Laparoscopic ovarian re-electro cautery versus ovulation induction with FSH for persistant anovulation after laparoscopic PCOS treatment

Objectives: To determine the effectiveness and safety of either another laparoscopic ovarian drilling or purified urinary FSH for induction of ovulation in PCOS patients who were treated previously by laparoscopic electrocautary but still anovulatory.
Design: Comparative prospective clinical study between two groups of anovulatory infertile women after laparoscopic electrocutary.
Setting: Infertility treatment unit in Assiut University Hospital, Assiut, Egypt.
Patients:Fifty five patients treated previously by laparoscopic ovarian drilling for anovulatory PCOS infertility and still anovulatory and infertile after six months at least from the procedure were included in this study.
Intervention: Thirty patients exposed to another laparoscopic ovarian drilling (group A) and 25 patients were stimulated by purified FSH for 3 cycles (group B).
Main Outcome measures: Pelvic adhesions, Hormonal profile, Ovulation rate and Pregnancy rate were estimated.
Results: Pelvic adhesions were found in 27.2% of patients, hormonal profile showed considerable change toward normal values in the group of patients who were exposed to another laparoscopic drilling, while there were slight changes in patients who were subsequently subjected to FSH stimulation.
Within three stimulated cycles ovulation occurred in 16 patients (53.3%) in drilling group after clomiphene citrate compared to 18 patients (72%) in FSH stimulated group. The pregnancy rate per cycle was very low (3.8% per cycle in all included patients and 6.6% per patient). The pregnancy rate per cycle was 2.2% in group A and 5.7% in group B and the cumulative pregnancy rate per patient was higher in FSH group (16%) versus 6.6% in the redrilling group. All pregnancies occurred in stimulated cycles.
Conclusion: Ovarian stimulation with purified FSH gave better ovulation and pregnancy rate than ovarian laparoscopic redrilling followed by clomiphene citrate stimulation. Although the ovulation rate of both procedures was to some extent high; yet the pregnancy rate was low and this should be discussed with the patients during counseling. Another laparoscopic redrilling is followed by low pregnancy rate and possible hazards of adhesion formation.

Keywords
polycystic ovary, infertility, induction of ovulation, second look laparoscopy, clomiphene citrate failure, laparoscopic re-electrocautary.