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Semin Reprod Med 2008; 26(1): 101-110
DOI: 10.1055/s-2007-992930
DOI: 10.1055/s-2007-992930
Laparoscopic Surgery in Polycystic Ovary Syndrome: Reproductive and Metabolic Effects
Further Information
Publication History
Publication Date:
08 January 2008 (online)
ABSTRACT
Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation. Clomiphene citrate (CC) is the first-line treatment for ovulation induction for infertile women with PCOS. In CC-resistant women, a particular surgical method, laparoscopic ovarian drilling (LOD), has been proposed in recent years as an alternative treatment. LOD produces overall spontaneous ovulation and pregnancy rates of 30 to 90% and 13 to 88%, respectively, for CC-resistant PCOS women. The mechanism of LOD is still unknown. The reduction of serum androgen level is believed to be the possible mechanism of LOD to improve spontaneous ovulation and promote fertility in women with PCOS. In addition, LOD may cause a significant reduction in serum luteinizing hormone and insulin levels. However, it should be kept in mind that postoperative adhesion is the most common adverse effect of LOD, and more punctures may be responsible for premature ovarian failure.
KEYWORDS
Polycystic ovary syndrome - laparoscopic ovarian drilling - clomiphene citrate-resistant - pregnancy rate - ovulation rate
REFERENCES
- 1 Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group . Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19 41-47
- 2 Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997; 18 774-800
- 3 Diamanti-Kandarakis E, Kouli C R, Bergiele A T et al.. A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile. J Clin Endocrinol Metab. 1999; 84 4006-4011
- 4 Asuncion M, Calvo R M, San Millan J L, Sancho J, Avila S, Escobar-Morreale H F. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000; 85 2434-2438
- 5 Ehrmann D A, Barnes R B, Rosenfield R L, Cavaghan M K, Imperial J. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999; 22 141-146
- 6 Legro R S, Kunselman A R, Dodson W C, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999; 84 165-169
- 7 Dunaif A.
Polycystic ovary syndrome and obesity . In Bjorntorp P, Brodoff BN Obesity. Philadelphia, PA; JB Lippincott 1992: 594-605Reference Ris Wihthout Link - 8 Kousta E, White D M, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update. 1997; 3 359-365
- 9 Hughes E, Colins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhea. Cochrane Database Syst Rev. 2000; 2 CD000056
- 10 Li T C, Saravelos H, Chow M S, Chisabingo R, Cooke I D. Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovary syndrome in women with anovulatory infertility. Br J Obstet Gynaecol. 1998; 105 338-344
- 11 Duleba A J, Banaszewska B, Spaczynski R Z, Pawelczyk L. Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels. Fertil Steril. 2003; 79 1008-1014
- 12 Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril. 1984; 41 20-25
- 13 Daniell J F, Miller W. Polycystic ovaries treated by laparoscopic laser vaporization. Fertil Steril. 1989; 51 232-236
- 14 Rossmanith W G, Kechstein J, Spatzier K, Lauritzen C. The impact of ovarian laser surgery on the gonadotrophin secretion in women with polycystic ovarian disease. Clin Endocrinol (Oxf). 1991; 34 223-230
- 15 Utsunomiya T, Sumioki H, Taniguchi I. Hormonal and clinical effects of multifollicular puncture and resection on the ovaries of polycystic ovary syndrome. Horm Res. 1990; 33(Suppl 2) 35-39
- 16 Stein I F, Leventhal M L. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935; 29 181-191
- 17 Campo S, Felli A, Lamanna M A, Barini A, Garcea N. Endocrine changes and clinical outcome after laparoscopic ovarian resection in women with polycystic ovaries. Hum Reprod. 1993; 8 359-363
- 18 Amer S A, Banu Z, Li T C, Cooke I D. Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes. Hum Reprod. 2002; 17 2851-2857
- 19 Stein I F.
