Does laparoscopic ovarian diathermy change clomiphene-resistant PCOS into clomiphene-sensitive?
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To test the role of laparoscopic ovarian diathermy (LOD) in improving the ovarian response to clomiphene citrate (CC) in clomiphene-resistant polycystic ovary syndrome (PCOS) patients.
The study comprised of 234 CC-resistant PCOS women who were treated with LOD. Eighty-four patients that remained anovulatory after LOD received 100–150 mg CC for 5 days starting from day 3 of induced menstruation for 1–3 cycles. Outcome measures were; ovulation, pregnancy, miscarriage and live birth rates.
Ovulation occurred in 80/162 cycles (49.4%) and in 30/84 patients (35.7%). Pregnancy occurred in 13/84 patients (15.5%) and in 13/80 cycles (16.2%). Miscarriage and live birth rates were 23.1 and 76.9%, respectively. Ovulatory women showed significantly lower baseline BMI (P < 0.001), Ferriman–Gallwey score (P = 0.02), testosterone (P = 0.03), higher sex hormone binding globulin and lower free androgen index (P < 0.001) compared with anovulatory women. The baseline fasting insulin was statistically significantly lower and fasting glucose:insulin ratio was statistically significantly higher (P = 0.003, 0.002) in ovulatory compared with anovulatory patients.
LOD improves the ovarian response to CC in at least one-third of CC-resistant patients who remained anovulatory following LOD especially in women who are less hyperandrogenic and less insulin resistant.
KeywordsPolycystic ovary syndrome Clomiphene resistance Laparoscopic ovarian diathermy
The authors would like to thank Dr. M. El Rakhawy MD, senior lecturer and consultant of Diagnostic Radiology, Mansoura, Faculty of Medicine, Mansoura University Hospitals, for his invaluable effort doing transvaginal ultrasound assessment and follow-up of patients enabling completion of this trial report.
Conflict of interest
We declare that we have no conflict of interest.
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