Treatment of Infertility in Women with Polycystic Ovary Syndrome in a Single Center Study

Background: Anovulatory infertility is caused by polycystic ovarian syndrome in 80 percent of patients. Preconception guidelines, such as lifestyle modification (weight loss) to avoid fetal neural tube abnormalities, and quitting smoking and drinking alcohol, are all part of the early treatment. A clomiphene citrate medication for timed intercourse is the first-line pharmacological treatment for producing ovulation. Exogenous gonadotropins or laparoscopic ovarian surgery are two options for second-line pharmaceutical treatment (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective, with a 70 % cumulative live birth rate. When laparoscopy is necessary, ovarian drilling should be done; this operation is usually successful in around half of the instances. Finally, when the previous interventions have failed, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is recommended. There is no evidence that metformin should be used routinely in the treatment of infertility in anovulatory women with polycystic ovary syndrome. Aromatase inhibitors show promise, but more research is needed to confirm their safety.Methods:This study was conducted in Department of gynecology and obstetrics, Dhaka Medical College Hospital, Dhaka, from January 2019 to December 2019. A total number of 100 patients with multiple myeloma were analyzed cytogenetically by interphase fluorescence in situ hybridization (iFISH). The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 24.0.Conclusion:PCOS is a frequent syndrome and the most frequent cause of infertility. PCOS is defined as a syndrome with at least two of three of the Rotterdam criteria. A complete evaluation of the infertility is needed to exclude other causes of infertility..

Comparative study of laparoscopic ovarian drilling and medical treatment in polycystic ovarian disease

Background: To evaluate the result after medical treatment and laparoscopic ovarian drilling in PCOS patients and to compare the results of these two methods.Methods: In this prospective study 50 women with polycystic ovarian disease, were divided into two group,25 women received medical treatment and 25 women received surgical (laparoscopic ovarian drilling) treatment. Effect of treatment on ovulation, menstruation, fertility and androgen level was determined 3 month after therapy.Results: There was significant increase in ovulation and fertility, decrease in androgen levels and decrease in LH/FSH in individual groups when compared with pretreatment levels but difference between groups A and B was not statistically significant for these parameters.Conclusions: Medical treatment and laparoscopic ovarian drilling are equally effective in treating the women of polycystic ovarian disease. Result of both the treatment are similar in this study. However medical treatment should be the first line therapy, it has significant benefit for use in OPD, low cost, no hospital stays and convenience to the patient.

Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice

Polycystic ovary syndrome represents 80% of anovulatory infertility cases. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), folic acid therapy to prevent the risk of fetal neural tube defects and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second-line pharmacological treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery (ovarian drilling). Ovulation induction using clomiphene citrate or gonadotropins is effective with cumulative live birth rates of approximately 70%. Ovarian drilling should be performed when laparoscopy is indicated; this procedure is typically effective in approximately 50% of cases. Finally, a high-complexity reproduction treatment (in vitro fertilization or intracytoplasmic sperm injection) is the third-line treatment and is recommended when the previous interventions fail. This option is also the first choice in cases of bilateral tubal occlusion or semen alterations that impair the occurrence of natural pregnancy. Evidence for the routine use of metformin in infertility treatment of anovulatory women with polycystic ovary syndrome is not available. Aromatase inhibitors are promising and longer term studies are necessary to prove their safety.

Study of 100 cases of Infertility in Polycystic ovarian syndrome and its management outcome.

