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Laparoscopic Ovarian Drilling

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Reproductive Surgery in Assisted Conception

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Abstract

Laparoscopic ovarian drilling has been widely accepted as the second line of choice for induction of ovulation in CC-resistant PCOS women in preference to gonadotrophin therapy. In addition to its proven efficacy, LOD offers several advantages over gonadotrophins such as avoiding multiple pregnancies and OHSS. Using a monopolar needle applied at right angle to the antimesentric surface of the ovary with penetration of the ovary to a depth of 7–8 mm at four points with a power setting of 30 W for 5 s per puncture seems to be an optimum approach that maximises effectiveness and safety. PCOS women could expect 50–60 % pregnancy rates during 12 months following LOD. The role of LOD before ART remains to be adequately investigated. In addition to the short term benefits of LOD, about one third women undergoing this surgery will continue to benefit for several years.

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References

  1. Michelmore KF, Balen AH, Dunger DB, Vessey MP. Polycystic ovaries and associated clinical and biochemical features in young women. Clin Endocrinol (Oxf). 1999;51:779–86.

    Article  CAS  Google Scholar 

  2. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, et al. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab. 1999;84:4006–11.

    Article  CAS  PubMed  Google Scholar 

  3. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000;85:2434–8.

    CAS  PubMed  Google Scholar 

  4. Hull MG. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol. 1987;1:235–45.

    Article  CAS  PubMed  Google Scholar 

  5. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41–7.

    Article  Google Scholar 

  6. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25:544–51.

    Article  PubMed  Google Scholar 

  7. Yildiz BO, Bozdag G, Yapici Z, Esinler I, Yarali H. Prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome under different diagnostic criteria. Hum Reprod. 2012;27:3067–73.

    Article  PubMed  Google Scholar 

  8. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008;23:462–77.

    Article  Google Scholar 

  9. Stein IF, Leventhal ML. Amenorrhoea associated with bilateral polycystic ovaries. Am J Obstet Gynaecol. 1935;29:181–91.

    Google Scholar 

  10. Greenblatt RB. Chemical induction of ovulation. Fertil Steril. 1961;12:402–4.

    CAS  PubMed  Google Scholar 

  11. Buttram VC, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril. 1975;26:874–6.

    PubMed  Google Scholar 

  12. Palmer R, de Brux J. Résulats histologiques, biochemiques et therapeutiques obtenus ches les femmes don’t les ovaries avaient été diagnostiqués Stein-Leventhal à la coelioscpie. Bull Fed Soc Gynecol Obstet Lang Fr. 1967;19:405–12.

    CAS  PubMed  Google Scholar 

  13. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril. 1984;41:20–5.

    CAS  PubMed  Google Scholar 

  14. Armar NA, McGarrigle HHG, Honour J, et al. Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome. Fertil Steril. 1990;53:45–9.

    CAS  PubMed  Google Scholar 

  15. Huber J, Hosmann J, Spona J. Polycystic ovarian syndrome treated by laser through the laparoscope [letter]. Lancet. 1988;2:215.

    Article  CAS  PubMed  Google Scholar 

  16. Moll E, Bossuyt PM, Korevaar JC, Lambalk CB, van der Veen F. Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial. BMJ. 2006;24:1485.

    Article  Google Scholar 

  17. Legro RS, Barnhart HX, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Engl J Med. 2007;356:551–66.

    Article  CAS  PubMed  Google Scholar 

  18. Bayram N, van Wely M, Kaaijk EM, Bossuyt PM, van der Veen F. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ. 2004;328:192.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Farquhar C, Brown J, Marjoribanks J. Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2012;13(6):CD001122.

    Google Scholar 

  20. Farquhar CM. An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate-resistant polycystic ovarian syndrome. Curr Opin Obstet Gynecol. 2005;17:347–53.

    Article  PubMed  Google Scholar 

  21. Nahuis MJ, Oude Lohuis E, Kose N, Bayram N, Hompes P, Oosterhuis GJ, Kaaijk EM, Cohlen BJ, Bossuyt PP, van der Veen F, Mol BW, van Wely M. Long-term follow-up of laparoscopic electrocautery of the ovaries versus ovulation induction with recombinant FSH in clomiphene citrate-resistant women with polycystic ovary syndrome: an economic evaluation. Hum Reprod. 2012;27:3577–82.

