrome between LOD and gonadotrophins (OR 0.08, 95% CI 0.00 to 1.61, 1 study, 33 women, low-quality evidence).There were fewer adhesions with transvaginal hydrolaparoscopy compared to LOD (OR 0.10, 95% CI 0.05 to 0.18, 1 study, 246 women, moderate-quality evidence). There appeared to be little or no difference in adhesions when variable energy LOD was compared with standard LOD (OR 0.96, 95% CI 0.32 to 2.88, 1 study, 64 women, low-quality evidence). Another study (44 women) reported that none of the women who returned for surgery following either traditional or unilateral LOD were found to have adhesions. AUTHORS' CONCLUSIONS There was no clear evidence that LOD improves menstrual regularity or the androgenic symptoms of PCOS, compared to most of the medical treatments used in the included studies. LOD was associated with fewer gastrointestinal side effects compared to metformin and clomiphene.There was also no clear evidence of different effectiveness between types of LOD, except that LOD with four to five punctures per ovary may be more effective than two or fewer punctures. There was little evidence comparing LOD with different types of surgery, although one study concluded that transvaginal hydrolaparoscopy had a lower risk of adhesions than LOD.There was evidence from one small study of benefit from LOD compared to gonadotrophins for menstrual regulation. However, gonadotrophins are seldom used for this indication.
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Affiliation(s)
- Sam Lepine
- Capital and Coast District Health BoardDepartment of Obstetrics and GynaecologyWellingtonNew Zealand
| | - Junyoung Jo
- Conmaul Hospital of Korean MedicineDepartment of Korean Obstetrics and GynecologyFl. 5, Lotte Castle Medici, 1656‐4, Seocho‐dong, Seocho‐guSeoulKorea, South
| | - Mostafa Metwally
- Sheffield Teaching HospitalsThe Jessop Wing and Royal Hallamshire HospitalSheffieldUKS10 2JF
| | - Ying C Cheong
- University of SouthamptonDepartment of Obstetrics and GynaecologyLevel F, Princess Anne HospitalCoxford RoadSouthamptonUKSO16 5YA
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Giampaolino P, Morra I, De Rosa N, Cagnacci A, Pellicano M, Di Carlo C, Nappi C, Bifulco G. Impact of transvaginal hydrolaparoscopy ovarian drilling on ovarian stromal blood flow and ovarian volume in clomiphene citrate-resistant PCOS patients: a case-control study. Gynecol Endocrinol 2017; 33:690-693. [PMID: 28412862 DOI: 10.1080/09513590.2017.1310837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in gynecology. In PCOS patients vascularization parameters are altered. Transvaginal hydrolaparoscopy (THL) is a mini-invasive approach for ovarian drilling in PCOS patients. In this study, we assessed the effect of ovarian drilling using THL on ovarian volume (OV) and vascularization index (VI) using 3D power Doppler ultrasonography in CC-resistant PCOS patients. A case-control study on 123 CC-resistant PCOS women who underwent THL ovarian drilling was performed. Patients underwent 3D ultrasound and power Doppler to measure VI, flow index (FI), vascularization flow index (VFI) and to evaluate OV before and after the procedure, at six months, and on the early follicular phase of the menstrual cycle. After THL ovarian drilling, OV and power Doppler flow indices were significantly reduced compared to pre-operative values (OV: 7.85 versus 11.72 cm3, p < 0.01; VI: 2.50 versus 4.81, p < 0.01; VFI: 1.10 versus 2.16, p < 0.01; FI: 32.05 versus 35.37, p < 0.01). In conclusion, THL ovarian drilling seems to reduce OV and 3D power Doppler indices, and could therefore be a viable alternative to LOD in PCOS patients resistant to medical therapy.
