Effect Analysis Of Laparoscopic Ovarian Drilling In Treatment Of Clomiphene-resistant Polycystic Ovary Syndrome

ObjectiveTo evaluate the efficacy and ovarian reserve after laparoscopic ovarian drilling intreatment of clomiphene-resistant polycystic ovary syndrome.Methods1) Research Object The clinical data of43inpatients who wereclomiphene-resistant polycystic ovary syndrome underwent laparoscopic ovariandrilling from March2008to March2013, in Gynecologic of The Guangzhou FirstMunicipal People’s Hospital Affiliated to Guangzhou Medical College. Thepatients’average age was27.03±3.31, ranging from22to39; their averageinfertility duration was3.71±1.81years,ranging from2to10years. There were32cases in the form of oligomenorrhea,11cases of amenorrhea. There were30patients with primary infertility and13cases of secondary infertility.2) Inclusion Criteria Objects should meet the following two criterion. First,they were clomiphene-resistant polycystic ovary syndrome. The drugs includedclomiphene citrate, gonadotropins and letrozole. Among them, clomiphene citratewas used100mg/d for five days at the fifth days of menstruation or drugwithdrawal bleeding at least three cycles,or had used other induce-ovulation such as gonadotropins and letrozole.Second,they were ruled out other infertility factorssuch as fallopian tube obstruction, endometriosis and immune diseases pre-orintra-operative.Meanwhile,their spouse semen were normal.3) Research Method All clomiphene-resistant PCOS who eliminated operationcontraindication had an laparoscopic surgery in condition of intubationanesthesia.The laparoscopic surgery included bilateral ovarian drilling,hydrotubation, taking bilateral ovarian tissue each little in order to send pathologicexamination and make clear diagnosis.The operation should be done atmenstruation or drug withdrawal bleeding clean3to7days, and patients shouldhave no intercourse before operation.4) Observation and Measures First, all patients were given clomiphene tablets(100mg, qd, per5days as a course) to stimulate ovulation from the5thday ofmenstrual cycle or medical withdrawal bleeding. From the eleventh day of themenstrual cycle, we began to monitor the follicular growth, development andovulation by vaginal B ultrasonography and guide her intercourse. We gave lutealsupport therapy if patients had pregnant; If not,we gave clomiphene tablets asabove for three treatment cycles. Second, we draw blood examination of fivehormone respectively on2-5days11:00am of menstrual cycle or medicalwithdrawal bleeding at preoperative one month, postoperative one,three and sixmonth; at the same time, monitored mean ovarian volume(MOV) and meanfollicle number(MFN) by vaginal ultrasound on5-6days.Third,we observed allpatients’ ovulation, pregnancy and menstrual changes at least1year follow-uptime.Result1. Laparoscopic View We saw that bilateral ovaries of clomiphene-resistantPCOS patients were pale,cortical thickening, increase uniformity of symmetry,and their surface had multiple small outstanding follicular cyst,but no signs ofovulation. And the pathological results from ovarian tissue was accord with polycystic ovary change.2. Comparison of hemorrhagic hormone five pre-and post-operation1) Luteinizing hormone (LH): The LH of postoperative one,three and six monthswere decreasing markedly than the one of preoperative one month,and thedifference were statistically significant (P<0.05).2) Testosterone (T): The T of postoperative one,three and six months weredecreasing markedly than the one of preoperative one month,and the differencewere statistically significant (P<0.05).3) Follicle Stimulating Hormone(FSH), Estrogen (E2) and Prolactin (PRL):Therewere no difference between postoperative one,three,six months andpreoperative one month, and there was no statistically significant difference(P>0.05).3. Comparison of mean ovarian volume(MOV) and mean follicle number(MFN)pre-and post-operation1) Mean Ovarian Volume(MOV): The MOV of postoperative one month wasdecreasing markedly than the one of preoperative one month, and the differencewas statistically significant (P<0.05).Meanwhile,the MOV of postoperativethree, six month had a little decrease than the one of preoperative one month,and there were no statistically significant difference (P>0.05).2) Mean Follicle Number(MFN):The MFN of postoperative one, three monthswere decreasing markedly than the one of preoperative one month, and thedifference were statistically significant (P<0.05).Meanwhile,the MFN ofpostoperative six month had a little decrease than the one of preoperative onemonth, and there was no statistically significant difference (P>0.05).4. Menstruation, Ovulation and Pregnancy after surgery1) Menstruation: After given Clomiphene tablets (100mg, qd, per5days as acourse) treatment from the fifth day of the menstrual cycle or drug withdrawalbleeding after operation three course, menstruation patterns of the38caseswere improved. Preoperative menopause10patients,8cases of postoperativerecovery normal menstruation,2cases of became oligomenorrhea.28cases of preoperative oligomenorrhea,27cases of postoperative period back to normal,1case of menstruation still oligomenorrhea, but the menstrual cycle reduced to2-3months from4-6months.2) Ovulation Outcomes: Given Clomiphene treatment as above three cycles afteroperation, there was a total of98menstrual cycle ovulation, and the ovulationrate was as high as87.5%(98/112).3) Pregnancy Outcomes: Given Clomiphene treatment as above three cycles afteroperation at least three cycles, postoperative, there was18cases of pregnancy,which was included3case missing abortion,and the pregnancy rate abortionrate were47.4%(18/38) and22.2%(3/18). There was no multiple pregnancy inthe18cases of patients.Conclusion1. LOD can reduce the level of luteinizing hormone (LH) and testosterone (T).2. LOD can improve the reactivity of ovarian to citrate clomiphene.3. LOD won’t destroy the ovarian reserve capacity.