Wedge resection of the ovaries: the Stein-Leventhal syndrome . In: Greenblatt RB Ovulation: Stimulation, Suppression, Detection. Philadelphia, PA; JB Lippincott 1966: 150-157Reference Ris Wihthout Link - 20 Malkawi H Y, Qublan H S. Laparoscopic ovarian drilling in the treatment of polycystic ovary syndrome: how many punctures per ovary are needed to improve the reproductive outcome?. J Obstet Gynaecol Res. 2005; 31 115-119
- 21 Tulandi T, Watkin K, Tan S L. Reproductive performance and three-dimensional ultrasound volume determination of polycystic ovaries following laparoscopic ovarian drilling. Int J Fertil Womens Med. 1997; 42 436-440
- 22 Weise H C, Naether O, Fischer R, Berger-Bispink S, Delfs T. Behandlungsergebnisse mit der oberflachenkuaterisierung polyzystischer Ovarien bei Sterilitatspatientinnen. Gebrutshilfe Frauenheilkd. 1991; 51 920-924
- 23 Armar N A, McGarrigle H H, Honour J, Holownia P, Jacobs H S, Lachelin G C. Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome. Fertil Steril. 1990; 53 45-49
- 24 Dabirashrafi H. Complications of laparoscopic ovarian cauterization. Fertil Steril. 1989; 52 878-879
- 25 Am S AK, Li T C, Cooke I D. A prospective dose-finding study of the amount of thermal energy required for laparoscopic ovarian diathermy. Hum Reprod. 2003; 18 1693-1698
- 26 McNatty K P, Smith D M, Makris A et al.. The intraovarian sites of androgen and estrogen formation in women with normal and hyperandrogenic ovaries as judged by in vitro experiments. J Clin Endocrinol Metab. 1980; 50 755-763
- 27 Kovacs G, Buckler H, Bangah M et al.. Treatment of anovulation due to polycystic ovarian syndrome by laparoscopic ovarian cautery. Br J Obstet Gynaecol. 1991; 98 30-35
- 28 Seow K M, Juan C C, Hsu Y P, Hwang J L, Huang L W, Ho L W. Amelioration of insulin resistance in women with PCOS via reduced insulin receptor substrate-1 Ser312 phosphorylation following laparoscopic ovarian electrocautery. Hum Reprod. 2007; 22 1003-1010
- 29 Seow K M, Juan C C, Ho L W et al.. Adipocyte resistin mRNA levels are downregulated by laparoscopic ovarian electrocautery in both obese and lean women with polycystic ovary syndrome. Hum Reprod. 2007; 22 1100-1106
- 30 Saleh A M, Khalil H S. Review of nonsurgical and surgical treatment and the role on insulin-sensitizing agents in the management of infertile women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2004; 83 614-621
- 31 Chang R J, Nakamura R M, Judd H L, Kaplan S A. Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab. 1983; 57 356-359
- 32 Shoupe D, Kumar D D, Lobo R A. Insulin resistance in polycystic ovary syndrome. Am J Obstet Gynecol. 1983; 147 588-592
- 33 Shepard M K, Balmaceda J P, Leika C G. Relationship of weight to successful induction of ovulation with clomiphene citrate. Fertil Steril. 1979; 32 641-645
- 34 Lobo R A, Gysler M, March C M, Goebelsmann U, Mishell Jr D R. Clinical and laboratory predictors of clomiphene response. Fertil Steril. 1982; 37 168-174
- 35 Nestler J E, Jakubowicz D J, Evans W S, Pasquali R. Effective metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. N Engl J Med. 1998; 338 1876-1880
- 36 Hasegawa I, Murakawa H, Suzuki M, Yamamoto Y, Kurabayashi T, Tanaka K. Effect of troglitazone on endocrine and ovulatory performance in women with insulin resistance-related polycystic ovary syndrome. Fertil Steril. 1999; 71 323-327
- 37 Vandermolen D T, Ratts V S, Evans W S, Stovall D W, Kauma S W, Nestler J E. Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone. Fertil Steril. 2001; 75 310-315
- 38 Neveu N, Granger L, St-Michel P, Lavoie H B. Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction and achievement of pregnancy in 154 women with polycystic ovary syndrome. Fertil Steril. 2007; 87 113-120
- 39 Lord J M, Flight I H, Norman R J. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ. 2003; 327 951-953
- 40 Kashyap S, Wells G A, Rosenwaks Z. Insulin-sensitizing agents as primary therapy for patients with polycystic ovarian syndrome. Hum Reprod. 2004; 19 2474-2483
- 41 Malkawi H Y, Qublan H S, Hamaideh A H. Medical vs. surgical treatment for clomiphene citrate-resistant women with polycystic ovary syndrome. J Obstet Gynaecol. 2003; 23 289-293
- 42 Palomba S, Orio Jr F, Falbo A et al.. Metformin administration and laparoscopic ovarian drilling improve ovarian response to clomiphene citrate (CC) in oligo-anovulatory CC-resistant women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 2005; 63 631-635