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Affiliation(s)
| | - Ilaria Morra
- b Department of Obstetrics, Gynecology, and Urology , University of Naples "Federico II" , Naples , Italy , and
| | - Nicoletta De Rosa
- b Department of Obstetrics, Gynecology, and Urology , University of Naples "Federico II" , Naples , Italy , and
| | - Angelo Cagnacci
- c Department of Obstetrics and Gynecology , University of Udine , Udine , Italy
| | - Massimiliano Pellicano
- b Department of Obstetrics, Gynecology, and Urology , University of Naples "Federico II" , Naples , Italy , and
| | - Costantino Di Carlo
- b Department of Obstetrics, Gynecology, and Urology , University of Naples "Federico II" , Naples , Italy , and
| | - Carmine Nappi
- a Department of Public Health , University of Naples "Federico II" , Naples , Italy
| | - Giuseppe Bifulco
- b Department of Obstetrics, Gynecology, and Urology , University of Naples "Federico II" , Naples , Italy , and
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Amer SA, Shamy TTE, James C, Yosef AH, Mohamed AA. The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis. Reproduction 2017; 154:R13-R21. [PMID: 28420801 DOI: 10.1530/rep-17-0063] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 01/27/2023]
Abstract
Laparoscopic ovarian drilling (LOD) has been widely used as an effective treatment of anovulatory women with polycystic ovarian syndrome (PCOS). However, there has been a growing concern over a possible damaging effect of this procedure on ovarian reserve. The objective of this study was to investigate the hypothesis that LOD compromises ovarian reserve as measured by post-operative changes in circulating anti-Müllerian hormone (AMH). This meta-analysis included all cohort studies as well as randomised controlled trials (RCTs) investigating serum AMH concentrations and other ovarian reserve markers in women with PCOS undergoing LOD. Various databases were searched including MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and Cochrane Library from January 2000 to December 2016. Sixty studies were identified, of which seven were deemed eligible for this review. AMH data were extracted from each study and entered into the RevMan software to calculate the weighted mean difference (WMD) between pre- and post-operative values. Pooled analysis of all studies (n = 442) revealed a statistically significant decline in serum AMH concentration after LOD (WMD -2.13 ng/mL; 95% confidence interval (CI) -2.97 to -1.30). Subgroup analysis based on duration of follow-up, AMH kit, laterality of surgery and amount of energy applied during LOD consistently showed a statistically significant fall in serum AMH concentration. In conclusion, although LOD seems to markedly reduce circulating AMH, it remains uncertain whether this reflects a real damage to ovarian reserve or normalisation of the high pre-operative serum AMH levels. Further long-term studies on ovarian reserve after LOD are required to address this uncertainty.
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Affiliation(s)
- Saad A Amer
- Department of Obstetrics and GynaecologyUniversity of Nottingham, Royal Derby Hospital, Derby, UK
| | - Tarek T El Shamy
- Derby Teaching Hospitals NHS Foundation TrustRoyal Derby Hospital, Derby, UK
| | - Cathryn James
- Derby Teaching Hospitals NHS Foundation TrustRoyal Derby Hospital, Derby, UK
| | - Ali H Yosef
- Department of Obstetrics and GynaecologyThe University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmed A Mohamed
- Department of Obstetrics and GynaecologyUniversity of Nottingham, Royal Derby Hospital, Derby, UK
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15
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Giampaolino P, Morra I, Della Corte L, Sparice S, Di Carlo C, Nappi C, Bifulco G. Serum anti-Mullerian hormone levels after ovarian drilling for the second-line treatment of polycystic ovary syndrome: a pilot-randomized study comparing laparoscopy and transvaginal hydrolaparoscopy. Gynecol Endocrinol 2017; 33:26-29. [PMID: 27228002 DOI: 10.1080/09513590.2016.1188280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Aim of the study was to asses and compare serum anti-Mullerian harmone (AMH) levels after laparoscopic ovarian drilling (LOD) and transvaginal hydrolaparoscopy (THL) ovarian drilling in clomifene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients; secondary outcome was to evaluate postoperative pain to estimate the acceptability of procedures. A total of 246 patients with CC-resistant PCOS were randomized into two groups: 123 underwent LOD and 123 underwent THL ovarian drilling. AMH serum levels were evaluated before and after the procedure; moreover, women were asked to rate pain on a visual analog scale (VAS) from 0 (no pain, perfectly acceptable) to 10 (unbearable pain, completely unacceptable). In both groups, postoperative serum AMH levels were significantly reduced compared to preoperative levels (6.06 ± 1.18 and 5.84 ± 1.16 versus 5.00 ± 1.29 and 4.83 ± 1.10; p < 0.0001). Comparing postoperative serum AMH levels, no statistically significant difference was observed between the two surgical technique. After the procedure, mean pain VAS score was significantly higher for women who underwent LOD ovarian drilling in comparison to THL (3.26 ± 1.1 versus 1.11 ± 0.5; p < 0.0001). In conclusion, THL ovarian drilling is comparable to the LOD in terms of reduction in AMH, but it is preferred by patients in terms of acceptability. These results could support to use of THL ovarian drilling in the treatment of patients with CC- resistant PCOS.
