Page 9 - World Journal of Laparoscopic Surgery

Laparoscopic Ovarian Drilling, Clomiphene-resistant PCOS, Treatment Outcome
2/3 FSH and LH, and Day 21 serum progesterone assay were done Table 1: Baseline characteristics of patients
in patients with spontaneous menses post-LOD to assess for Variables Frequency (n = 43) Percentage
ovulation. Subsequent ovulation monitoring was done by either Age (years)
follicular tracking with TVS or the use of ovulation prediction kits
from day 10 to 16 of the cycle. Patients who resumed spontaneous 21–25 18 41.9
ovulation were observed for 6 months for conception to occur while 26–30 8 18.6
on ovulation monitoring and timed intercourse (TI). After that, 31–35 6 14.0
we subjected to either superovulation induction (SI) with timed >35 11 25.5
intercourse (TI) or intrauterine insemination (IUI) on case-to-case Range 21–43 Mean = 29.5 ± 4.8
basis. We offered patients who failed to conceive by these methods Type of infertility
IVF. Patients who failed to ovulate following LOD will use other forms Primary 30 69.8
of second-line management of PCOS. Secondary 13 30.2

Ethical Consideration Infertility duration (years)
We obtained ethical clearance for this study from the Bowen 1–5 22 51.2
University Teaching Hospital’s ethical review board, Ogbomoso. 6–10 14 32.6
During data collection, we informed the individual patient about >10 7 16.2
the purpose of the study, confidentiality, and the right not to Range 1–18 Mean = 6.0 ± 3.7
participate or withdraw at any time without affecting their health Social class
or other services. We obtained written consent from each of the Upper 7 16.2
participants before the commencement of the study.
Middle 8 18.6
Low 28 65.2
results Irregular cycles
We analyzed the patients’ characteristics, hormonal profile, and Yes 40 93
the outcome of 43 eligible patients. Of the 430 patients who had
infertility consultation at our facility, we diagnosed 80 (18.6%) as a No 3 7
PCOS case. Forty-three (53.8%) patients with clomiphene citrate- Altered LH/FSH ratio (≥2.0)
resistant PCOS underwent LOD. We followed the patients up for an Yes 28 65.2
average duration of 11.2 ± 6.3 months (range 9–36 months), during No 15 34.8
which we lost four (9.3%) patients to follow-up. The patients aged Mean = 3.9 (±1.8)
2
21–43 years with a mean age of 29.5 ± 4.8 years. Thirty (69.8%) BMI (kg/M )
had primary infertility, 39 (90.7%) were nulligravida, while 28 (65%) <25 2 4.7
belonged to low social class. The duration of infertility ranged from 25–29 18 41.9
1 to 18 years (6.5 ± 3.7). We recorded irregular cycles in 40 (93%)
patients, while 28 (65.1%) had altered LH–FSH ratio (>2.0). The Body ≥30 23 53.4
2
Mass Index (BMI) ranged from 24.3 to 39.7 kg/m (26.3 ± 8.5). The Range 24.3–39 Mean = 30.3 (3 ± 6.5)
number of drills per ovary ranged from 4 to 10 (6.5 ± 2.7).
Thirty (76.9%) of the remaining 39 patients with irregular cycles
resumed regular menses with spontaneous ovulation with a mean Table 2: Outcome variables studied in the patients
duration of 5.2 ± 2.6 days and 3.4 ± 2.3 weeks, respectively. Most
of those who resumed regular menses (66.7%) did so within 4 to Outcome variables Frequency Percentage
6 days post-LOD. Twenty-three (59%) patients had spontaneous Resumption of spontaneous regular menses/ovulation
conception (mean time of conception post drilling was 4.8 ± 1.6 Yes 30 76.9
months). Four patients (10.3%) of 39 had an early first-trimester No 9 23.1
miscarriage and 19 (48.7%) successful delivery. There was no record Total 39 100.0
of complication of laparoscopy, multiple pregnancies, or ovarian Clinical pregnancy
hyperstimulation syndrome (OHSS). Yes 23 59.0
There was a significant association between failed LOD and
2
maternal age above 35years (χ = 10.063, p value = 0.004), ≥5 years No 16 41.0
2
of infertility (χ = 4.587, p value = 0.036), and moderate to morbid Total 39 100.0
2
obesity(χ = 6.453, p value = 0.012). Conception after drilling (in months) n = 23
According to the logistic regression, women who were aged 1–3 4 10.3
35 years and above were twice more likely to have failed LOD than 4–6 12 52.2
their younger age-group (OR = 2, CI = 1.5–45, p value = 0.003). ≥7 7 37.5
Women with altered LH/FSH (i.e., ratio > 2.0) were twice less likely Mean time of conception post-drilling 4.8 ± 1.6 months
to have failed LOD compared to those without altered LH/FSH Pregnancy outcome
(OR = 0.5, CI = 0.1–0.8, p value = 0.004). Other predictors of failed
LOD were infertility duration of 5 years and above (OR = 3, CI = Miscarriage 4 10.3
2.2–6.7, p value = 0.005), obesity (OR = 4, CI = 2–6, p value = 0.002) Live birth 19 48.7
(Tables 1 to 4). Total 23 59.0

World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020) 103