بررسي اثرات درماني كوتريزاسيون لاپاروسكوپيك تخمدان در درمان ناباروري زنان مبتلا به سندرم تخمدان پلي كيستيك مقاوم به كلوميفنسيترات و گنادوتروپين

Therapeutic Effect of Laparoscopic Ovarian Drilling on Treatment of Infertility in Women with Polycystic Ovarian Syndrome, Resistant to Clomiphene Citrate and Gonadotropins

Introduction: Polycystic ovarian syndrome (PCOS) is one of the causes of anovulation, oligoovulation and infertility. There are two categories of treatment for these patients: 1) medical treatments such as Metformin, Clomiphene citrate, Gonadotropins; 2) surgical treatments such as cauterization of ovaries and laparoscopic ovarian drilling (LOD). The aim of this study was to evaluate the efficacy and successful rate of LOD in PCOS with infertility that was irresponsive to medical therapy. Methods: This Semi-experimental (before-after) study was done in 45 infertile women with PCOS who were resistant to medical treatment by Clomiphene citrate in Besat hospital in Sanandaj, Iran. LOD was performed in all patients. The patients were followed up to 12 months after LOD for regularity of menses, pregnancy rate, outcome of pregnancy, and complications after surgery. Data were collected by SPSS software and were analyzed by Chi square, McNemar and T-test. Results: Before surgery 40 patients (88.9%) had irregular menses. After surgery this rate was reduced to 15 patients (31.1%). 28 patients (60%) became pregnant during 12 months. The average time for the patients to become pregnant after ovarian cauterization was 5 months. Complication after surgery was seen in only one patient as adhesion of sigmoid colon to ovary. There was no hyperstimulation (OHSS) or multiple gestations after induction ovulation. 21 of the 28 pregnant patients (75%) delivered healthy infants. There was no significant correlation between body mass index, FSH/LH ratio before operation and the rate of regularity of menses in our patients. Conclusion: LOD is an effective treatment for infertile women with PCOS resistant to Clomiphene citrate and it could be the first line of treatment for the infertile women with PCOS.