Comparison of the effects of bilateral and unilateral laparoscopic ovarian drilling on pregnancy rates in infertile patients with polycystic ovary syndrome
A prospective cohort study, conducted at the Antalya Training and Research Hospital, compared the effectiveness of unilateral (single ovary) and bilateral (both ovaries) laparoscopic ovarian drilling (LOD) on future pregnancy rates, in women with PCOS and resistant to clomiphene citrate.
A total of 75 women participated in the study, with 37 undergoing unilateral LOD and 38 bilateral LOD. Baseline characteristics and hormone analysis of the women showed no significant difference between the 2 groups with the exception of right ovary volume, LH and Estradiol which was statistically higher in the bilateral LOD group. Age, duration of infertility and other hormone results, pre and post operation did not differ significantly between the two groups, suggesting any difference in results was strictly due to the type of operation.
In the unilateral LOD group, the largest ovary in volume terms was selected for LOD, unlike previous studies where only the right ovary was treated irrespective of size. For consistency, between patients and groups, ovarian drilling dose was adjusted according to individual ovary volume using an equation (number of punctures = 60 x [Volume in cm3 / 30W] x 4).
Twelve months post-surgery the spontaneous pregnancy rates were 54.1% (unilateral LOD) and 34.2% (bilateral LOD). The same trend was observed in live birth rates with 45.9% and 26.3% of women, in the unilateral and bilateral LOD groups respectively, continuing on to a successful live birth. Although due to the small study size, the results were deemed statistically insignificant.
Further analysis found that pregnancy following LOD overall was significantly more effective in women with secondary infertility (previous clinical pregnancy) compared to women with primary infertility (no previous clinical pregnancy).
Interestingly almost 70% of pregnancies occurred within the first 6 months, post operation, for both groups of women. AMH levels also dropped significantly in both groups post operation (Unilateral LOD AMH: 10.9 ±7.86 to 7.2 ±5.37, Bilateral LOD AMH: 14.1 ±9.47 to 9.1 ±5.4) which may limit this type of procedure strictly to women with sufficient ovarian reserve levels.
SUMMARY: HOW SUCCESSFUL IS OVARIAN DRILLING
In this study, both unilateral and bilateral ovarian drilling, successfully restored ovulation in 80% of women with PCOS, leading to pregnancy success rates of 54.1% and 34.2% respectively. A 70% majority of these pregnancies successfully occurred within 6 months following ovarian drilling.
- Study size too small to statistically confirm the difference
Sunj M, et al. (2013). Does unilateral laparoscopic diathermy adjusted to ovarian volume increase the chances of ovulation in women with polycystic ovary syndrome? https://doi.org/10.1093/humrep/det273
Zakherah M S, et al. (2011). Laparoscopic ovarian drilling in polycystic ovary syndrome: efficacy of adjusted thermal dose based on ovarian volume. https://doi.org/10.1016/j.fertnstert.2010.10.037
Amer S A K, et al. (2002). Long term follow-up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. https://doi.org/10.1093/humrep/17.8.2035
Balen A H and Jacobs H S, (1994). A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome. https://doi.org/10.1016/s0015-0282(16)57051-4
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