    Article  CAS  PubMed  Google Scholar 

  22. Amer S, Li TC, Emarh M, Metwally M, Ledger WL. Randomized controlled trial comparing laparoscopic ovarian diathermy with clomifene citrate as a first line method of ovulation induction in women with polycystic ovarian syndrome. Hum Reprod. 2009;24:219–25.

    Article  CAS  PubMed  Google Scholar 

  23. Weise HC, Naether O, Fischer R, Berger-Bispink S, Delfs T. Behand-lungebnisse mit der oberflachenkuater-isierung polyzystischer ovarian bei Sterilitatspatientinnen. Geburtshilfe Frauenheilkd. 1991;51:920–4.

    Article  CAS  PubMed  Google Scholar 

  24. Naether OGJ, Fischer R, Weise HC, Geiger-Kotzler L, Delfs T, Rudolf K. Laparoscopic electrocoagulation of the ovarian surface in infertile patients with polycystic ovarian disease. Fertil Steril. 1993;60:88–94.

    CAS  PubMed  Google Scholar 

  25. Amer SA, Li TC, Cooke ID. Laparoscopic ovarian diathermy in women with polycystic ovarian syndrome: a retrospective study on the influence of the amount of energy used on the outcome. Hum Reprod. 2002;17:1046–51.

    Article  CAS  PubMed  Google Scholar 

  26. Amer S, Li TC, Cooke ID. A prospective dose finding study of the amount of energy required for laparoscopic ovarian diathermy in women with polycystic ovarian syndrome. Hum Reprod. 2003;18:1693–8.

    Article  CAS  PubMed  Google Scholar 

  27. Felemban A, Tan SL, Tulandi T. Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril. 2000;73(2):266–9.

    Article  CAS  PubMed  Google Scholar 

  28. Greenblatt E, Casper RF. Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome. Am J Obstet Gynaecol. 1987;156:279–85.

    Article  CAS  Google Scholar 

  29. Lemieux S, Lewis GF, Ben-Chetrit A, Steiner G, Greenblatt EM. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovarian syndrome is not accompanied by improved insulin sensitivity or lipid-lipoprotein levels. J Clin Endocrinol Metab. 1999;84:4278–82.

    CAS  PubMed  Google Scholar 

  30. Pelosi MA, Pelosi MA. Laparoscopic electrosurgical furrowing technique for the treatment of polycystic ovaries. J Am Assoc Gynaecol Laparosc. 1996;4:57–62.

    Article  CAS  Google Scholar 

  31. Merchant RN. Treatment of polycystic ovary disease with laparoscopic low-watt bipolar electrocoagulation of the ovaries. J Am Assoc Gynaecol Laparosc. 1996;3:503–8.

    Article  CAS  Google Scholar 

  32. Gurgan T, Kisnisci H, Yarali H, Develioglu O, Zeyneloglu H, Aksu T. Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease. Fertil Steril. 1991;56:1176–8.

    CAS  PubMed  Google Scholar 

  33. Keckstein G, Rossmanith W, Spatzier K, Schneider V, Borchers K, Steiner R. The effect of laparoscopic treatment of polycystic ovarian disease by CO2− laser or Nd:YAG laser. Surg Endosc. 1990;4:103–7.

    Article  CAS  PubMed  Google Scholar 

  34. Keckstein J. Laparoscopic treatment of polycystic ovarian syndrome. Baillieres Clin Obstet Gynaecol. 1989;3:563–81.

    Article  CAS  PubMed  Google Scholar 

  35. Kojima E, Yanagibori A, Otaka K, Hirakawa S. Ovarian wedge resection with contact Nd:YAG laser irradiation used laparoscopically. J Reprod Med. 1989;34:444–6.

    CAS  PubMed  Google Scholar 

  36. Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID. Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynaecol. 1998;105:338–44.

    Article  CAS  PubMed  Google Scholar 

  37. Naether OGJ, Baukloh V, Fischer R, Kowalczyk T. Long-term follow-up in 206 infertility patients with polycystic ovarian syndrome after laparoscopic electrocautery of the ovarian surface. Hum Reprod. 1994;9:2342–9.

    CAS  PubMed  Google Scholar 

  38. Mio Y, Toda T, Tanikawa M, Terado H, Harada T, Terakawa N. Transvaginal ultrasound-guided follicular aspiration in the management of anovulatory infertility associated with polycystic ovaries. Fertil Steril. 1991;56:1060–5.

