Published date: Dec 14 2023

Journal Title: International Journal of Reproductive BioMedicine

Issue title: International Journal of Reproductive BioMedicine (IJRM): Volume 21, Issue No. 11

Pages: 901–908

DOI: 10.18502/ijrm.v21i11.14653

Ashraf Moinia_moini@royaninstitute.orgDepartment of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Tayebeh EsfidaniDepartment of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Arezoo ArabipoorDepartment of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.

Reihaneh HosseiniDepartment of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Shima MohitiDepartment of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.

Sakineh Noor MohammadiDepartment of Gynecology and Obstetrics, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject.

Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures.

Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women’s hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups.

Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups.

Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

 Key words: Laparoscopy, General surgery, Polycystic ovary syndrome, Embryo implantation, Immunology, Pregnancy outcome.

[1] Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110: 364–379.

[2] Wang R, Mol BWJ. The Rotterdam criteria for polycystic ovary syndrome: Evidence-based criteria? Hum Reprod 2017; 32: 261–264.

[3] Bordewijk EM, Ng KYB, Rakic L, Mol BWJ, Brown J, Crawford TJ, et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2020; 2: CD001122.

[4] Eskiyörük İ, Melekoğlu R, Çetin C, Ürünsak IF, Çetin MT. Laparoscopic ovarian drilling: Is it a safe alternative of gonadotropin treatment for second-line therapy in patients with polycystic ovary syndrome resistant to clomiphene citrate? 25th European Congress of Obstetrics and Gynaecology and 15th Congress of Turkish Society of Obstetrics and Gynaecology; 17–21 May 2017; Turkey.

[5] Xu B, Zhou M, Cheng M, Zhang D, Wu X, Si C, et al. Transvaginal ovarian drilling followed by controlled ovarian stimulation from the next day improves ovarian response for the poor responders with polycystic ovary syndrome during IVF treatment: A pilot study. Reprod Biol Endocrinol 2020; 18: 7.

[6] Eftekhar M, Dehghani Firoozabadi R, Khani P, Ziaei Bideh E, Forghani H. Effect of laparoscopic ovarian drilling on outcomes of in vitro fertilization in clomiphene-resistant women with polycystic ovary syndrome. Int J Fertil Steril 2016; 10: 42–47.

[7] Azzam MEED, Mohamed MEDM, Taha MO, Abozeid I. The effect of laparoscopic ovarian drilling on anti-Müllerian hormone, LH/FSH ratio and inhibin B. Evid Based Women’s Health J 2020; 10: 37–45.

[8] Hashim HA. Management of women with clomifene citrate resistant polycystic ovary syndrome-an evidence based approach. Polycystic Ovary Syndrome 2012; 7: 1–22.

[9] Mitra S, Nayak PK, Agrawal S. Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome. J Nat Sci Biol Med 2015; 6: 40–48.

[10] Moazami Goudarzi Z, Fallahzadeh H, Aflatoonian A, Mirzaei M. Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis. Iran J Reprod Med 2014; 12: 531–539.

[11] Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharmaceutical Statistics 2005; 4: 287–291.

[12] Yanamandra NK, Gundabattula SR. Outcome of ovarian drilling in women with polycystic ovary syndrome. J Clin Diagn Res 2015; 9: QC01–QC03.

[13] Abu Hashim H. Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: An evidence-based approach. Arch Gynecol Obstet 2015; 291: 11–18.

[14] Rimington MR, Walker SM, Shaw RW. 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.

[15] Ferraretti AP, Gianaroli L, Magli MC, Iammarrone E, Feliciani E, Fortini D. Transvaginal ovarian drilling: A new surgical treatment for improving the clinical outcome of assisted reproductive technologies in patients with polycystic ovary syndrome. Fertil Steril 2001; 76: 812–816.