Abstract
Objective: A randomized, prospective pilot study was conducted to evaluate the clinical and endocrine parameters following laparoscopic unipolar and bipolar ovarian drilling in infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS). Study Design: This was a randomized, prospective pilot study of 20 patients with clomiphene–resistant PCOS attending the gynecology outpatient department and gynecology endocrinology clinic of the All India Institute of Medical Sciences (New Delhi, India). The patients were randomly assigned to 2 groups: unipolar (group I) and bipolar (group II), of 10 patients each. Outcome measures were ovulation rate, pregnancy rate, changes in luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone levels, and alteration of glucose tolerance and insulin levels. Results: After ovarian drilling, 6 patients (60%) in group I and 8 (80%) in group II ovulated spontaneously (p = 0.63), and 3 (30%) more patients ovulated after clomiphene citrate in group I and 1 (10%) in group II, with a total ovulation rate of 90% in both groups (p = 0.46). Six (6; 60%) pregnancies resulted in group I and 8 (80%) pregnancies resulted in group II (p = 0.63). LH levels fell significantly only in group II after 3 months (11.11 ± 1.25 to 4.88 ± 1.34 mIu/mL; p = 0.036), and there was no significant change in FSH and testosterone levels in either group. The fasting serum insulin levels increased nonsignificantly from 17.70 ± 5.27 µIU/mL to 21.90 ± 7.43 µIU/mL (p = 0.71) in group I and from 7.73 ± µIU/mL to 13.11 ± 3.55 µIU/mL (p = 0.27) in group II 3 months after surgery. Area under curve (AUC) glucose and insulin values fell postoperatively in both the groups. Conclusions: Laparoscopic bipolar ovarian drilling is an effective alternative to unipolar drilling in resuming ovulatory cycles and conception. Bipolar electrocoagulation has merits of favorable success rates along with expected safety and chances of fewer postoperative adhesions. (J GYNECOL SURG 22:105)
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