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Affiliation(s)
| | - Ilaria Morra
- a Department of Obstetrics , Gynecology, and Urology and
| | | | | | | | - Carmine Nappi
- b Department of Public Health , University of Naples "Federico II" , Naples , Italy
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16
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Cai J, Liu L, Sun L, Sha A, Jiang X, Ren J. Effects of previous ovarian drilling on cumulative ongoing pregnancy rates among patients with polycystic ovarian syndrome undergoing in vitro fertilization. Int J Gynaecol Obstet 2016; 134:272-7. [PMID: 27268224 DOI: 10.1016/j.ijgo.2016.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/15/2016] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine if history of undergoing laparoscopic ovarian drilling (LOD) was associated with changes in cumulative ongoing pregnancy rates following in-vitro fertilization in patients with polycystic ovary syndrome (PCOS). METHODS The present retrospective study was performed in an in vitro fertilization unit in Xiamen, China, between June 1, 2008 and December 31, 2012. Patient characteristics and in vitro fertilization treatment outcomes were compared between patients with PCOS and a history of LOD (LOD group), patients with PCOS without a history of LOD (no-LOD group), and age-matched patients without PCOS and with no history of LOD (age-matched group). RESULTS The study included 110 patients in the LOD group, 127 patients in the no-LOD group, and 990 patients in the age-matched group. A lower number of retrieved oocytes, fewer available embryos, and a lower number of cryopreserved embryos were observed in among patients in the LOD-group compared with the other groups (P≤0.001). No differences in birth rates following fresh embryo transfers were observed between the LOD-group, and the age-matched group (P=0.274) and the no-LOD group (P=0.120). A higher adjusted odds ratio of cumulative pregnancy per initiated in vitro fertilization cycle was observed in the no-LOD group when compared with the LOD group (1.976; 95% confidence interval 1.091-3.580). CONCLUSION LOD could compromise cumulative ongoing pregnancy rates during subsequent in vitro fertilization.
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Affiliation(s)
- Jiali Cai
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Lanlan Liu
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Lingbin Sun
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Aiguo Sha
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Xiaoming Jiang
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianzhi Ren
- The Affiliated ChengGong Hospital of Xiamen University, Xiamen, Fujian, China.
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Rezk M, Emarh M, Alhalaby A. Anti-Müllerian hormone and luteinizing hormone for prediction of spontaneous ovulation after laparoscopic ovarian drilling in clomiphene-resistant polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Garg D, Tal R. The role of AMH in the pathophysiology of polycystic ovarian syndrome. Reprod Biomed Online 2016; 33:15-28. [PMID: 27174394 DOI: 10.1016/j.rbmo.2016.04.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
Abstract
Polycystic ovarian syndrome (PCOS) affects 5 - 10% of reproductive age women, but its pathogenesis is still poorly understood. The aim of this review is to collate evidence and summarize our current knowledge of the role of anti-Müllerian hormone (AMH) in PCOS pathogenesis. AMH is increased and correlated with the various reproductive and metabolic/endocrine alterations in PCOS. AMH plays an inhibitory role in follicular development and recruitment, contributing to follicular arrest. AMH inhibitory action on FSH-induced aromatase production likely contributes to hyperandrogenism in PCOS, which further enhances insulin resistance in these women. Elevated serum AMH concentrations are predictive of poor response to various treatments of PCOS including weight loss, ovulation induction and laparoscopic ovarian drilling, while improvement in various clinical parameters following treatment is associated with serum AMH decline, further supporting an important role for AMH in the pathophysiology of this syndrome. This review emphasizes the need for understanding the exact mechanism of action of AMH in the pathophysiology of PCOS. This may lead to the development of new treatment modalities targeting AMH to treat PCOS, as well as help clinicians in prognostication and better tailoring existing treatments for this disease.
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Affiliation(s)
- Deepika Garg
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York
| | - Reshef Tal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
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Roman H, Bubenheim M, Auber M, Marpeau L, Puscasiu L. Antimullerian hormone level and endometrioma ablation using plasma energy. JSLS 2016; 18:JSLS-D-14-00002. [PMID: 25392649 PMCID: PMC4208885 DOI: 10.4293/jsls.2014.00002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To investigate the impact of ovarian endometrioma vaporization using plasma energy on antimullerian hormone (AMH) level. Method: We report a prospective, noncomparative series (NCT01596985). Twenty-two patients with unilateral ovarian endometriomas ≥30 mm, with no surgical antecedent and no ongoing pregnancy, underwent vaporization of ovarian endometriomas using plasma energy during the period of November 29, 2010 to November 28, 2012. We assessed AMH levels before surgery, 3 months postoperatively, and at the end of follow-up. Results: The mean length of postoperative follow-up was 18.2 ± 8 months. AMH level significantly varied through the 3 assessments performed in the study, as the mean values ± SD were 3.9 ± 2.6 ng/mL before the surgery, 2.3 ± 1.1 ng/mL at 3 months, and 3.1 ± 2.2 ng/mL at the end of the follow-up (P = .001). There was a significant increase from 3 months postoperatively to the end of follow-up (median change 0.7 ng/mL, P = .01). Seventy-one percent of patients had an AMH level >2 ng/mL at the end of the follow-up versus 76% before the surgery (P = 1). During the postoperative follow-up, 11 patients tried to conceive, of whom 8 (73%) became pregnant. Conclusions: The ablation of unilateral endometriomas is followed in a majority of cases by a significant decrease in AMH level 3 months after surgery. In subsequent months, this level progressively increases, raising questions about the real factors that impact postoperative ovarian AMH production.
