The Optimal Number of Ovarian Punctures to Be Applied During Laparoscopic Ovarian Diathermy in Women with Polycystic Ovarian Syndrome

Abstract

Abstract

Objective: The purpose of this study was to determine the amount of thermal energy required during laparoscopic ovarian diathermy (LOD) for polycystic ovary syndrome (PCOS) to produce an optimal success rates without excessive ovarian damage. Design: This study was designed as a prospective comparative study. Setting: The study took place in a fertility unit in a specialized hospital. Participants: The participants were women with clomiphene-resistant PCOS. Intervention: Subjects underwent LOD and were divided into five groups by number of punctures per ovary. Main outcome measure(s): The outcome measures were reproductive performance and endocrine assays. Results: The subjects' reproductive performance significantly improved after three or more punctures per ovary; in each group, the rates of restoration of menstrual regularity were 30, 73, 82, 82, and 50%; the rates of spontaneous ovulation were 23, 60, 64, 58, and 42%; and the rates of conception were 15, 40, 53, 47, and 28%, respectively, after LOD. Serum luteinizing hormone (LH) and LH:follicle stimulating hormone (LH:FSH) ratio was reduced in all studied groups proportionally with increasing amount of thermal energy. There was only a significant increase in serum FSH after six or more punctures. The reductions of serum androgen after LOD were observed significantly in women receiving three or more punctures per ovary. Conclusions: The clinical response to LOD seems to be thermal energy dose-dependent. Two punctures (300 J) per ovary are associated with poor results. Between three and five (450– 750 J) punctures per ovary seem to represent the effective thermal dose. The application of six or more (≥900 J) punctures per ovary may result in excessive destruction to the ovary and should therefore be discouraged. (J GYNECOL SURG 27:217)