- 43 Farquhar C M, Williamson K, Gudex G, Johnson N P, Garland J, Sadler L. A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome. Fertil Steril. 2002; 78 404-411
- 44 Szilágyi A, Hole R, Kechstein J, Rossmanith W G. Effects of ovarian surgery on the dopaminergic and opiodergic control of gonadotropin and prolactin secretion in women with polycystic ovarian disease. Gynecol Endocrinol. 1993; 7 159-166
- 45 Greenblatt E M, Caper R F. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril. 1993; 60 766-770
- 46 Tiitinen A, Tenhunen A, Seppälä M. Ovarian electrocauterization causes LH-regulated but not insulin-regulated endocrine changes. Clin Endocrinol (Oxf). 1993; 39 181-184
- 47 Sakata M, Tasaka K, Kurahci H, Terakawa N, Miyake A, Tanizawa O. Changes of bioactive luteinizing hormone after laparoscopic ovarian cautery in patients with polycystic ovarian syndrome. Fertil Steril. 1990; 53 610-613
- 48 Yanagibori A, Kojima E, Ohtaka K, Morita M, Hirakawa S. Nd-YAG laser therapy for infertility with a contact-type probe. J Reprod Med. 1989; 34 456-460
- 49 Kato M, Kikuchi I, Shimaniki H et al.. Efficacy of laparoscopic ovarian drilling for polycystic ovary syndrome resistant to clomiphene citrate. J Obstet Gynaecol Res. 2007; 33 174-180
- 50 Palomba S, Falbo A, Orio Jr F et al.. Efficacy of laparoscopic ovarian diathermy in clomiphene citrate-resistant women with polycystic ovary syndrome: relationships with chronological and ovarian age. Gynecol Endocrinol. 2006; 22 329-335
- 51 van Wely M, Bayram N, van der Veen F, Bossuyt P M. Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate-resistant polycystic ovary syndrome. Hum Reprod. 2005; 20 900-905
- 52 Gürgan T, Urman B, Aksu T, Yarali H A, Develioglu O, Kisnisci H. The effect of short-interval laparoscopic lysis of adhesions on pregnancy rates following Nd-YAG laser photocoagulation of polycystic ovaries. Obstet Gynecol. 1992; 80 45-47
- 53 Balen A H, Tan S L, MacDougall J, Jacobs H S. Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin. Hum Reprod. 1993; 8 959-964
- 54 Homburg R, Armar N A, Eshel A, Adams J, Jacobs H S. Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. BMJ. 1988; 297 1024-1026
- 55 Regan L, Owen E J, Jacobs H S. Hypersecretion of luteinizing hormone, infertility, and miscarriage. Lancet. 1990; 336 1141-1144
- 56 Sagle M, Bishop K, Ridley N et al.. Recurrent early miscarriage and polycystic ovaries. BMJ. 1988; 297 1027-1028
- 57 Abdel Gadir A, Mowafi R S, Alnaser H M, Alrashid A H, Alonezi O M, Shaw R W. Ovarian electrocautery versus human menopausal gonadotrophins and pure follicle stimulating hormone therapy in the treatment of patients with polycystic ovarian disease. Clin Endocrinol (Oxf). 1990; 33 585-592
- 58 Rimington M R, Walker S M, Shaw R W. The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum Reprod. 1997; 12 1443-1447
- 59 Farquhar C, Vandekerckhove P, Arnot M, Likford R. Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2000; CD001122
- 60 Greenblatt E, Casper R F. Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome. Am J Obstet Gynecol. 1987; 156 279-285
- 61 Gjönnaess H, Norman N. Endocrine effects of the ovarian electrocautery in patients with polycystic ovarian disease. Br J Obstet Gynaecol. 1987; 94 779-783
- 62 Aakvaag A, Gjönnaess H. Hormonal response to electrocautery of the ovary in patients with polycystic ovarian disease. Br J Obstet Gynaecol. 1985; 92 1258-1264
- 63 Balen A H, Jacobs H S. A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome. Fertil Steril. 1994; 62 921-925
- 64 Balen A H, Tan S L, Jacobs H S. Hypersecretion of luteinizing hormone: a significant cause of infertility and miscarriage. Br J Obstet Gynaecol. 1993; 100 1082-1089
- 65 Stanger J D, Yovich J L. Reduced in-vitro fertilization of human oocyte from patients with raised basal luteinising hormone levels during the follicular phase. Br J Obstet Gynaecol. 1985; 92 385-393
- 66 Smitz J, Ron-EL R, Tarlatzis B C. The use of gonadotrophin releasing hormone agonists for in vitro fertilization and other assisted procreation techniques: experience from three centres. Hum Reprod. 1992; 7(Suppl 1) 49-66
- 67 Am S AK, Li T C, Ledger W L. Ovulation induction using laparoscopic ovarian drilling in women with polycystic ovary syndrome: predictors of success. Hum Reprod. 2004; 19 1719-1724
