Predictors of Treatment Failure after Laparoscopic Electrocautery of the Ovaries in Women with Clomiphene Citrate Resistant Polycystic Ovarian Syndrome

Document Type : Original Article

Authors

Abstract

Introduction: Laparoscopic ovarian electrocautery is well established treatment in the
women with clomiphen- resistant polycystic ovary syndrome (PCOS). With regard of
its potential risks, performing of laparoscopic electrocautery may not be acceptable in
women at high risk of persistant anovulation after electrocautery. The aim of this study
was evaluation of predictors of treatment failure after laparoscopic electrocautery of the
ovaries in clomiphene –resistant PCOS women.
Methods and Material: This is a cross sectional and prospective study performed
between March 2004 and March 2006 in Al-Zahra Hospital of Rasht. Ninety three
women who did not ovulate on clomiphen with maximum dose of 150mg/d for 5 days
were treated with laparoscopic electrocautery of ovaries. Of ninety-three women who
were treated with laparoscopy, 6 women had concomitant tubal disease on laparoscopy
& nine women did not complete the study according to protocol and dropped out and
seventy-eight patients were studied. Studied variables before laparoscopy were age,
menarche, type of infertility, duration of infertility, body mass index, ovarian volume,
and levels of LH/FSH, Testosterone and DHEAS. After laparoscopic
electrocauterization the patients underwent induction of ovulation with clomiphen
citrate with maximum does of 150 mg /d for five days, and were evaluated for ovulation
and subsequent ongoing pregnancy. To evaluate the predictors of ovulation and
pregnancy failure, data were analyzed using SPSS, descriptive statistic & logistic
regression analysis; p≤0.05 considered statistically significant.
Results: Of seventy –eight women treated with laparoscopic electrocautery of the
ovaries, thirty nine (50%) did not ovulate on clomiphen citrate with maximum dose of
150mg/day for 5 days and were considered to be non-responders. Twenty- four women
reached an ongoing pregnancy. Mean age of women was 25.9±4.4 and mean duration
of infertility was 5.2±2.9. From the studied variables only increased DHEAS
determined as predictor for failure to ovulation after laparoscopic electrocautery and
no significant predictors of failure to reach an ongoing pregnancy could be identified.
Conclusion: DHEAS is an androgen, absolutely secreted from adrenal glands, and if
the pathophysiology of ovarian electrocauterization is noticed, it seems that in cases
with increased DHEAS ovarian electrocauterization cannot improve the ovarian
response to clomiphen citrate, so the other modality of treatment such as antiandrogens
in these patients with increased DHEAS is recommended 

Keywords

References

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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 10, Issue 2 - Serial Number 2
September 2008
Pages 17-26

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