ovarian drilling

PCOS AND INFERTILITYPCOS (Polycystic Ovarian Syndrome) is a condition that affects as manyas 10% of all women, or more. While researchers have been able todefine a fairly consistent set of symptoms for PCOS, they have notfound a singe cause, as of yet. It is a leading cause of infertility,and no cure has yet been found. The most common symptoms include:* Irregular menstrual cycles, or even the lack of cycles* Multiple ovarian cysts in many cases* Elevated blood pressure* Acne* Insulin resistance, or even diabetes* Infertility* Increased body and facial hair, along with alopecia (loss of hair)* Weight problems(From the Polycystic Ovarian Syndrome Associationhttp://www.pcosupport.org/medical/whatis.php)Other conditions that a physician may consider are “Cushing’s disease(overactive adrenal gland), thyroid problems, congenital adrenalhyperplasia or increased prolactin production by the pituitary gland.”Blood tests ordered may include thyroid functions, prolactin levels,17-hydroxyprogesterone, and a dexamethasone suppression test. In manycases PCOS sufferers will have elevated androgen (male hormone) levelsso these hormones will be tested as well. Insulin resistance is also aproblem so a two-hour glucose tolerance test will probably beperformed. Women with PCOS also have a number of cardiac complicationsso tests such as cholesterol, homocysteine, CRP, and PAI-1 levels maybe obtained to assess their cardiac risk factors.(From the Georgia Reproductive Specialists, http://www.ivf.com/pcostreat.html)Both of these sites have information regarding basic treatments forPCOS as well as brief introductions into various reproductivetechnologies. Since you have asked about a few things in particular, Iwill focus my detailed explanation on these three.- - - - - - - - - - - - - - - - - - - -OVARIAN DRILLINGOvarian drilling is a laparoscopic procedure, where instruments areintroduced through very small incisions in the abdomen, and thesurgeon uses a camera to guide him or her. A small needle puncturesthe cyst in the ovary, and then an electrical current is used todestroy part of the cyst. At Pregnancy-info.net, they state thatsuccess rates are less than 50%, but they do not specify what outcomesdetermine “success” in their opinions. At any rate, side effects, suchas scarring, could further impact the ability to become pregnant inthe long run.http://www.pregnancy-info.net/infertility_PCOS.htmlA study published in the British Journal of Obstetrics and Gynaecologyin March 1998 discusses success rates in achieving pregnancy afterovarian drilling. The study enrolled 118 women with documented casesof PCOS and then performed the procedure on them over a five-yearperiod. The total conception rate within the first 12 months after theprocedure was 54%. Women who successfully conceived had had “a shorterduration of infertility, were treated with diathermy (rather thanlaser), had higher pre-operative luteinising hormone [LH] levels, wereyounger and were more likely to have ultrasonographic evidence ofpolycystic ovarian disease.” When considering only women who had beeninfertile for 3 years or less prior to the procedure, the success rateincreases to 79%.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9532997&dopt=AbstractIn March 2005 a study regarding laparoscopic ovarian drilling (LOD)was published in the European Journal of Obstetrics, Gynecology, andReproductive Biology. In this study 45 women who had beenunsuccessfully treated with clomiphene (Clomid) were selected toundergo LOD. “Serum testosterone (T), follicle stimulating hormone(FSH) and luteinizing hormone (LH), fasting insulin and glucoselevels, body mass indexes, modified Ferriman Gallwey (FG) hirsutismscores of the subjects are recorded before and after the procedure.”After LOD, 93.3% of the women reported normal menstrual cycles, and64.4% achieved pregnancy spontaneously. “The serum levels of T, freeT, LH, LH:FSH ratio, insulin and FG scores were significantly reducedafter LOD, although glucose levels and glucose/insulin ratio remainedunchanged.”http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15734089&dopt=AbstractA smaller study was performed in 2002 at the Ayub Medical College inAbbottabad and the Khyber Medical College in Peshawar, both inPakistan. Sixteen women with PCOS were selected to undergo LOD. Theyall had a full infertility workup before the procedure, including a6-month trial of clomiphene. After the procedure 14 (87.5%) women hadregular menstrual cycles and 11 (68.8%) achieved pregnancy.http://www.ayubmed.edu.pk/JAMC/PAST/15-4/Azizun.htmIn a study published in 2004 in Human Reproduction, they list factorsrelated to pregnancy success after LOD. They state that, “markedobesity, marked hyperandrogenism and/or long duration of infertilityin women with PCOS seem to predict resistance to LOD. High LH levelsin LOD responders appear to predict higher probability of pregnancy.”http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15178663&query_hl=6&itool=pubmed_docsumA study reviewed in the Cochrane Database in 2006 shows no significantdifference in pregnancy rates after LOD versus treatment withgonadotropins (LH, FSH, HMG, etc.). About 50% of women will have alive birth and about 16% will have a miscarriage after achievingpregnancy. There were fewer multiple births associated with LOD,however.http://www.cochrane.org/reviews/en/ab001122.htmlA 2003 review article in Reproductive Biology and Endocrinologydiscusses various treatment options for infertility and PCOS. Theauthors reviewed multiple studies and compiled the data to determineoverall success rates. They report that 82% of women in the studiesexperienced ovulation following LOD and 63% achieved pregnancy. Thisdata compares favorably with a similar Cochrane review. The authorsalso state that if ovulation has not been achieved spontaneously after2-3 months following LOD, adding an ovulation stimulator (likeclomiphene) is more successful at this point than it would have beenbefore LOD.http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=14617367Other patient information sites seem to report the same 50% successrate for LOD (although I did see rates as high as 75% after 3 years).For the most part, it looks as though they are using birth rate ratherthan pregnancy rate to determine this success. This is the statisticthat will be most important to patients.http://www.womens-health.co.uk/infertility6.asphttp://www.ivf-infertility.com/infertility/treatment/ovarian11.phphttp://www.conceivingconcepts.com/medical/askthedoc/polycystic_ovaries/http://health.ivillage.com/gyno/gynoovaries/0,,677r,00.html