SURGICAL TREATMENT OF POLYCYSTIC OVARIES IN INFERTILE PATIENTS

Abstract

Background. Polycystic ovaries (PCO) are manifested either independently or as a syndrome (PCOS). They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO). The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S), in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3%) responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET) treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10) punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.Results. After LECO 99 (63.3%) of the 157 patients conceived, 56 (54.6%) spontaneously and 43 (45.4%) after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0%) patients with primary, and in 41 (41%) patients with secondary infertility, in 20 (57%) patients with PCO, 79 (65%) with PCOS, in 71 (64.1%) patients with a normal partner’s spermiogram, and in 28 (46.1%) patients with the partner’s oligoasthenoteratospermia of the 1st or 2nd degree. The differences were not statistically significant. Pregnancy ended with delivery in 87 (88.1%) patients, and in spontaneous abortion in 11 (11%); 1 (0.9%) pregnancy was ectopic. Singletons were born to 82 (82.9%) and twins to 5 (5.2%) patients, the latter to the patients receiving ovarian stimulation immediately after surgery. In the patients, enrolled in IVF-ET treatment for a failed hormonal and/or surgical treatment, the delivery rate per ET was 23.4% (19/48) in those with a previous LECO, and 12.9% (36/115) in those without a previous LECO (p < 0.05). No surgical complications were registered.Conclusions. LECO is an efficient treatment of infertility in patients with PCO(S). It results in high pregnancy and low spontaneous abortion rates, and reduces the risk of ovarian hyperstimulation syndrome following gonadotropin treatment.

Keywords

• polycystic ovaries
• infertility
• surgical treatment