Background: With all the modern needs of contraception rising on one side, infertility is still a major challenge to the gynaecological practitioners on other hand. Polycystic ovarian syndrome (PCOS) is the most common cause of anovulatory infertility, being found in ∼75% of cases. PCOS now proves to be a significant factor in female infertility with prevalence of 0.6 to 3.4% in infertile couples. With improving laboratory facilities, sonography and with routine laparoscopic evaluation of infertility, PCOS has shown a remarkable increase of incidence in recent years. Aims & Objective: The diagnosis of PCOS by ultrasonography & investigations like LH, FSH, Prolactin and or Laparoscopy. The evaluation of treatment options like clomiphene citrate, metformin and laparoscopic ovarian drilling. Material and Methods: This is a study of 100 cases of infertility with polycystic ovarian syndrome and its pregnancy outcome. In this study from May 2011 to April 2013,100 cases of Infertility with PCOS were studied at the tertiary care center. Hormonal assay, Ultrasound and laparoscopy were used for diagnosis. Clomiphene citrate, metformin and laparoscopic ovarian drilling were used as treatment modalities. Results: In our study 58% patients were in the age group of 21-25 years and 100% patients complained of infertility among which 60% were of primary type. LH:FSH ratio was more than 1.6 in nearly 82% patients. Among all treatment modalities conception rate with Clomiphene citrate was 40%, with metformin it was 20% and with laparoscopic ovarian drilling followed by C/C it was 65%. Conclusion: PCOS is emerging disease of the new generation found more in young adults being the leading cause of infertility. Apart from diet and exercise changes in lifestyle modification treatment is required in most patients with good conception rate with C/C and laparoscopic ovarian drilling.

Observation on the effect of laparoscopic ovarian drilling technique in the treatment of polycystic ovarian syndrome / 中国基层医药

Objective To explore the effect of laparoscopic ovarian drilling technique in the treatment of polycystic ovarian syndrome.Methods 60 patients with polycystic ovarian syndrome were randomly devided into observation group( 30 cases) and the control group(30 cases).The effect of the two groups was observed.Results LH and T of all the patients were significantly improved after the treatments( t =27.2158,20.4752,9.7169,0.4551,all P ＜0.05);The ovulation rate and the pregnancy rate of observation group(86.7％ and 86.7％ ) was significantly higher than those of the control group( x2 =5.4545,9.3496,all P ＜ 0.05 ),and the OHSS rate of observation group was 0,significantly lower than that of the control group ( 16.7％ ) ( x2 =5.4545,P ＜ 0.05 ).Conclusion Laparoscopic ovarian drilling technique was effective and safe in treating polycystic ovarian syndrome.

The Comparison of PCOS during Pre-and Pro-cure of Laparoscopic Ovarian Drilling / 中国现代医生

Objective To explore the ultrasound comparison of PCOS during pre-and pro-cure of laparoscopic ovarian drilling.Methods 14 PCOS cases of the application of pre-and pro-laparoscopic ovarian drilling ovarian were monitored. The changes in the structure,colorful Doppler blood flow characteristics and blood flow parameters changes were observed. Results Significant improvement was observed in post-operative ovarian morphology,ovarian artery blood flow parameters. Conclusion Transvaginal colorful Doppler before and after laparoscopic ovarian drilling has played an indispensable role in monitoring ovarian morphology and blood flow parameters changes on the recovery of ovarian review,evaluating the effect of surgery and the monitoring of ovulation,guiding pregnancy in patients to improve the pregnancy rate.

Laparoscopic treatment of clomiphene-resistant polycystic ovarian syndrome: A clinical analysis of 38 cases / 中国微创外科杂志

Objective To evaluate the efficacy of laparoscopic ovarian drilling for treating clomiphene-resistant polycystic ovary syndrome(PCOS).Methods Laparoscopic ovarian drilling,with pelvic adhesion release and salpingoplasty,was performed in 38 cases of clomipheneresistant PCOS from March 2001 to May 2005 in this hospital.Serum concentrations of luteinizing hormone(LH),follicle-stimulating hormone(FSH),androgen(T),and estradiol(E2) were measured before and after operation.Ovarian follicular development,pregnancy rate,and abortion rate were observed after operation. Results Postoperatively,there was a significant decline of levels of LH(from 22.36?3.17 U/L to 8.73?1.95 U/L;t=3.13,P

Transvaginal Hydrolaparoscopic Ovarian Drilling in the Treatment of Polycystic Ovarian Syndrome / 中国微创外科杂志

