Published: 2021-09-27

Laparoscopic ovarian drilling in clomiphene resistant polycystic ovarian syndrome: clinical response and outcome

Jesmine Banu, Shakeela Ishrat, Farzana Deeba, Chowdhury Faisal Alamgir, Maliha Darmoni, Nurjahan Begum, Shaheen Ara Anawary


Background: Laparoscopic ovarian drilling (LOD) is an alternative method for ovulation induction in clomiphene citrate (CC) resistant polycystic ovary syndrome (PCOS) patients instead of gonadotropins. Objective were to identify the changes in clinical and biochemical profiles and the ovulation and pregnancy rate following LOD in CC resistant PCOS patients.

Methods: It was an interventional study infertility unit, department of obstetrics and gynecology, Bangabandhu Sheikh Mujib medical university, Dhaka, between from July 2014 to June 2015. Changes of the above-mentioned parameters were recorded during follow up of patients after LOD. The information is collected and recorded in the preset questionnaire.

Results: The characteristics of study population were same before LOD and following LOD. Before LOD, infrequent menstruation was present in 83.3% patients whereas regular menstruation was found in 58.3% patients after 6 months following LOD. Endometrial thickness ≤8 was found in 100.0% in before LOD and endometrial thickness >8 was found in 70.0% after 6 month following LOD. Ovulation was found in 25.0% in after 3-month LOD and was found in 70.0% after 6 months following LOD. Pregnancy was found in 20.0% after 3 months following LOD and 50.0% in after 6 months following LOD. Ovulation and pregnancy outcome was significantly higher in after 6 months following LOD.

Conclusions: LOD produces long-term improvement in menstrual regularity and reproductive performance. A sustained improvement observed in acne and BMI. Ovulation and pregnancy were found in 70% and 50.0% respectively after 6 months following LOD.


Laparoscopic, Ovarian drilling, Clomiphene resistant, PCOS

Full Text:



Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovarian syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000;85:2434-8.

Hull MG. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol. 1987;1:235-45.

Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update. 2003;9(6):505-14.

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 Consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.

Radwan J, Bielak A, Banaszczsk R, Pawlicki J. The effects of micro-laparoscopic ovarian electrocautery as a method of polycystic ovary syndrome treatment. Ginekol Pol. 2001;72(8):642-6.

Liguori G, Tolino A, Mocciia G, Scongnamiglio G, Nappi C. Laparoscopic ovarian treatment in infertile patients with polycystic ovary syndrome: endocrine changes and clinical outcome. Gynecol Endocrinol. 1996;10(4):257-64.

Amer SAK, Gopalan V, Li TC, Ledger WL, Cooke ID. Long term follow up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod. 2002;17:2035-2042.

Lemieux S, Lewis GF, Ben-Chetrit A, Steiner G, Greenblatt EM. Correction of hyperandrogenemia by laparoscopic ovarian cautery in women with polycystic ovary syndrome is not accompanied by improved insulin sensitivity or lipid lipoprotein levels. J Clin Endocrinol Metab. 1999;84(11):4278-82.

Felemban A, Tan SL, Tulandi T. Laparoscopic treatment of with insulated needle cautery: a reappraisal. Fertil Steril. 2000;73:266-9.

Tulandi T, Watkin K, Tan SL. Reproductive performance and three-dimensional USG volume measurements of polycystic ovary syndrome following laparoscopic ovarian drilling. Int J Fertil Womens med. 1997;42:436-40.

Abdel-Gadir A, Mowafi RS, Alnaser HMI, Alrashid AH, Alonezi OM, Shaw RW. Laparoscopic ovarian drilling versus Recombinant FSH therapy in the treatment of patients with polycystic ovarian syndrome. Clin Endocrinol. 1990;33:585-92.

Amer SAK, Li TC, Cooke ID. Laparoscopic ovarian diathermy in women with polycystic ovarian syndrome: a retrospective study on the influence of the amount of energy used on the outcome. Hum Reprod. 2002;17(4):1046-51.

Amer SAK, Li TC, Ledger WL. Ovulation induction using Laparoscopic ovarian drilling in women with polycystic ovarian syndrome: predictors of success. Hum Reprod. 2004;19:1719-24.

Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID. Factors affecting outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. Br J Obstet Gynecol. 1998;105:338-44.

De Frene V, Gerris J, Weyers S, Dhont M, Vansteelandt S, Annemans L et al. Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost- Effectiveness Analysis. Gynecol Obstet Invest. 2015;80(3):164-9.

Brown J, Farquhar C, Beck J, Boothroyd C, Hughes E. Clomiphene and anti-estrogens for ovulation induction in PCOS. Cochrane Database Systematic Reviews. 2009;4:CD002249.

National Collaborating Centre for Women's and Children's Health / National Institute for Clinical Excellence. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline London. UK. 2004;11.

Imani B, Eijkemans MJC, Velde ER, Habbema JD, Fauser BC. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normo-gonadotropic oligomenorrheic infertility. J Clin Endocrinol Metab. 1998;83(7):2361-5.

Parsanezhad ME, Alborzi S, Zarei A, Dehbashi S, Omrani G. Insulin resistance in clomiphene responders and nonresponders with polycystic ovarian disease and therapeutic effects of metformin. Int J Gynecol Obstetr. 2001;75(1):43-50.

Overbeek A, Kuijper EA, Hendriks ML, Blankenstein MA, Ketel IJ, Twisk JW et al. Clomiphene citrate resistance in relation to follicle-stimulating hormone receptor Ser680Ser-polymorphism in polycystic ovary syndrome. Human Reproduction. 2009;24(8):2007-13.

Mwan MD. Evaluation of compound optimality criteria for second order rotatable designs constructed using balanced incomplete block design (Doctoral dissertation, MOI university). 2017.

Shahrokhi M, Khorasani SK, Ebrahimi A. Study of genetic components in various maize (Zea mays L.) traits, using generation mean analysis method. Int J Agronomy Plant Product. 2013;4(3):405-12.

Radwan OK, Shehata AM. Comparison of the therapeutic actions of taurine, methyl sulfonyl methane and silymarin against acetaminophen-induced neuro-and hepato-toxicity in adult male albino rats. J biomed pharmaceutical res. 2016;5(3):10-7.