Short term effects of laparoscopic ovarian drilling in clomiphene citrate resistant patients with polycystic ovary syndrome

Abstract Objective The study aims to assess the effect of laparoscopic ovarian drilling (LOD) in clomiphene citrate resistant patients with polycystic ovary syndrome (PCO) on the changes occurred in ovarian reserve. Study design A prospective cohort study. Setting Sohag University Hospital, Sohag, Egypt. Materials and methods Thirty-seven patients with PCO were enrolled in the study. We evaluated the effect of LOD on the ovarian reserve using hormonal assay (measuring FSH, LH, AMH, Testosterone, SHBG, E2 and FAI) and sonographic markers (including ovarian volume, antral follicle count (AFC) and ovarian stromal blood flow). Results Amongst the 37 patients underwent LOD, regulation of the cycle occurred in 20 patients after 6 months (54.06%) (p = 0.001). Occurrence of pregnancy occurred in 4 patients after three months and in 18 patients after 6 months. As regard the hormonal profile, LOD has reducing effect on the serum levels of FSH, LH, AMH, SHBG, Testosterone and free androgen index. This reduction is of statistically significance in case of LH, AMH, testosterone and FAI especially after 6 months (p = 0.01, 0.001, 0.05, 0.05 respectively). The deleterious effect of LOD was statistically significant in the AFC which was reduced from 18.1 ± 2.7 to 11.5 ± 1.8 after 6 months (p = 0.05). Also, the ovarian blood flow indices were reduced with p = 0.01 for all indices. Conclusions Using the AMH and AFC as reliable markers of the ovarian reserve and measuring them for women with anovulatory PCO undergoing LOD may provide a useful tool in evaluating the outcome of LOD as the gold standard treatment for CC resistant PCO women.