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/m2), 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.
Similar content being viewed by others
References
Overbeek A, Lambalk CB (2009) Phenotypic and pharmacogenetic aspects of ovulation induction in WHO II anovulatory women. Gynecol Endocrinol 25:222–234. doi:10.1080/09513590802571118
Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H (2012) Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod 27:3067–3073. doi:10.1093/humrep/des232
Fox R, Ryan A (2002) Polycystic ovary syndrome: not ovarian, not simple, unkind. Hum Fertil (Camb) 5(1 Suppl):S28–S32. doi:10.1080/1464727022000199881
Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81:19–25. doi:10.1016/j.fertnstert.2003.10.004
Thessaloniki ESHRE/ASRM-sponsored PCOS consensus workshop group (2008) Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril 89:505–522. doi:10.1016/j.fertnstert.2007.09.041
The Amsterdam ESHRE/ASRM-sponsored 3rd PCOS consensus workshop group (2012) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). Fertil Steril 97:28–38. doi:10.1016/j.fertnstert.2011.09.024
Stein IF, Leventhal ML (1935) Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 29:181–191
Abu Hashim H, Al-Inany H, De Vos M, Tournaye H (2013) Three decades after Gjönnaess’s laparoscopic ovarian drilling for treatment of PCOS; what do we know? An evidence-based approach. Arch Gynecol Obstet 288:409–422. doi:10.1007/s00404-013-2808-x
Farquhar C, Brown J, Marjoribanks J (2012) Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 6:CD001122. doi:10.1002/14651858.CD001122.pub4
Felemban A, Lin Tan S, Tulandi T (2000) Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril 73:266–269. doi:10.1016/S0015-0282(99)00534-8
Mercorio F, Mercorio A, Di Spiezio Sardo A, Barba GV, Pellicano M, Nappi C (2008) Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Fertil Steril 89:1229–1233. doi:10.1016/j.fertnstert.2007.05.009
Lockwood GM, Muttukrishna S, Groome NP, Matthews DR, Ledger WL (1998) Mid-follicular phase pulses of inhibin B are absent in polycystic ovarian syndrome and are initiated by successful laparoscopic ovarian diathermy: a possible mechanism regulating emergence of the dominant follicle. J Clin Endocrinol Metab 83:1730–1735. doi:10.1210/jc.83.5.1730
Seow KM, Juan CC, Hwang JL, Ho LT (2008) Laparoscopic surgery in polycystic ovary syndrome: reproductive and metabolic effects. Semin Reprod Med 26:101–110. doi:10.1055/s-2007-992930
Seow KM, Juan CC, Hsu YP, Hwang JL, Huang LW, Ho LT (2007) Amelioration of insulin resistance in women with PCOS via reduced insulin receptor substrate-1 Ser312 phosphorylation following laparoscopic ovarian electrocautery. Hum Reprod 22:1003–1010. doi:10.1093/humrep/del466
Bayram N, van Wely M, Kaaijk EM, Bossuyt PM, van der Veen F (2004) Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ 328:192. doi:10.1136/bmj.328.7433.192
Al-Azemi M, Omu FE, Omu AE (2004) The effect of obesity on the outcome of infertility management in women with polycystic ovary syndrome. Arch Gynecol Obstet 270:205–210. doi:10.1007/s00404-003-0537-2
Pasquali R, Gambineri A, Pagotto U (2006) The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 113:1148–1159. doi:10.1111/j.1471-0528.2006.00990.x
Baghdadi LR, Abu Hashim H, Amer SAK et al (2012) Impact of obesity on reproductive outcomes after ovarian ablative therapy in PCOS: a collaborative meta-analysis. Reprod BioMed Online 25:227–241. doi:10.1016/j.rbmo.2012.05.010
Shaw ND, Histed SN, Srouji SS, Yang J, Lee H, Hall JE (2010) Estrogen negative feedback on gonadotropin secretion: evidence for a direct pituitary effect in women. J Clin Endocrinol Metab 95:1955–1961. doi:10.1210/jc.2009-2108
National collaborating centre for women’s and children’s health/national institute for clinical excellence (2013) Fertility: assessment and treatment for people with fertility problems. Clinical guideline no. 156, RCOG Press, London. http://www.nice.org.uk/nicemedia/live/14078/62769/62769.pdf
Ott J, Wirth S, Nouri K et al (2009) Luteinizing hormone and androstenedione are independent predictors of ovulation after laparoscopic ovarian drilling: a retrospective cohort study. Reprod Biol Endocrinol 7:153. doi:10.1186/1477-7827-7-153
Abdel Gadir A, Khatim MS, Alnaser HM, Mowafi RS, Shaw RW (1993) Ovarian electrocautery: responders versus non-responders. Gynecol Endocrinol 7:43–48
Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID (1998) Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynaecol 105:338–344. doi:10.1111/j.1471-0528.1998.tb10097.x
