Laparoscopic ”drilling” for ovulation induction in polycystic ovary syndrome

Laparoscopic drilling appears to have similar efficacy as gonadotrophin therapy in terms of live birth rate and miscarriage rate in the treatment of clomiphene resistant PCOS.

A Cochrane review included 25 studies with a total of 429 participants. Treatment consisted of laparoscopic ovarian "drilling" (LOD) in order to induce ovulation in subfertile women with PCOS. There was no evidence of a difference in live birth rate (9 trials, 1210 women) when compared with clomiphene citrate + tamoxifen (OR 0.81, 95% CI 0.42 to 1.53; 1 trial, n=150), gonadotrophins (OR 0.97, 95% CI 0.59 to 1.59; 2 trials, n=318), aromatase inhibitors (OR 0.84, 95% CI 0.54 to 1.31; 2 trials, n=407) or clomiphene citrate (OR 1.21, 95%CI 0.64 to 2.32; 1 trial, n=176). There was evidence of significantly fewer live births following LOD compared with clomiphene citrate + metformin (OR 0.44; 95% CI 0.24 to 0.82; I² 78%, 2 trials, n=159). Multiple pregnancy rates were lower with ovarian drilling than with gonadotrophins (1% versus 16%; OR 0.13, 95% CI 0.03 to 0.52; 5 trials, n=166). There was no evidence of a difference in miscarriage rates between the two groups.

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).

Ədəbiyyat

1. Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P. Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2007 Jul 18;(3):CD001122 [Review content assessed as up-to-date: 14 May 2012].