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Affiliation(s)
- Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France, Research Group 4308 ≪ Spermatogenesis and Gamete Quality≫, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France
| | | | - Mathieu Auber
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France, Research Group 4308 ≪ Spermatogenesis and Gamete Quality≫, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France
| | - Loïc Marpeau
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France, Research Group 4308 ≪ Spermatogenesis and Gamete Quality≫, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France
| | - Lucian Puscasiu
- Department of Gynecology and Obstetrics, University Hospital, Targu Mures, Romania
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Dumont A, Robin G, Catteau-Jonard S, Dewailly D. Role of Anti-Müllerian Hormone in pathophysiology, diagnosis and treatment of Polycystic Ovary Syndrome: a review. Reprod Biol Endocrinol 2015; 13:137. [PMID: 26691645 PMCID: PMC4687350 DOI: 10.1186/s12958-015-0134-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/13/2015] [Indexed: 11/10/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation and hyperandrogenism in young women. Excessive ovarian production of Anti-Müllerian Hormone, secreted by growing follicles in excess, is now considered as an important feature of PCOS. The aim of this review is first to update the current knowledge about the role of AMH in the pathophysiology of PCOS. Then, this review will discuss the improvement that serum AMH assay brings in the diagnosis of PCOS. Last, this review will explain the utility of serum AMH assay in the management of infertility in women with PCOS and its utility as a marker of treatment efficiency on PCOS symptoms. It must be emphasized however that the lack of an international standard for the serum AMH assay, mainly because of technical issues, makes it difficult to define consensual thresholds, and thus impairs the widespread use of this new ovarian marker. Hopefully, this should soon improve.
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Affiliation(s)
- Agathe Dumont
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, 2 Avenue Eugène Avinée, 59037, Lille, France.
| | - Geoffroy Robin
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, 2 Avenue Eugène Avinée, 59037, Lille, France.
| | - Sophie Catteau-Jonard
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, 2 Avenue Eugène Avinée, 59037, Lille, France.
| | - Didier Dewailly
- Service de Gynécologie Endocrinienne et de Médecine de la Reproduction, Hôpital Jeanne de Flandre, CHRU, 2 Avenue Eugène Avinée, 59037, Lille, France.
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Iwase A, Nakamura T, Osuka S, Takikawa S, Goto M, Kikkawa F. Anti-Müllerian hormone as a marker of ovarian reserve: What have we learned, and what should we know? Reprod Med Biol 2015; 15:127-136. [PMID: 29259429 DOI: 10.1007/s12522-015-0227-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/06/2015] [Indexed: 01/05/2023] Open
Abstract
Ovarian reserve reflects the quality and quantity of available oocytes. This reserve has become indispensable for the better understanding of reproductive potential. Measurement of the serum anti-Müllerian hormone (AMH) level allows quantitative evaluation of ovarian reserve. It has been applied to a wide range of clinical conditions, and it is well established that the measurement of serum AMH levels is more useful than qualitative evaluation based on the menstrual cycle. AMH levels are monitored during infertility treatments; in patients undergoing medically assisted reproductive technology; and in the diagnosis of ovarian failure, polycystic ovarian syndrome, and granulosa cell tumor. It is also useful in the evaluation of iatrogenic ovarian damage. Population-based studies have indicated a potential role for serum AMH in the planning of reproductive health management. While AMH is currently the best measure of ovarian reserve, its predictive value for future live births remains controversial. Furthermore, there is a serious practical issue in the interpretation of test results, as currently available assay kits use different assay ranges and coefficients of variation due to the absence of an international reference standard. The pros and cons of the serum AMH level as a definitive measure of ovarian reserve merits further review in order to guide future research.
