PKOS'da Ovarian Drillinge Güncel Bakış
Yıl 2023,
Cilt: 20 Sayı: 4, 2031 - 2036, 31.12.2023
Nafiye Yılmaz
,
Cavide Ali Algan
,
Ruhat Karakuş
Öz
Polikistik over sendromu, üreme çağındaki kadınların yaklaşık 5–18%’ini etkileyen en yaygın endokrin problemdir ve anovulasyona bağlı infertiliteye yol açabilir. İnfertiliteye yönelik tedavilerde yaşam tarzı değişikliği ve kilo verme ilk basamak yaklaşımdır. Medikal tedavilerde birinci basamak tedavi yaklaşımı Klomifen Sitrat (KS) ile ovulasyon indüksiyonudur (Oİ), son yıllarda aromataz inhibitörlerinin (Aİ) de birinci basamak tedavide olmasına yönelik öneriler ve bulgular bildirilmektedir. Tekrarlı KS kullanımına rağmen % 25 oranda KS'a yanıt alınamayabilir, bu hasta grubu KS dirençli PKOS grup olarak tanımlanır. Bu hastalarda ovulasyon oranlarını artırmaya yönelik ikinci basamak tedavi yaklaşımları uygulanır. İkinci basamak tedavi yaklaşımları Gonadotropin ile Oİ olabileceği gibi Ovarian Drilling (OD) gibi cerrahi tedaviler de olabilir. Bu makalede OD konusundaki geçmiş ve güncel uygulamalar sunulacaktır.
Kaynakça
- 1.Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and
features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol
Metab 2004;89(6):2745–9.
- 2. Joham AE, Boyle JA, Ranasinha S, Zoungas S, Teede HJ. Contraception use and
pregnancy outcomes in women with polycystic ovary syndrome: data from the Australian
Longitudinal Study on Women’s Health. Hum Reprod Oxf Engl 2014;29(4):802–8.
10
- 3. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The
management of anovulatory infertility in women with polycystic ovary syndrome: an analysis
of the evidence to support the development of global WHO guidance. Hum Reprod Update.
2016; 22(6): 687-708.
- 4. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on
infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008; 23(3): 462-
477.
- 5. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003
consensus on diagnostic criteria and long-term health risks related to polycystic ovary
syndrome (PCOS). Hum Reprod. 2004; 19(1): 41-47.
- 6. Final Report National Institute of Health. Evidence-based Methodology Workshop on
Polycystic Ovary Syndrome. Executive summary at
https://prevention.nih.gov/sites/default/files/2018-06/ FinalReport.pdf. (3-5 Dec 2012).
- 7. Final Report National Institute of Health. Evidence-based Methodology Workshop on Polycystic Ovary Syndrome December 3–5, 2012 Executive summary at http://prevention.nih.gov/workshops/2012/pcos/resourc-es.aspx.
- 8. Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for
distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992;
41: 1257–66.
- 9. Moran LJ, Brinkworth G, Noakes M, Norman RJ. Eff ects of lifestyle modifi cation in
polycystic ovarian syndrome. Reprod Biomed Online 2006; 12: 569–78.
- 10. Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by
lifestyle modifi cation in obese polycystic ovary syndrome: role of insulin sensitivity and
luteinizing hormone. J Clin Endocrinol Metab 1999; 84: 1470–74.
- 11. Evidence-based guidelines for the assessment and management of polycystic ovary
syndrome. Jean Hailes for Women’s Health on behalf of the PCOS Australian Alliance;
Melbourne. https:// jeanhailes.org.au/contents/documents/Resources/Tools/PCOS_ evidence
based_guideline_for_assessment_and_management_ pcos.pdf. 2015.
- 12. Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial
of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome.
Hum Reprod. 2017; 32(8): 1631-1638.
- 13. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. american
association of clinical endocrinologists, american college of endocrinology, and androgen
excess and pcos society disease state clinical review: guide to the best practices in the
evaluation and treatment of polycystic ovary syndrome--part 2. Endocr Pract. 2015; 21(12):
1415-1426.
- 14. Imani B, Eijkemans MJ, Te Velde ER, Habbema JD, Fauser BC.Predictors of patients
remaining anovulatory during clomiphenecitrate induction of ovulation in
normogonadotropicoligomenorrheic infertility. J Clin Endocrinol Metab 1998; 83:2361–2365.
11
- 15. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility
inwomen with polycystic ovary syndrome: an analysis of the evidence to support
thedevelopment of global who guidance. Hum Reprod Update 2016;22:687–708.
- 16. Imani B, Eijkemans MJC, te Velde ER, et al. A nomogram to predict the probabilityof live
birth after clomiphene citrate induction of ovulation in normogonadotropicoligoamenorrheic
infertility. Fertil Steril 2002;77:91–7.
- 17.Nahuis MJ, Oude Lohuis EJ, Bayram N, et al. Pregnancy complications and
metabolicdisease in women with clomiphene citrate-resistantanovulation randomized
toreceive laparoscopic electrocautery of the ovaries or ovulation induction withgonadotropins:
a 10-yearfollow-up.Fertil Steril 2014;101:270–4.
- 18. Gjönnaess H , Polycystic ovarian syndrome treated by ovarian electrocautery through the
laparoscope. Fertil. Steril. 1984, 41, 20–25.
- 19. Stein, I.F.; Leventhal, M.L. Amenorrhea associated with bilateral polycystic ovaries. Am.