    CAS  PubMed  Google Scholar 

  39. Syritsa A. Transvaginal ultrasound-guided electrocautery of the ovaries in infertile patients with polycystic ovarian disease. Int J Gynaecol Obstet. 1998;63:293–4.

    Article  CAS  PubMed  Google Scholar 

  40. Zhu W, Li X, Chen X, Lin Z, Zhang L. Ovarian interstitial YAG-laser: an effective new method to manage anovulation in women with polycystic ovary syndrome. Am J Obstet Gynecol. 2006;195:458–63.

    Article  PubMed  Google Scholar 

  41. Fernandez H, Watrelot A, Alby JD, et al. Fertility after ovarian drilling by transvaginal fertiloscopy for treatment of polycystic ovary syndrome. J Am Assoc Gynecol Laparosc. 2004;11:374–8.

    Article  PubMed  Google Scholar 

  42. Ramzy AM, Al-Inany H, Aboulfoutouh I, Sataar M, Idrees OA, Shehata MH. Ultrasonographic guided ovarian stroma hydrocoagulation for ovarian stimulation in polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2001;80:1046–50.

    Article  CAS  PubMed  Google Scholar 

  43. Chiesa-Montadou S, Rongieres C, Garbin O, Nisand I. About two complications of ovarian drilling by fertiloscopy. Gynecol Obstet Fertil. 2003;31:844–6.

    Article  CAS  PubMed  Google Scholar 

  44. Kovacs G, Buckler H, Bangah M, et al. Treatment of anovulation due to polycystic ovarian syndrome by laparoscopic ovarian electrocautery. Br J Obstet Gynaecol. 1991;98:30–5.

    Article  CAS  PubMed  Google Scholar 

  45. Liguori G, Tolino A, Moccia G, Scognamiglio G, Nappi C. Laparoscopic ovarian treatment in infertile patients with polycystic ovarian syndrome (PCOS): endocrine changes and clinical outcome. Gynaecol Endocrin. 1996;10:257–64.

    Article  CAS  Google Scholar 

  46. Aakvaag A, Gjonnaess H. Hormonal response to electrocautery of the ovary in patients with polycystic ovarian disease. Br J Obstet Gynaecol. 1985;92:1258–64.

    Article  CAS  PubMed  Google Scholar 

  47. Gjonnaess H, Norman N. Endocrine effects of the ovarian electrocautery in patients with polycystic ovarian disease. Br J Obstet Gynaecol. 1987;94:779–83.

    Article  CAS  PubMed  Google Scholar 

  48. Abdel-Gadir A, Mowafi RS, Alnaser HMI, Alrashid AH, Alonezi OM, Shaw RW. Ovarian electrocautery versus human gonadotrophins and pure follicle stimulating hormone therapy in the treatment of patients with polycystic ovarian disease. Clin Endocrinol (Oxf). 1990;33:585–92.

    Article  CAS  Google Scholar 

  49. Amer S, Laird S, Ledger WL, Li TC. Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovarian syndrome. Hum Reprod. 2007;22:389–94.

    Article  CAS  PubMed  Google Scholar 

  50. Gjonnaess H. Late endocrine effects of ovarian electrocautery in of women with polycystic ovary syndrome. Fertil Steril. 1998;69:697–701.

    Article  CAS  PubMed  Google Scholar 

  51. Elting MW, Korsen TJM, Rekers-Mombarg LTM, Schoemaker J. Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Hum Reprod. 2000;15:24–8.

    Article  CAS  PubMed  Google Scholar 

  52. Amer S, Li TC, Banu Z, Cooke ID. Long term follow up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes. Hum Reprod. 2002;17:2851–7.

    Article  CAS  PubMed  Google Scholar 

  53. Amer S, Li TC, Gopalan V, Ledger WL, Cooke ID. Long term follow up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod. 2002;17:2035–42.

    Article  CAS  PubMed  Google Scholar 

  54. Fukaya T, Murakami T, Tamura M, Watanabe T, Terada Y, Yajima A. Laser vaporization of the ovarian surface in polycystic ovary disease results in reduced ovarian hyperstimulation and improved pregnancy rates. Am J Obstet Gynecol. 1995;173:119–25.