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Affiliation(s)
- Akira Iwase
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
- Department of Maternal and Perinatal Medicine Nagoya University Hospital 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Sachiko Takikawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine 65 Tsurumai-cho, Showa-ku 466-8550 Nagoya Japan
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Al-Rab MTG, Mohammed ABF, Hassan MM, Razek MA. Three-dimensional power Doppler indices of ovarian stromal blood flow and serum vascular endothelial growth factor after laparoscopic ovarian drilling in women with polycystic ovary syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Ozdemir O, Sari ME, Kalkan D, Koc EM, Ozdemir S, Atalay CR. Comprasion of ovarian stromal blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and healthy women with ultrasonographic evidence of polycystic. Gynecol Endocrinol 2015; 31:322-6. [PMID: 25558942 DOI: 10.3109/09513590.2014.995617] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare ovarian stromal artery blood flows measured by Doppler ultrasonography of polycystic ovary syndrome (PCOS) patients and healthy women with polycystic ovarian image in ultrasonography. METHODS Forty-two patients diagnosed with PCOS according to the criteria of 2003 Rotterdam Concencus Conferance on PCOS and 38 healthy volunteers with polycystic ovarian image in ultrasonography were included in the study. Ovarian volumes and ovarian stromal artery blood flows were measured by 3-dimensional (3-D) ultrasonography and Doppler ultrasonography in all patients. RESULTS In patients with PCOS, ovarian stromal artery pulsatility index (PI) and resistivity index (RI) were found significantly different from healthy women with polycystic ovarian image in ultrasonography (p < 0.05). 3-D ovarian volumes were found significantly higher in patients with PCOS (p < 0.05), and a negative correlation was also obtained between ovarian volumes and ovarian stromal artery resistivity indices. CONCLUSION Ovarian stromal artery Doppler examination could have an importance to explain the pathophysiology of PCOS, but there are few publications in the literature about PCOS and the details of ovarian stromal artery Doppler parameters in patients with polycystic ovarian image only. We conclude that Doppler ultrasonography findings of PCOS patients might be helpful in understanding the clinical follow-up and etiology of the disease.
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Affiliation(s)
- Ozhan Ozdemir
- Department of Obstetrics and Gynecology, Ankara Numune Education and Research Hospital , Ankara , Turkey
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Abu Hashim H. Response to: Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome; an evidence-based approach. Arch Gynecol Obstet 2015; 291:717-8. [PMID: 25638451 DOI: 10.1007/s00404-015-3637-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt,
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Seyam EM, Mohamed T, Hasan MM, Abd Al Mawgood MH. Evaluation of ultrasonographic and Anti-Müllerian Hormone (AMH) changes as predictors for ovarian reserve after laparoscopic ovarian drilling for women with polycystic ovarian syndrome. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2014. [DOI: 10.1016/j.mefs.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Hendriks ML, Konig T, Korsen T, Melgers I, Dekker J, Mijatovic V, Schats R, Hompes PGA, Homburg R, Kaaijk EM, Twisk JWR, Lambalk CB. Short-term changes in hormonal profiles after laparoscopic ovarian laser evaporation compared with diagnostic laparoscopy for PCOS. Hum Reprod 2014; 29:2544-52. [DOI: 10.1093/humrep/deu237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abu Hashim H. Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach. Arch Gynecol Obstet 2014; 291:11-8. [PMID: 25186279 DOI: 10.1007/s00404-014-3447-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic ovarian drilling (LOD) is currently recommended as a successful second-line treatment for ovulation induction in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). PURPOSE To provide a comprehensive review of the current evidence regarding different clinical, biochemical and ultrasonographic parameters that help in predicting ovulation and or pregnancy after LOD. METHODS A PubMed search of published studies on LOD and reproductive outcome was conducted using defined keywords. Abstracts of 121 articles were screened and relevant articles were identified. Clinical studies were included with priority for level I evidence, i.e., randomized controlled trials (RCTs) followed by other levels. RESULTS Based on the current evidence, LOD could be predicted to result in poor reproductive outcome in women with CC-resistant PCOS when they are obese (BMI >25 kg/m(2)), long duration of infertility >3 years, low basal LH levels <10 IU/L, marked biochemical hyperandrogenism (testosterone levels ≥4.5 nmol/L, free androgen index >15) and high basal AMH ≥7.7 ng/mL. CONCLUSION Setting eligibility criteria based on the existing evidence concerning predictors of success of LOD is critical not only for improving its outcome, but also to avoid unnecessary surgery with possible risk of impairment of ovarian reserve and other complications.
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Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt,
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Siristatidis C, Vogiatzi P, Bettocchi S, Basios G, Mastorakos G, Vrachnis N. Transvaginal ovarian trauma, poor responders and improvement of success rates in IVF: anecdotal data and a hypothesis. Med Hypotheses 2014; 83:227-31. [PMID: 24837687 DOI: 10.1016/j.mehy.2014.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/14/2014] [Indexed: 11/15/2022]
Abstract
In this report, we propose an intervention capable of improving IVF outcomes in subfertile women with poor ovarian response. This intervention derives from anecdotal data and observations in our daily practice, but most importantly from trials on experimental models and subfertile women with Polycystic Ovarian Syndrome (PCOS). Our hypothesis suggests that transvaginal induction of trauma to the ovary in the cycle preceding IVF should benefit poor ovarian responders and their lowered pregnancy rates by increasing - at least - the number of retrieved oocytes during oocyte retrieval. Up-to-the minute data show that, via this means, there is a unique response of the ovarian surface epithelium and stroma to the induced trauma. The potential pathways of this beneficial response involve an improvement of the raised gonadotrophins to act either through the mechanical reduction of the size of the ovary or through alterations of the hormonal profile by lowering LH, inhibin and local androgen concentrations through hypothalamic-pituitary axis feedbacks, the induction of increased blood flow to the ovaries, a differentiated local immune reaction and a non-elucidated as yet role of reactive oxygen species. In this report, we also describe the technique and the associated possible negative points while we try to point out the needed research steps to ensure its efficiency before it enters daily clinical practice.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece.
