PCOS
Conditions
Keywords
polycystic ovary syndrome,laparoscopic ovarian drilling
Brief summary
The objective of our study was to compare the efficiency of the right ULOD using thermal doses adjusted to ovarian volume (60 J/cm3) with the BLOD method at constant dose and to assess treatment efficiency.
Detailed description
The study included 96 infertile, clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS), who underwent either unilateral or bilateral laparoscopic diathermy at the Clinical Hospital Split, Croatia. PCOS was diagnosed following the Rotterdam consensus criteria. In the ULOD group, we treated the right ovary with thermal dose of 60 J applied per one cubic centimeter of ovarian. In the comparator, BLOD group, all patients received 600 J per ovary. The follow-up period encompassed six menstrual cycles for all subjects.Sample size was based on the test of the primary hypothesis that ULOD treatment would result in a higher ovulation rate than BLOD. In our pilot study in 61 patients, ovulation rates were estimated to 44% in the BLOD arm and 69% in the ULOD arm. Assuming 5% significance and 80% power, we calculated that the minimal sample size for a one-sided test had to be 96 patients. The aims of our prospective study: 1. Compare the efficiency of the right ULOD using thermal doses adjusted to ovarian volume (60 J/cm3) with the BLOD method at constant dose and to assess treatment efficiency and predict ovulatory response based on clinical parameters (right or left ovary and its volume) and received thermal doses. 2. Evidence the effects of ULOD using thermal doses adjusted to ovarian volume on endocrine (changes in androgen and AMH) and reproductive outcomes (ovulation rate) in clomiphene-resistant women with PCOS. 3. To determine whether unilateral laparoscopic ovarian drilling (ULOD) using thermal doses adjusted to ovarian volume diminishes ovarian reserve less than bilateral LOD (BLOD) using a fixed thermal dose
Interventions
PROCEDUREUnilateral laparoscopic drilling
Unilateral laparoscopic drilling with diathermy adjusted to ovarian volume
PROCEDUREBilateral laparoscopic drilling
Bilateral laparoscopic drilling with fixed doses energy
Sponsors
KBC Split
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
25 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
PCOS was diagnosed following the Rotterdam consensus criteria Inclusion Criteria: * age between 25 and 35 years, * BMI\<30 kg/m2, * infertility period 1-3 years, * normal partner's semen findings, * LH≥10 or LH:FSH ratio ≥2, * testosterone \>2.5 nmol/L, * FAI\>4, * normal oral glucose tolerance test (OGTT).
Exclusion criteria
* adrenal hyperplasia, * thyroid disease, * Cushing's syndrome, * hyperprolactinemia, * tumor-related androgen excess
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Ovulation rate | Six menstrual cycles after LOD for each women | The main output parameter study is the difference in the rate of ovulation after LOD between the groups with respect to the input parameters (anti-Müller hormone AMH \[ng / ml\], free androgen index (FAI), T \[nmol / L\],luteinizing hormone (LH) \[IU / L\], androstenedione A \[nmol / L\], the number of follicles in both ovaries (AFC), total ovarian volume \[cm3\], the volume of the right ovary \[cm3\], the volume of the left ovary \[cm3\] and received thermal doses) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pregnancy | Six menstrual cycles after LOD for each women | The secondary output parameter is the difference in the probability of pregnancy between the two groups, with the input parameters (AFC, total ovarian volume \[cm3\], the volume of the right ovary \[cm3\], the volume of the left ovary \[cm3\] and received thermal doses), during follow-up of patients (first and sixth cycle after LOD). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Ovarian reserve | Six menstrual cycles after LOD for each women | The secondary outcome measures were: correlations and differences in values (and changes) measured markers (unilateral / bilateral or ovulation / anovulation). Markers that are considered: AMH \[ng / ml\], follicle stimulating hormone (FSH) \[IU / L\], the number of follicles in both ovaries, total ovarian volume \[cm3\], the volume of the right ovary \[cm3\], the volume of the left ovary \[cm3\], FAI, T \[nmol / L\], LH \[IU / L\], A \[nmol / L\], sex hormone-binding globulin (SHBG) \[nmol / L\], dehydroepiandrosterone sulfate (DEHASO4), \[mmol / L\],prolactin (PRL), BMI \[kg/m2\] and years. |
Countries
Croatia
Outcome results
None listed