SURGICAL TREATMENT OF POLYCYSTIC OVARIES IN INFERTILE PATIENTS
Abstract
Background. Polycystic ovaries (PCO) are manifested either independently or as a syndrome (PCOS). They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO). The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.
Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S), in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3%) responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET) treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10) punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.
Results. After LECO 99 (63.3%) of the 157 patients conceived, 56 (54.6%) spontaneously and 43 (45.4%) after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0%) patients with primary, and in 41 (41%) patients with secondary infertility, in 20 (57%) patients with PCO, 79 (65%) with PCOS, in 71 (64.1%) patients with a normal partner’s spermiogram, and in 28 (46.1%) patients with the partner’s oligoasthenoteratospermia of the 1st or 2nd degree. The differences were not statistically significant. Pregnancy ended with delivery in 87 (88.1%) patients, and in spontaneous abortion in 11 (11%); 1 (0.9%) pregnancy was ectopic. Singletons were born to 82 (82.9%) and twins to 5 (5.2%) patients, the latter to the patients receiving ovarian stimulation immediately after surgery. In the patients, enrolled in IVF-ET treatment for a failed hormonal and/or surgical treatment, the delivery rate per ET was 23.4% (19/48) in those with a previous LECO, and 12.9% (36/115) in those without a previous LECO (p < 0.05). No surgical complications were registered.
Conclusions. LECO is an efficient treatment of infertility in patients with PCO(S). It results in high pregnancy and low spontaneous abortion rates, and reduces the risk of ovarian hyperstimulation syndrome following gonadotropin treatment.
Downloads
References
Homburg R. Polycystic ovary syndrome – from gynecologic curiosity to multisystem endocrinopathy. Hum Reprod 1996; 11: 29–39.
Meden-Vrtovec H. Sindrom policističnih ovarijev – diagnostika in zdravljenje. In: Kralj B, Denona V, eds. 2. kongres ginekologov in porodničarjev Slovenije z mednarodno udeležbo: Zbornik, Portorož, 19.–22. november 2000. Ljubljana: Združenje ginekologov in porodničarjev Slovenije, 2000: 54–8.
Lewis V. Polycystic ovary syndrome: a diagnostic challenge. Obstet Gynecol Clin North Am 2001; 28: 1–20.
Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935; 29: 181–91.
GjŘnnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril 1984; 15: 20–5.
Donesky BW, Adashi EY. Surgically induced ovulation in the polycystic ovary syndrome: wedge resection revisited in the age of laparoscopy. Fertil Steril 1996; 63: 439–63.
Rimington MR, Walker SM, Shaw RW. The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilisation treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum Reprod 1997; 12: 1443–7.
Gjonnaess H. Late endocrine effects of ovarian electrocautery in women with polycystic ovary syndrome. Fertil Steril 1998; 69: 697–701.
Verhelst J, Gerris J, Joostens M, Van der Meer S, Van Royen E, Mahler C. Clinical and endocrine effects of laser vaporisation in patients with polycystic ovarian disease. Gynecol. Endocrinol 1993; 7: 49–55.
Meden-Vrtovec H. A new approach to treatment of the patients with PCOD. Eur J Obstet Gynecol Reprod Biol 1994; 55: 36–7.
Felemban A, Lin Tan S, Tulandi T. Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril 2000; 73: 266–9.
Šimunić V. Kronične hiperandrogene anovulacije – endokrinologija masnog tkiva. In: Šimunić V ed. Humana reprodukcija, ginekološka endokrinologija, klimakterij i postmenopavza. Zagreb: Litograf, 1999; 5–19.
Armar NA, Lachelin GC. Laparoscopic ovarian diathermy: an effective treatment in anti-estrogen resistant anovulatory infertility in women with polycystic ovary syndrome. Br J Obstet Gynaecol 1993; 100: 161–4.
Ribič-Pucelj M, Bola-Natek A, Valentinčič-Gruden B, Meden-Vrtovec H, Tomaževič T. Does laparoscopic ovarian drilling improve IVF-ET results in patients with polycystic ovaries? In: Meden-Vrtovec H, Pirc M, Trenkič M eds. 2nd International Symposium on Assisted reproduction: Proceedings, Bled 1999. Slovene Association of Reproductive Medicine, Ljubljana 1999; 11–5.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