    Article  CAS  PubMed  Google Scholar 

  55. Colacurci N, Zullo F, De Franciscis P, Mollo A, De Placido G. In vitro fertilization following laparoscopic ovarian diathermy in patients with polycystic ovarian syndrome. Acta Obstet Gynecol Scand. 1997;76:555–8.

    Article  CAS  PubMed  Google Scholar 

  56. Tozer AJ, Al-Shawaf T, Zosmer A, Hussain S, Wilson C, Lower AM, Grudzinskas JG. laparoscopic ovarian diathermy affect the outcome of IVF embryo transfer in women with polycystic ovarian syndrome? A retrospective comparative study. Hum Reprod. 2001;16:91–5.

    Article  CAS  PubMed  Google Scholar 

  57. Rimington MR, Walker SM, Shaw RW. The use of laparoscopic ovarian electrocautery in preventing cancellation of in vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum Reprod. 1997;12:1443–7.

    Article  CAS  PubMed  Google Scholar 

  58. Amin AF, Abdel-Aal DE, Darwish AM, Mbeki AR. Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stoma blood flow, serum vascular endothelial growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome. Fertil Steril. 2003;79:938–42.

    Article  PubMed  Google Scholar 

  59. Parsanezhad ME, Bagheri MH, Alborzi S, Schmidt EH. Ovarian stromal blood flow changes after laparoscopic ovarian cauterization in women with polycystic ovary syndrome. Hum Reprod. 2003;18:1432–7.

    Article  PubMed  Google Scholar 

  60. El Behery MM, Diab AE, Mowafy H, Ebrahiem MA, Shehata AE. Effect of laparoscopic ovarian drilling on vascular endothelial growth factor and ovarian stromal blood flow using 3-dimensional power Doppler. Int J Gynaecol Obstet. 2011;112:119–21.

    Article  PubMed  Google Scholar 

  61. Rossmanith WG, Keckstein J, Spatzier K, Lauritzen C. The impact of ovarian laser surgery on the gonadotrophin secretion in women with polycystic ovarian disease. Clin Endocrinol (Oxf). 1991;34:223–30.

    Article  CAS  Google Scholar 

  62. Amer S, Li TC, Ledger WL. Ovulation induction using laparoscopic ovarian drilling in women with polycystic ovarian syndrome: predictors of success. Hum Reprod. 2004;19:1719–24.

    Article  CAS  PubMed  Google Scholar 

  63. Amer S, Li TC, Ledger WL. The value of measuring anti-Müllerian hormone in women with anovulatory polycystic ovary syndrome undergoing laparoscopic ovarian diathermy. Hum Reprod. 2009;24:2760–6.

    Article  CAS  PubMed  Google Scholar 

  64. Greenblatt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril. 1993;60:766–70.

    CAS  PubMed  Google Scholar 

  65. Naether OGJ. Significant reduction of adnexal adhesions following laparoscopic electrocautery of the ovarian surface (LEOS) by lavage and artificial ascites. Gynaecol Endosc. 1995;4:17–9.

    Google Scholar 

  66. Saravelos H, Li TC. Post-operative adhesions after laparoscopic electrosurgical treatment for polycystic ovarian syndrome with the application of Interceed to one ovary: a prospective randomized controlled study. Hum Reprod. 1996;11:992–7.

    Article  CAS  PubMed  Google Scholar 

  67. Amer S, Li TC, Cooke ID. Repeated laparoscopic ovarian diathermy is effective in women with anovulatory infertility due to polycystic ovarian syndrome. Fertil Steril. 2003;79:1211–5.

    Article  PubMed  Google Scholar 

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  1. Department of Gynaecology, Nottingham University, The Medical School, Royal Derby Hospital, Derby, UK

    Saad A. K. Amer FRCOG, MSc, MD

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  1. Saad A. K. Amer FRCOG, MSc, MD
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Correspondence to Saad A. K. Amer FRCOG, MSc, MD .

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  1. Reproductive Medicine and Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom

    Mostafa Metwally

  2. Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong, China

    Tin-Chiu Li

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Amer, S.A.K. (2015). Laparoscopic Ovarian Drilling. In: Metwally, M., Li, TC. (eds) Reproductive Surgery in Assisted Conception. Springer, London. https://doi.org/10.1007/978-1-4471-4953-8_6

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  • DOI: https://doi.org/10.1007/978-1-4471-4953-8_6

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