| | - Paraskevi Vogiatzi
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece.
| | - Stefano Bettocchi
- 1st Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University "Aldo Moro", Bari, Italy.
| | - George Basios
- Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece.
| | - George Mastorakos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece.
| | - Nikos Vrachnis
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece.
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Ortega-Hrepich C, Polyzos NP, Anckaert E, Guzman L, Tournaye H, Smitz J, De Vos M. The effect of ovarian puncture on the endocrine profile of PCOS patients who undergo IVM. Reprod Biol Endocrinol 2014; 12:18. [PMID: 24564914 PMCID: PMC3936928 DOI: 10.1186/1477-7827-12-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 02/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine whether ovarian puncture for immature oocyte retrieval and in-vitro maturation (IVM) has an effect on the endocrine profile of patients with polycystic ovary syndrome (PCOS). METHODS Twenty-two consecutive patients with PCOS undergoing IVM treatment were included. Serum anti-Müllerian hormone (AMH), sex hormone-binding globulin (SHBG), total testosterone (TT) and luteinized hormone (LH) levels were analyzed at the start of the cycle, on the day of immature oocyte retrieval (OR) and at fixed intervals thereafter, for up to three months after OR. RESULTS Five days after OR circulating AMH, TT, calculated free testosterone (FTc), and LH levels were significantly reduced and circulating SHBG was significantly increased. Two weeks after OR, TT, FTc and LH remained reduced, whereas circulating AMH and SHBG levels recovered to pre-puncture values. Three months after OR, all circulating hormone levels had recovered to baseline values. CONCLUSION Ovarian puncture for the retrieval of immature oocytes and IVM in patients with PCOS has a significant impact on the ovarian endocrine profile, but this impact is brief and transient.
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Affiliation(s)
| | - Nikolaos P Polyzos
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ellen Anckaert
- Laboratory of Clinical Chemistry and Radioimmunology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Luis Guzman
- Laboratory of Clinical Chemistry and Radioimmunology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Herman Tournaye
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Johan Smitz
- Laboratory of Clinical Chemistry and Radioimmunology, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Michel De Vos
- Centre for Reproductive Medicine, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Abuelghar WM, Bayoumy HA, Ellaithy MI, Khalil MS. Women with clomiphene citrate resistant polycystic ovarian disease: predictors of spontaneous ovulation after laparoscopic ovarian drilling. Eur J Obstet Gynecol Reprod Biol 2014; 175:178-85. [PMID: 24576485 DOI: 10.1016/j.ejogrb.2014.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/21/2013] [Accepted: 01/09/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the role of different clinical, biochemical and sonographic factors as predictors of spontaneous ovulation after laparoscopic ovarian drilling (LOD) in women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD). STUDY DESIGN This prospective study recruited 251 infertile women with CCR-PCOD. Several clinical, biochemical and sonographic criteria were tested as possible predictors of spontaneous ovulation after LOD using multivariate analysis. RESULTS Women with higher preoperative levels of LH, FSH and/or androstenedione had significantly higher rates of spontaneous ovulation within the first eight weeks after LOD, but only FSH and androstenedione were found to be independent predictors. Other factors including age, BMI, type of infertility, duration of infertility, menstrual pattern, testosterone level, ovarian volume and SHBG were insignificant predictors. Receiver-operating characteristic (ROC) curves derived from FSH, LH, androstenedione, and a logistic regression model showed that the best cut-off values were 4.1IU/l, 7.8IU/l, 1.2ng/ml, and 0.4897, respectively, with sensitivity of 91.18%, 100%, 73.53%, and 88.24% and specificity of 69.57%, 69.57%, 65.22%, and 73.91% for FSH, LH, androstenedione, and logistic regression model respectively. An extended follow up (9 months after LOD) was conducted for the anovulatory and the non-pregnant ovulatory women, who were treated individually according to their clinical situation. Of these women, 53.5% (69/129) got pregnant, resulting in a cumulative pregnancy rate of 48% (82/171). Of these pregnancies, 16/82 (19.5%) were spontaneous while 35.4% (29/82) and 45.1% (37/82) occurred after ovulation induction by CC and gonadotropins, respectively. CONCLUSION This study supports the use of androstenedione, LH and FSH as a simple reliable tool in triaging patients with CCR-PCOD to select the ideal candidates for LOD.
