Bilateral, Clomiphene Citrate, Laparoscopic, Ovarian Drilling, Polycystic Ovarian Syndrome, Unilateral
Conditions
Brief summary
The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response (regularity of the cycle), change in biochemical parameters, ovulation rate over six months, pregnancy rate within six months.
Detailed description
Polycystic ovary syndrome (PCOS), is considered the most common endocrine disorder in reproductive age in females. Polycystic ovary syndrome (PCOS) is characterized by reproductive and metabolic disturbances. Androgen excess is a hallmark of polycystic ovary syndrome (PCOS), driving many of the phenotypic features The clinical response to laparoscopic ovarian drilling (LOD) seems to be thermal energy dose-dependent. Two punctures (300 J) per ovary are associated with poor results. Between three and five (450-750 J) punctures per ovary seem to represent the effective thermal dose. The application of six or more (C900 J) punctures per ovary may result in excessive destruction to the ovary and should therefore be discouraged.
Interventions
OTHERUnilateral laparoscopic ovarian drilling
Laparoscopic drilling was performed under general anesthesia as follows: 10-mm subumbilical entry and two 5-mm secondary ports in the lower part of the abdomen just above the anterior superior iliac spine. The laparoscope is introduced through the subumbilical port, and secondary ports was used for introduction of the instruments, the type of needle was an insulated unipolar needle electrode with a non-insulated distal end. We are planning to use the least thermal effective dose which is 60 J/cm3 of ovarian tissue. The number of punctures (Np) per ovary was calculated according to the following formula: N p = 60 J/cm3/40 W × 4 s, with 3 mm diameter and 4 mm depth for each puncture using power setting of 300 W for 2-4 s. Unilateral: was done on the larger ovary.
OTHERBilateral laparoscopic ovarian drilling
Laparoscopic drilling was performed under general anesthesia as follows: 10-mm subumbilical entry and two 5-mm secondary ports in the lower part of the abdomen just above the anterior superior iliac spine. The laparoscope is introduced through the subumbilical port, and secondary ports was used for introduction of the instruments, the type of needle was an insulated unipolar needle electrode with a non-insulated distal end. We are planning to use the least thermal effective dose which is 60 J/cm3 of ovarian tissue. The number of punctures (Np) per ovary was calculated according to the following formula: N p = 60 J/cm3/40 W × 4 s, with 3 mm diameter and 4 mm depth for each puncture using power setting of 300 W for 2-4 s. Bilateral: Using dose adjusted according to ovarian volume.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
25 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Age within 25-35 years. * Polycystic ovarian syndrome as diagnosed according to modified Rotterdam criteria 2018: oligomenorrhea or amenorrhea; clinical and/or biochemical signs of hyperandrogenism; and transvaginal sonographic appearance of polycystic ovaries (≥ 20 follicles or an ovarian volume 10 cm3) . * Infertile women who have clomiphene citrate -resistant polycystic ovary syndrome (150 mg/daily for 5 days for six cycles with no ovulation). * Normal semen analysis in the husband.
Exclusion criteria
* Hyper-androgenic disorders like late onset congenital adrenal hyperplasia, hyperprolactinemia, thyroid diseases. * Cushing's syndrome and androgen-secreting tumors. * Body mass index \> 30 kg/m2. * Other medical problems like diabetes, Hypertesion, patients on steroid hormone …. etc. * Other causes of infertility as multiple uterine fibroids.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Restoration of ovulation | 6 month after operation. | Restoration of ovulation was measured before operation and for 6 month after operation . |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Folliculometry | 6 month after operation. | Folliculometry was measured before operation and for 6 month after operation . |
| Follicle-stimulating hormone (FSH) | 6 month after operation. | Follicle-stimulating hormone (FSH) was measured before operation and for 6 month after operation . |
| Luteinizing hormone (LH) | 6 month after operation. | Luteinizing hormone (LH) was measured before operation and for 6 month after operation . |
| Anti-müllerian hormone(AMH) | 6 month after operation. | Anti-müllerian hormone(AMH) was measured before operation and for 6 month after operation . |
| Pregnancy rate | 6 month after operation. | Pregnancy rate was measured before operation and for 6 month after operation . |
Countries
Egypt
Outcome results
None listed