Unilateral versus bilateral laparoscopic ovarian electrocautery in patients with polycystic ovarian syndrome: a prospective hormonal and clinical study

ABSTRACT

The aim of this work was to assess the efficacy of unilateral and bilateral laparoscopic ovarian electrocautery in correcting the endocrine abnormalities and inducing ovulation in infertile patients with clomiphene citrate resistant PCOS. Fifty patients were included in this study. They were randomly allocated to either unilateral [25 cases] or bilateral [25 cases] laparoscopic ovarian electrocautery. Serum LH FSH and testosterone [T] levels were estimated in the early follicular phase before and after the operation. The cases were followed postoperatively for 6 months to detect, the occurrence of ovulation and pregnancy. A highly significant postoperative fall of serum LH and LH/FSH ratio [P<0.0001] was detected following either unilateral or bilateral ovarian electrocautery. Also serum FSH increased significantly [P<0.05] and serum T decreased significantly [P<0.05]. Ovulation occurred in 72% of the patients following unilateral ovarian electrocautery and in 76% following bilateral ovarian electrocautery. It was found that neither the preoperative LH, FSH nor T level could be used to predict the occurrence of postoperative response. Unilateral ovarian electrncautery resulted in bilateral ovarian activity in all responders. Pregnancy occurred in 48% of the patients of unilateral ovarian electrocautery and in 56% of the patients of bilateral ovarian electrocautery. The less traumatizing technique of unilateral laparcscopic ovarian electrocautery resulted in endocrine and clinical effects nearly similar to that produced by bilateral ovarian elctrocautery with no statistically significant difference. It has the advantage of preserving one side of the pelvis away from possible postoperative adhesions