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Affiliation(s)
- Wessam M Abuelghar
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Hassan A Bayoumy
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Mohamed I Ellaithy
- Obstetrics and Gynecology Department, Faculty of Medicine, Ain-shams University, Cairo, Egypt.
| | - Marian S Khalil
- Obstetrics and Gynecology Department, Imbaba Hospital, Cairo, Egypt
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Pabuccu R, Pabuccu EG, Gursoy AY, Caglar GS, Yilmaz MB, Ozdegirmenci O. Improved cycle outcomes after laparoscopic ovarian diathermy in hyper-responder patients with previous ART failure. Gynecol Endocrinol 2014; 30:881-4. [PMID: 25079516 DOI: 10.3109/09513590.2014.943729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Recai Pabuccu
- a Department of Obstetrics and Gynaecology, Faculty of Medicine, Ufuk University Ankara Turkey
- b Centrum Clinic Women Health and IVF Center Ankara Turkey
| | - Emre Goksan Pabuccu
- a Department of Obstetrics and Gynaecology, Faculty of Medicine, Ufuk University Ankara Turkey
| | - Asli Yarci Gursoy
- a Department of Obstetrics and Gynaecology, Faculty of Medicine, Ufuk University Ankara Turkey
| | - Gamze Sinem Caglar
- a Department of Obstetrics and Gynaecology, Faculty of Medicine, Ufuk University Ankara Turkey
| | - Muserref Banu Yilmaz
- a Department of Obstetrics and Gynaecology, Faculty of Medicine, Ufuk University Ankara Turkey
| | - Ozlem Ozdegirmenci
- c Zekai Tahir Burak Women Healthcare, Education and Research Hospital Ankara Turkey
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Barthelmess EK, Naz RK. Polycystic ovary syndrome: current status and future perspective. Front Biosci (Elite Ed) 2014; 6:104-19. [PMID: 24389146 DOI: 10.2741/e695] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a widespread reproductive disorder that encompasses many associated health conditions and has an impact on various metabolic processes. PCOS is depicted by hyperandrogenism, polycystic ovaries, and anovulation. It increases the risk of insulin resistance (IR), type 2 diabetes, obesity, and cardiovascular disease. The etiology of the disease remains unclear, and the subjective phenotype makes a united diagnosis difficult among physicians. It seems to be a familial genetic syndrome caused by a combination of environmental and genetic factors. It can be linked with metabolic disorders in first-degree family members. PCOS is the cause of up to 30% of infertility in couples seeking treatment. Currently, there is no cure for PCOS. Despite the growing incidence of this syndrome, limited research has been done that encompasses the entirety of PCOS spectrum. In this review, the current status and possible future perspective will be discussed.
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Affiliation(s)
- Erin K Barthelmess
- Reproductive Immunology and Molecular Biology Lab, Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV 26506-9186
| | - Rajesh K Naz
- Reproductive Immunology and Molecular Biology Lab, Department of Obstetrics and Gynecology, West Virginia University School of Medicine, Health Sciences Center, Morgantown, WV 26506-9186
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Abu Hashim H, Al-Inany H, De Vos M, Tournaye H. Three decades after Gjönnaess’s laparoscopic ovarian drilling for treatment of PCOS; what do we know? An evidence-based approach. Arch Gynecol Obstet 2013; 288:409-22. [DOI: 10.1007/s00404-013-2808-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight the impact of polycystic ovary syndrome (PCOS) on menstrual function, fertility and reproductive outcomes. Women with PCOS often present with anovulation, menstrual disturbances and hyperandrogenism. Management options for the reproductive disorders of PCOS will be discussed. RECENT FINDINGS The role of metformin in treating PCOS is narrowing. New data show improved live birth rates by skipping a progestin withdrawal bleed and proceeding directly with a dose escalation of clomiphene for ovulation induction. The Pregnancy in PCOS trial II will determine the safety and efficacy of clomiphene citrate compared to letrozole, in achieving live birth in infertile women with PCOS. SUMMARY Initial treatment for reproductive disorders in overweight and obese women with PCOS is weight loss. This helps menstrual disturbances, shortens the time to conception and reduces adverse obstetric risks. Clomiphene citrate is considered the first-line therapy for ovulatory infertility. Clomiphene citrate-resistant women may be offered aromatase inhibitors or laparoscopic ovarian surgery. Metformin does not improve live birth rate or reduce miscarriage rate and is no longer considered an option for ovulation induction. Women with PCOS need to be counseled about risks of multiple gestations with gonadotropin therapy.
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Affiliation(s)
- Rebecca S Usadi
- Center for Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina, USA.
