Single versus multiple laparoscopic diathermy punctures polycystic ovaries: ovarian morphology and clinical outcome

ABSTRACT

To evaluate and compare two different techniques of laparoscopic ovarian diathermy in polycystic ovaries Single puncture technique and multiple punctures technique, as regard ovarian morphology and clinical outcome. Thirty six anovulatory PCO patients were randomly allocated to either single puncture technique [group I 18 patients] or multiple punctures technique [group II 18 patients]. Ovarian morphology was sonographically assessed just before and 3 months after the procedures. Clinical outcome was analysed before and at 6, 12 months after the surgery. Single puncture technique as well as multiple puncture technique markedly affected the ovarian morphology. Its significantly [P<0.01] reduced mean ovarian volume, and mean follicular number and significantly [P<0.01] increased the mean follicular diameter. Resumption of regular spontanous menses were insignificantly different between the two techniques [83.3% vs 88.8 at 6 months and 72.2% vs 77.7% at 12 months after the procedures respectively]. Pregnancy rate was significantly higher in single puncture technique than in multiple puncture technique at 6 and 12 months after the procedure [33.3% vs 22.2%, P<0.05 and 55.5%, vs 44.4%, P<0.05 respectively]. In each technique, pregnancy rate was significantly higher at 12 months rather than at 6 months [55.5% vs 33.3%, P<0.01 for single puncture technique and 44.4% vss 22.2% P<0.01 for multiple punctures]. Adhesions were significantly less and of minimal degree following single puncture when compared to that, following multiple punctures [16.7% vs 35.7%, P<0.01] and this may be the cause of the lesser pregnancy rate following multiple puncture technique. Single puncture laparoscopic ovarian diathermy is quite effective as multiple puncture procedure in treating anovulatory PCO patients, correcting the ovarian morphology and resuming regular menses, even it has the advantages of higher pregnancy rate and lesser incidence of postoperative adhesions