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Unilateral or bilateral laparoscopic ovarian drilling in polycystic ovary syndrome: a meta-analysis of randomized trials

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Abstract

Purpose

This systematic review and meta-analysis aimed to compare the effectiveness of unilateral vs. bilateral laparoscopic ovarian drilling (ULOD vs. BLOD) for improving fertility outcomes in infertile women with clomiphene-resistant polycystic ovary syndrome (PCOS) as well as its effect on ovarian reserve.

Methods

Searches were conducted on PubMed, ScienceDirect, ClinicalTrials.gov, and CENTRAL databases from January 1984 to January 2017. Only randomized trials comparing ULOD with BLOD were included. The PRISMA Statement was followed. Main outcomes were ovulation and clinical pregnancy rates per woman randomized. Secondary outcomes were; live birth and miscarriage rates as well as postoperative serum anti-mullerian hormone (AMH) concentration and antral follicle count (AFC). Quality assessment was performed by the Cochrane Collaboration risk of bias tool.

Results

Eight eligible trials (484 women) were analyzed. No significant difference was found in rates of ovulation (OR 0.73; 95% CI 0.47–1.11), clinical pregnancy (OR 0.56; 95% CI 0.22–1.41), live birth (OR 0.77; 95% CI 0.28–2.10), or miscarriage (OR 0.90; 95% CI 0.33–2.84) when ULOD was compared with BLOD. The reduction in AMH was comparable between the two procedures (MD 0.64 ng/ml; 95% CI − 0.08 to 1.36). A significantly higher AFC at 6-month follow-up was found with dose-adjusted ULOD (MD 2.20; 95% CI 1.01–3.39).

Conclusions

After carefully weighing up the well-known benefits of BLOD against a potential risk to ovarian reserve, clinicians could be advised to offer the fixed-dose ULOD to their infertile patients with clomiphene-resistant PCOS. This is concordant with the “primum non nocere” principal if LOD will be envisaged.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Hatem Abu Hashim

  2. Endocrinology Unit, Department of Internal Medicine, Mansoura University, Mansoura, Egypt

    Osama Foda

  3. Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Mohamed El Rakhawy

Authors
  1. Hatem Abu Hashim
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  2. Osama Foda
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  3. Mohamed El Rakhawy
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Contributions

All authors contributed to the development of the manuscript and all authors consented to its submission and publication. Specific contributions are as follows; HAH: design and institution of the study protocol, collection, and analysis of data, drafting, review, and final preparation of the article, and approval of the final version. OF: design and institution of the study protocol, collection and analysis of data, drafting, review and final preparation of the article, and approval of the final version. MELR: institution of the study protocol, analysis of data, review, and approval of the final version.

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Correspondence to Hatem Abu Hashim.

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Abu Hashim, H., Foda, O. & El Rakhawy, M. Unilateral or bilateral laparoscopic ovarian drilling in polycystic ovary syndrome: a meta-analysis of randomized trials. Arch Gynecol Obstet 297, 859–870 (2018). https://doi.org/10.1007/s00404-018-4680-1

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