Kriplani A, Manchanda R, Agarwal N, Nayar B (2001) Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome. J Am Assoc Gynecol Laparosc 8:511–518
van Wely M, Bayram N, van der Veen F, Bossuyt PM (2005) Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate resistant polycystic ovary syndrome. Hum Reprod 20:900–905. doi:10.1093/humrep/deh712
Amer SA, Li TC, Ledger WL (2004) Ovulation induction using laparoscopic ovarian drilling in women with polycystic ovarian syndrome: predictors of success. Hum Reprod 19:1719–1724. doi:10.1093/humrep/deh343
Kato M, Kikuchi I, Shimaniki H et al (2007) Efficacy of laparoscopic ovarian drilling for polycystic ovary syndrome resistant to clomiphene citrate. J Obstet Gynaecol Res 33:174–180. doi:10.1111/j.1447-0756.2007.00504.x
Rice S, Pellatt L, Ramanathan K, Whitehead SA, Mason HD (2009) Metformin inhibits aromatase via an extracellular signal-regulated kinase-mediated pathway. Endocrinology 150:4794–4801. doi:10.1210/en.2009-0540
Ott J, Mayerhofer K, Nouri K, Walch K, Seemann R, Kurz C (2014) Perioperative androstenedione kinetics in women undergoing laparoscopic ovarian drilling: a prospective study. Endocrine. doi:10.1007/s12020-014-0267-1
Alborzi S, Khodaee R, Parsanejad ME (2001) Ovarian size and response to laparoscopic ovarian electro-cauterization in polycystic ovarian disease. Int J Gynaecol Obstet 74:269–274. doi:10.1016/S0020-7292(01)00454-4
Apridonidze T, Essah PA, Iuorno MJ, Nestler JE (2005) Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab 90:1929–1935. doi:10.1210/jc.2004-1045
Moran LJ, Misso ML, Wild RA, Norman RJ (2010) Impaired glucose tolerance, type 2 diabetes and metabolic syndrome: a systematic review and meta-analysis. Hum Reprod Update 16:347–363. doi:10.1093/humupd/dmq001
NCEP expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285:2486–2497. doi:10.1001/jama.285.19.2486
Alberti KG, Zimmet P, Shaw J (2006) Metabolic syndrome—a new world wide definition. A consensus statement from the international diabetes federation. Diabet Med 23:469–480. doi:10.1111/j.1464-5491.2006.01858.x
Kong GW, Cheung LP, Lok IH (2011) Effects of laparoscopic ovarian drilling in treating infertile anovulatory polycystic ovarian syndrome patients with and without metabolic syndrome. Hong Kong Med J 17:5–10
Weenen C, Laven JS, Von Bergh AR et al (2004) Anti-Mullerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod 10:77–83. doi:10.1093/molehr/gah015
Visser JA, de Jong FH, Laven JSE, Themmen APN (2006) Anti-Mullerian hormone: a new marker for ovarian function. Reproduction 131:1–9. doi:10.1530/rep.1.00529
Laven JS, Mulders AG, Visser JA, Themmen APN, De Jong FH, Fauser BC (2004) Anti-Mullerian hormone serum concentrations in normoovulatory and anovulatory women of reproductive age. J Clin Endocrinol Metab 89:318–323. doi:10.1210/jc.2003-030932
Pigny P, Merlen E, Robert Y et al (2003) Elevated serum level of anti-Mullerian hormone in patients with polycystic ovary syndrome: relationship to the ovarian follicle excess and to the follicular arrest. J Clin Endocrinol Metab 88:5957–5962. doi:10.1210/jc.2003-030727
Pellatt L, Hanna L, Brincat M et al (2007) Granulosa cell production of anti-Müllerian hormone is increased in polycystic ovaries. J Clin Endocrinol Metab 92:240–245. doi:10.1210/jc.2006-1582
Durlinger AL, Kramer P, Karels B et al (1999) Control of primordial follicle recruitment by anti-Mullerian hormone in the mouse ovary. Endocrinology 140:5789–5796. doi:10.1210/endo.140.12.7204
Durlinger AL, Gruijters MJ, Kramer P et al (2001) Anti-Mullerian hormone attenuates the effects of FSH on follicle development in the mouse ovary. Endocrinology 142:4891–4899. doi:10.1210/endo.142.11.8486
Amer SA, Li TC, Ledger WL (2009) The value of measuring anti-Mullerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy. Hum Reprod 24:2760–2766. doi:10.1093/humrep/dep271
Elmashad AI (2011) Impact of laparoscopic ovarian drilling on anti-Müllerian hormone levels and ovarian stromal blood flow using three-dimensional power Doppler in women with anovulatory polycystic ovary syndrome. Fertil Steril 95:2342–2346. doi:10.1016/j.fertnstert.2011.03.093
Conflict of interest
No conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abu Hashim, H. Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach. Arch Gynecol Obstet 291, 11–18 (2015). https://doi.org/10.1007/s00404-014-3447-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3447-6