Alternative to ovarian electrocauterization in the treatment of women with the polycystic ovary syndrome

ABSTRACT

To compare the efficacy of laparoscopic ovarian needle puncture versus laparoscopic ovarian electrocauterization in the treatment of the polycystic ovary syndrome and to assess the degree of postoperative adhesion formation after each procedure. Patients and methods: Forty women with anovulatory infertility due to polycystic ovary syndrome were enrolled in the study and were equally divided into 2 groups. Laparoscopic ovarian electrocauterization was performed for women in group I while laparoscopic ovarian needle puncture was performed for patients enrolled in group II. Blood samples were drawn before and 1 month after the laparoscopic procedures in both groups to determine levels of lutenizing hormone [LH], follicle stimulating hormone [FSH], LH/FSH ratio, testosterone, androstendione and insulin-like growth factor binding protein- 1. Doppler resistance index of the ovarian stromal vasculature was measured before surgery in both groups at days 11,13,15 and 17 of the menstrual cycle. All women enrolled in the study were followed up for a period of 1 2 months for regularity of the menstrual cycle, occurrence of ovulation and pregnancy. The hormonal profile and the Doppler resistance index of the ovarian stromal vasculature were reassesed 1 month after surgery at the same period of the menstrual cycle. There was no significant differences in the clinical characteristics of women enrolled in both groups. There was a highly significant postoperative improvement in cycle regularity, occurrence of ovulation and conception in both groups [p < 0.001]. There were a highly significant decrease in LH, LH/FSH, testosterone and androstendione levels after surgery in both groups [p< 0.0001]. FSH level increased significantly in both groups after surgery but the IGFBP showed a non significant increase [p > 0.05] in both groups. A significant rise in the Doppler resistance index of ovarian artery was noted at days 13, 15 and 17 of the cycle after both procedures. Second look laparoscopy for cases that did not get pregnant by the end of the 12 months follow up revealed a significant increase in the incidence of postoperative adhesion formation in group 1 compared to group II [p < 0.001]. laparoscopic ovarian needle puncture is an effective alternative to ovarian electrocauterization in the treatment of the polycystic ovary syndrome. In addition laparoscopic ovarian needle puncture results in statistically lower incidence of postoperative pelvic adhesions