- 68 Hamori M, Zwirner M, Clédon P, Tinneberg H R. Androgen response in polycystic ovary syndrome to FSH treatment after LHRH agonist suppression. Int J Fertil. 1992; 37 171-175
- 69 Lemieux S, Lewis G F, Ben-Chetrit A, Steiner G, Greenblatt E M. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovarian syndrome is not accompanied by improved insulin sensitivity or lipid-lipoprotein levels. J Clin Endocrinol Metab. 1999; 84 4278-4282
- 70 Saleh A, Morris D, Tan L S, Tulandi T. Effects of laparoscopic ovarian drilling on adrenal steroids in polycystic ovary syndrome patients with and without hyperinsulinemia. Fertil Steril. 2001; 75 501-504
- 71 Api M, Gorgan H, Cetin A. Laparoscopic ovarian drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2005; 119 76-81
- 72 Buttram V C, Vaquero Jr C. Post-ovarian wedge resection adhesive disease. Fertil Steril. 1975; 26 874-876
- 73 Luciano A A, Maier D B, Koch E L, Nulsen J C, Whitman G F. A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model. Obstet Gynecol. 1989; 74 220-224
- 74 Naether O G, Baukloh V, Fischer R, Kowalczyk T. Long term follow up in 206 infertility patients with polycystic ovarian syndrome after laparoscopic electrocautery of the ovarian surface. Hum Reprod. 1994; 9 2342-2349
- 75 Kucuk M, Kilic-Okman T. Hormone profiles and clinical outcome after laparoscopic ovarian drilling in women with polycystic ovary syndrome. Med Sci Monit. 2005; 11 CR29-CR34
- 76 Bayram N, van Wely M, Kaajik E M, Bossuyt P M, van der Veen F. Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial. BMJ. 2004; 328 192
- 77 Cleemann L, Lauszus F F, Trolle B. Laparoscopic ovarian drilling as first line of treatment in infertile women with polycystic ovary syndrome. Gynecol Endocrinol. 2004; 18 138-143
- 78 Felemban A, Tan S L, Tulandi T. Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal. Fertil Steril. 2000; 73 266-269
- 79 Merchant R N. Treatment of polycystic ovary disease with laparoscopic low-watt bipolar electrocoagulation of the ovaries. J Am Assoc Gynecol Laparosc. 1996; 3 503-508
- 80 Pelosi 3rd M A, Pelosi M A. Laparoscopic electrosurgical furrowing technique for the treatment of polycystic ovaries. J Am Assoc Gynecol Laparosc. 1996; 4 57-62
- 81 Wu M H, Huang M F, Tsai S J, Pan H A, Cheng Y C, Lin Y S. Effects of laparoscopic ovarian drilling on young adult women with polycystic ovarian syndrome. J Am Assoc Gynecol Laparosc. 2004; 11 184-190
- 82 Amin A F, Abd el-Aal D E, Darwish A M, Meki A R. Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stromal blood flow, serum vascular endothelial growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome. Fertil Steril. 2003; 79 938-941
- 83 Am S A, Li T C, Cooke I D. Repeated laparoscopic ovarian diathermy is effective in women with anovulatory infertility due to polycystic ovary syndrome. Fertil Steril. 2003; 79 1211-1215
- 84 Tulandi T, Saleh A, Morris D, Jacobs H S, Payne N, Tan S L. Effects of laparosocpic ovarian drilling on serum vascular endothelial growth factor (VDGF) and on insulin responses to oral glucose tolerance test. Fertil Steril. 2000; 74 585-588
- 85 Zullo F, Pellicano M, Zupi E, Guida M, Mastrantonio P, Nappi C. Minilaparoscopic ovarian drilling under local anesthesia in patients with polycystic ovary syndrome. Fertil Steril. 2000; 74 376-379
- 86 Taskin O, Yalcinoglu A I, Kafkasli A, Burak F, Ozekici U. Comparison of the effects of ovarian cauterization and gonadotropin-releasing hormone agonist and oral contraceptive therapy combination on endocrine changes in women with polycystic ovary disease. Fertil Steril. 1996; 65 1115-1118
- 87 Tasaka K, Sakata M, Kurachi H, Komura H, Miyake A, Tanizawa O. Electrocautery in polycystic ovary syndrome. Horm Res. 1990; 33 40-42
- 88 Gadir A A, Khatim M S, Mowafi R S, Alnaser H M, Alzaid H G, Shaw R W. Hormonal changes in patients with polycystic ovarian disease after ovarian electrocautery or pituitary desensitization. Clin Endocrinol (Oxf). 1990; 32 749-754
- 89 Sumioki H, Utsunomyiya T, Matsuoka K, Korenaga M, Kadota T. The effect of laparoscopic multiple punch resection of the ovary on hypothalamo-pituitary axis in polycystic ovary syndrome. Fertil Steril. 1988; 50 567-572
Low-Tone HoM.D.
Department of Medical Research and Education
Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Taipei, Taiwan
Email: ltho@vghtpe.gov.tw