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Alcázar JL, Kudla MJ. Ovarian stromal vessels assessed by spatiotemporal image correlation-high definition flow in women with polycystic ovary syndrome: a case-control study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:470-475. [PMID: 22605534 DOI: 10.1002/uog.11187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare spatiotemporal image correlation-high definition flow (STIC-HDF) indices from spherical samples of ovary between women with polycystic ovary syndrome (PCOS) and normal women. METHODS This was a prospective case-control study of premenopausal women with a diagnosis of PCOS according to the Rotterdam criteria and of healthy, regularly menstruating, premenopausal women (controls) matched for age (< 35 years) and body mass index. Women were assessed in the follicular phase of the menstrual cycle by 4D STIC-HDF transvaginal ultrasound. Based on 1-cm(3) spherical sampling, we calculated for each woman the vascularization index (VI) for the most vascularized part of the ovarian stroma in all three-dimensional volumes of the 4D STIC-HDF sequence. The maximum (VI(sys)) and minimum (VI(diast)) values were assumed to represent systole and diastole, respectively, and the mean VI for all frames from one cardiac cycle was calculated. Based on these three VI values, we calculated the following indices: volumetric systolic/diastolic ratio (vS/D), volumetric resistance index (vRI) and volumetric pulsatility index (vPI), and compared them between study and control groups. RESULTS The study included 32 PCOS women (mean age, 29.6 years) and 32 controls (mean age, 30.4 years). Mean VI(sys) (26.246% vs 8.136%, P < 0.0001) and mean VI(diast) (22.242% vs 5.997%, P < 0.0001) were significantly higher in PCOS women compared with controls. Median vS/D (1.15 vs 1.33, P < 0.001), mean vRI (0.17 vs 0.30, P < 0.001) and median vPI (0.14 vs 0.28, P < 0.001) were significantly lower in PCOS women compared with controls. CONCLUSION 4D STIC-HDF indices from 1-cm(3) spherical samples of the ovaries were different between PCOS women and controls, suggesting lower impedance to flow in ovarian stromal vessels in PCOS women.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, University of Navarra, Pamplona, Spain.
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Wu MH, Cheng YC, Chang CH, Ko HC, Chang FM. Three-dimensional Ultrasound in Evaluation of the Ovary. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Farzadi L, Nouri M, Ghojazadeh M, Mohiti M, Aghadavod E. Evaluation of ovarian reserve after laparoscopic surgery in patients with polycystic ovary syndrome. BIOIMPACTS : BI 2012; 2:167-70. [PMID: 23678455 DOI: 10.5681/bi.2012.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/19/2012] [Accepted: 06/21/2012] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ovarian reserve depends on the size and quality of oocytes stored in ovary. Aging and some diseases reduce ovarian reserve, leading to decreased reproductive performance. Laparoscopic surgery is used to treat infertility in women with PCOS. The purpose of this study was measurement of ovarian reserve in patients with PCOS before and after laparoscopic surgery. METHODS In this study thirty infertile patients with PCOS that had not responded to initial treatment with drug were selected. We assessed the serum levels of anti-mullerian hormone, testosterone, luteinizing hormone (LH), and the number of antral follicles before laparoscopic surgery and 1 week, 3 and 6 months after the surgery. RESULTS The average amount of anti-mullerian hormone serum levels was 8.4±4.7 before laparoscopic surgery and 7.5±4.5, 7±4.5, and 7.7±4.4 ng/ml one week, 3 and 6 months after surgery, respectively. Serum levels of LH was 13.6±6.7 and 12.7±11.1 IU /ml (P=0.87) before surgery and 6 months after laparoscopy, respectively. Mean serum testosterone levels were 0.9±0.8, 0.8±0.9 ng/ml (P=0.86) before and after surgery. Annual reproductive rate was 26.7 percent in this population. CONCLUSION Laparoscopic ovarian puncture didn't change anti-mullerian hormone serum, testosterone and LH in women with PCOS and hence has no adverse effects on the ovarian reserve.
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Affiliation(s)
- Laya Farzadi
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Cheong YC, Metwally M, Shreeve N, Sadek K, Farquhar C. Ovarian surgery for symptom relief in women with polycystic ovary syndrome. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ying C Cheong
- University of Southampton; Obstetrics and Gynaecology; Level F, Princess Anne Hospital Coxford Road Southampton UK SO16 5YA
| | | | - Norman Shreeve
- Southampton University; School of Medicine; Highfield Southampton UK SO16 5YA
| | - Khaled Sadek
- Division of Developmental Origins of Adult Diseases (DOHaD) Level F, Princess Anne Hospital; Princess Anne Hospital; Coxford Road Southampton UK S016 5YA
| | - Cindy Farquhar
- University of Auckland; Obstetrics and Gynaecology; FMHS Park Road Grafton Auckland New Zealand 1003
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