Objective To evaluate the efficacy and safety of transvaginal hydrolaparoscopic ovarian drilling for treatment of the polycystic ovary syndrome(PCOS)in clomiphene citrate-resistant infertile women.Methods Between February 2008 and November 2008,11 clomiphene citrate-resistant anovulatory women with PCOS mean age:(29.3?3.7)years,mean body mass index:(24.3?8.3)kg/m2] were enrolled in this study.Transvaginal hydrolaparoscopy using a F5 bipolar needle was performed on the patients to create 5-15 holes with a free length of 0.8 cm and a diameter of 0.2 mm in each ovary(electrocoagulation time 10-15 sec).Results A mean of(17?6)holes were made in both the ovaries in the patients.No surgical complications occurred.The levels of LH,FSH,and androstenedione dropped from(14.7?4.5)IU/L,(7.1?6.4)IU/L,and(12.2?4.4)nmol/L to(10.5?3.7)IU/L,(6.4?1.7)IU/L,and(8.9?3.0)nmol/L(t=2.389,P=0.027;t=1.007,P=0.326;and t=2.104,P=0.048)respectively after the operation.The patients were followed up for 2 to 9 months,during the period 6(54.5%)patients recovered spontaneous menstruation,among which 3 recovered ovulatory cycles(27.3%)and 2(18.2%)had spontaneous pregnancy.In the other 8 patients who didn't recover spontaneous menstruation,5 cases received CC or FSH(one of them was pregnant after the treatment);1 case was not pregnant though received IVF;and 2 are still in follow-up.Conclusions Transvaginal hydrolaparoscopic ovarian drilling is safe and effective for clomiphene citrate-resistant infertile women.

Laparoscopic Ovarian Drilling for the Treatment of Polycystic Ovarian Syndrome with Infertility:Report of 51 Cases / 中国微创外科杂志

Objective To explore the value of laparoscopic ovarian drilling in the treatment of polycystic ovarian syndrome with infertility.Methods The clinical data of 51 patients with polycystic ovarian syndrome with infertility undergone laparoscopic ovarian drilling were reviewed.The Serum concentrations of follicle-stimulating hormone(FSH),luteinizing hormone(LH),androgen(T),and estradiol(E2) were measured before and after the operation in all of the cases.Meanwhile,ovarian follicular development and pregnancy rate were observed during follow-up.Results Significantly decreased levels of FSH,LH,LH /FSH,and T were observed after the laparoscopic ovarian drilling in the patients(P

Pelviscopic ovarian drilling in infertile patients with polycystic ovarian syndrome resistant to Clomiphene citrate / 대한산부인과학회잡지

OBJECTIVE: To evaluate the clinical effect and reproductive outcome of pelviscopic ovarian drilling in infertile patients with polycystic ovarian syndrome resistant to clomiphene citrate. METHODS: Twenty two patients involved in this study were taken pelviscopic ovarian drilling with needle electrocautery. Change of characteristic LH/FSH ratio before and after operative treatment, ovulation and pregnancy success were followed up. Paired t-test was applied for hormonal change (p<0.05). RESULTS: Thirteen of 14 patients (93%) treated only with pelviscopic ovarian drilling showed successful ovulation with or without clomiphene citrate and among these 10 patients (71%) were success in pregnancy and 9 patients delivered full term babies. When including patients who needed other assisted reproductive technique and specific medication of endometriosis 17 of 22 patients (77%) were successfully pregnant and 15 patients (68%) delivered healthy babies. The mean LH/FSH ratio 2.0+/-0.5 before treatment were decreased to 1.26+/-0.37 after treatment (p<0.05). Interestingly, among 22 patients, various degree endometriosis were found during pelviscopy and specific medication with GnRH analogue were followed. CONCLUSION: Pelviscopic ovarian drilling showed successful ovulation rate and effective reproductive outcome in clomiphene-resistant infertile patients with PCO. This surgical technique seems to be an alternative step for the management of clomiphene-resistant infertile patients with PCO and also for the diagnosis of possible high rate of endometriosis in these patents.