The first established treatment for anovulatory women having polycystic ovarian syndrome (PCOS) who failed to respond to medical treatment was laparoscopic ovarian wedge resection. Since then, the risk of adhesion formation has prompted the development of less invasive surgical procedures such as ovarian wedge resection by minilaparotomy. This study compared the risk of adhesion formation in 37 anovulatory infertile women with PCOS who had failed to respond to clomiphene citrate and who had ovarian wedge resection by minilaparotomy (group I), and 39 others who underwent laparoscopic ovarian electrodrilling (group II). All participants had a second-look laparoscopy 1 week after the initial procedure. Adhesion formation was assessed using the American Fertility Society classification. The 2 treatment groups were similar demographically and with respect to serum gonadotropin levels.
Three women in group II (7.7%) had periovarian adhesions. In contrast, 81% of group I women had periovarian adhesions, and 54% and 46%, respectively, had intra-abdominal and uterine adhesions. Adhesions at all 3 sites were significantly more frequent in group I women, and AFS adhesion scores differed significantly between the 2 surgical groups. Postoperatively, all the women ovulated spontaneously or with clomiphene therapy. Nearly 60% of women in group I and 87% of group II women conceived a child within a year after surgery. The difference in pregnancy rates was statistically significant. The interval from surgery to pregnancy was significantly shorter in group II women (4.4 vs. 6.5 months). There were no complications in either group, but group II women lost significantly more blood during surgery.
The investigators conclude that laparoscopic ovarian electrodrilling should be considered at an early stage for infertile women with PCOS who have not responded to clomiphene citrate.
Department of Obstetrics and Gynecology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Ohtsu, Shiga, Japan; and Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Japan
Gynecol Surg 2007;4:25–30