Comparing the effectiveness of laparoscopic ovarian drilling and gonadotropins inachieving pregnancy in clomiphene citrate-resistant polycystic ovarian patients

Öz

Aim: We aimed to compare laparoscopic ovarian drilling with gonadotropins in terms of efficacy and pregnancy outcomes in second-line therapy of infertile patients with clomiphene citrate resistant polycystic ovary syndrome. Materials and Methods: A total of 145 clomiphene citrate resistant voluntary participants with polycystic ovary syndrome who were met the study criteria and whose ages were ranging 20 to 35 years were recruited and registered between June 2017 and December 2019. The patients were divided into two groups; laparoscopic ovarian drilling was applied to the study group consisting of 56 individuals and low-dose step-up protocol was initiated to gonadotropin-induced group consisting of 89 patients. Multiple regression analysis was applied to investigate the possible associations between laboratory parameters and live birth rate. Differences among groups were assessed by using Student’s t test. P value <0.05 was considered significant. Results: Age, body mass index and duration of infertility were similar in both groups (p=0.35, p=0.56, p=0.067). There was no difference between the groups in terms of fasting glucose and insulin levels, hormone and androgen profile, antral follicle count, level of hemoglobin A1c (Hba1c), hirsutism score, LH/FSH ratio and anti-mullerian hormone (AMH) levels.AMH, antral follicle count (AFC), adrogen indexes and LH / FSH rates were lower in group 1 after six months of treatment (p=0.011, p<0.001, and p=0.002, respectively). Although clinical pregnancy and abortion rates were higher in group 1, live birth rates were similar between groups. Conclusion: At the end of six months treatment; although live births ratio between groups were similar in clomiphene citrate-resistant PCOS patients, we found that androgen indexes, anti-mullerian hormone, LH/FSH ratio, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS) rate were significantly lower in LOD group so when considering the second-line treatment options of PCOS patients resistant to clomiphene citrate LOD may be more suitable preference.

Anahtar Kelimeler

• Anti-mullerian hormone
• Clomiphene citrate resistance
• laparoscopic ovarian drilling

Klomifen sitrata dirençli polikistik over sendromunda ikincil tedavi olarak laparoskopik over drilling ve gonadotropinlerle ovulasyon indüksiyonunun etkinliğinin karşılaştırılması

Öz

Amaç: Klomifen sitrata dirençli polikistik over sendromlu infertil hastaların ikinci basamak tedavisinde; laparoskopik ovaryan drilling ile gonadotropinlerin etkinlik ve gebelik sonuçlarını karşılaştırmayı amaçladık. Gereç ve Yöntem: Haziran 2017 ile Aralık 2019 tarihleri arasında, polikistik over sendromlu toplam 145 klomifen sitrata dirençli gönüllü katılımcı çalışmaya dahil edildi. Hastalar iki gruba ayrıldı ; 56 hastaya laparoskopik over drilling uygulandı , 89 hastaya ise gonadotropin ile indüksiyon yapıldı. Her 2 grup laboratuar parametreleri ve gebelik sonuçları açısından kıyaslanarak değerlendirildi. Bulgular: Her iki grupta yaş, vücut kitle indeksi ve infertilite süresi benzerdi (p=0.35, p=0.56, p=0.067). Gruplar arasında açlık glukoz ve insülin düzeyleri, hormon ve androjen profili, antral folikül sayısı, hemoglobin A1c düzeyi (Hba1c), hirsutizm skoru, LH/FSH oranı ve anti-müllerian hormon (AMH) düzeyleri açısından fark bulunmadı. AMH, antral folikül sayısı (AFC), adrojen indeksleri ve LH/FSH oranları, altı aylık tedaviden sonra LOD grubunda daha düşüktü (sırasıyla, p=0.011, p<0.001 ve p=0.002). LOD grubunda klinik gebelik ve abortus oranları daha yüksek olmasına rağmen canlı doğum oranları gruplar arasında benzerdi. Sonuç: Altı aylık tedavi sonunda, her 2 grupta canlı doğum oranları benzer olmasına rağmen, LOD grubunda androjen indeksleri, anti-müllerian hormon, LH/FSH oranı, çoğul gebelikler ve over hiperstimülasyon sendromu (OHSS) oranının anlamlı olarak daha düşük olduğunu bulduk. Klomifen sitrata dirençli PKOS hastalarının ikinci basamak tedavi seçenekleri düşünüldüğünde LOD de uygun bir tercih olabilir

Anahtar Kelimeler

• Anti-müllerian hormon
• Klomifen sitrat direnci
• laparoskopik over drilling

Kaynakça

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