J. Obstet. Gynecol. 1935, 29, 181–191.
- 20. Abu Hashim, H.; Foda, O.; El Rakhawy, M. Unilateral or bilateral laparoscopic ovarian
drilling in polycystic ovary syndrome: A meta-analysis of randomized trials. Arch. Gynecol.
Obstet. 2018, 297, 859–870
- 21. Yu, Y.; Fang, L.; Zhang, R.; He, J.; Xiong, Y.; Guo, X.; Du, Q.; Huang, Y.; Sun, Y.
Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene
citrate-resistant polycystic ovary syndrome: A network meta-analysis. Sci. Rep. 2017, 7,
3812.
- 22. Sun, H.D.; Horng, H.C.; Liu, C.H.; Hsiao, S.M.; Chen, Y.J.; Chang, W.H.; Wang, P.H.
Comparison of single-port and three-port laparoscopic salpingectomy in the management of
tubal pregnancy. J. Chin. Med. Assoc. 2018, 81, 469–474.
- 23. Yang, J.; Song, Y.J.; Na, Y.J.; Kim, H.G. Two-port myomectomy using bag-contained
manual morcellation: A comparison with three-port myomectomy using power morcellation.
Taiwan J. Obstet. Gynecol. 2019, 58, 423–427.
- 24. Lee, Y.L.; Hsu, T.F.; Jiang, L.Y.; Chao, H.T.; Wang, P.H.; Chen, Y.J. Transvaginal
natural orifice transluminal endoscopic surgery for female-to-male transgender men. J.
Minim. Invasive Gynecol. 2019, 26, 135–142.
- 25. Amer, S.A.; Li, T.C.; Cooke, I.D. A prospective dose-finding study of the amount of
thermal energy required for laparoscopic ovarian diathermy. Hum. Reprod. 2003, 18,
1693–1698.
- 26. Balen, A.H.; Morley, L.C.; Misso, M.; Franks, S.; Legro, R.S.; Wijeyaratne, C.N.; Stener-
Victorin, E.; Fauser, B.C.; Norman, R.J.; Teede, H. The management of anovulatory
infertility in women with polycystic ovary syndrome: An analysis of the evidence to support
the development of global WHO guidance. Hum. Reprod. Update 2016, 22, 687–708.
12
- 27. Tsai, H.W.; Wang, P.H.; Yen, M.S.; Chao, K.C.; Hsu, T.F.; Chen, Y.J. Prevention of
postlaparoscopic shoulder and upper abdominal pain: A randomized controlled trial. Obstet.
Gynecol. 2013, 121, 526–531.
- 28. Tsai, H.W.; Chen, Y.J.; Ho, C.M.; Hseu, S.S.; Chao, K.C.; Tsai, S.K.; Wang, P.H.
Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: A
randomized controlled study. Arch. Surg. 2011, 146, 1360–1366.
- 29. Hafizi, L.; Amirian, M.; Davoudi, Y.; Jaafari, M.; Ghasemi, G.H. Comparison of
laparoscopic ovarian drilling success between two standard and dose-adjusted methods in
polycystic ovary syndrome: A randomized clinical trial. Int. J. Fertil. Steril. 2020, 13,
282–288.
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Current Approach in Ovarian Drilling in PCOS
Yıl 2023,
Cilt: 20 Sayı: 4, 2031 - 2036, 31.12.2023
Nafiye Yılmaz
,
Cavide Ali Algan
,
Ruhat Karakuş
Öz
Polycystic ovary syndrome is the most common endocrine problem affecting about 5-18% of women of reproductive age and can lead to infertility due to anovulation. Lifestyle change and weight loss are the first-line approaches in infertility treatment. The first-line treatment approach in medical treatments is ovulation induction (OI) with Clomiphene Citrate (CC), and in recent years, recommendations and findings have been reported for the use of aromatase inhibitors (AI) in first-line treatment. Despite repeated use of CC, there may be no response to CC at a rate of 25%, this group of patients is defined as a CC-resistant PCOS group. In these patients, second-line treatment approaches are applied to increase ovulation rates. Second-line treatment approaches can be OI with Gonadotropin, as well as surgical treatments such as Ovarian Drilling (OD). In this article, past and current practices on OD will be presented.
Kaynakça
- 1.Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and
features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol
Metab 2004;89(6):2745–9.
- 2. Joham AE, Boyle JA, Ranasinha S, Zoungas S, Teede HJ. Contraception use and
pregnancy outcomes in women with polycystic ovary syndrome: data from the Australian
Longitudinal Study on Women’s Health. Hum Reprod Oxf Engl 2014;29(4):802–8.
10
- 3. Balen AH, Morley LC, Misso M, Franks S, Legro RS, Wijeyaratne CN, et al. The
management of anovulatory infertility in women with polycystic ovary syndrome: an analysis
of the evidence to support the development of global WHO guidance. Hum Reprod Update.
2016; 22(6): 687-708.
- 4. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on
infertility treatment related to polycystic ovary syndrome. Hum Reprod. 2008; 23(3): 462-
477.
- 5. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003
consensus on diagnostic criteria and long-term health risks related to polycystic ovary
syndrome (PCOS). Hum Reprod. 2004; 19(1): 41-47.
- 6. Final Report National Institute of Health. Evidence-based Methodology Workshop on
Polycystic Ovary Syndrome. Executive summary at
https://prevention.nih.gov/sites/default/files/2018-06/ FinalReport.pdf. (3-5 Dec 2012).
- 7. Final Report National Institute of Health. Evidence-based Methodology Workshop on Polycystic Ovary Syndrome December 3–5, 2012 Executive summary at http://prevention.nih.gov/workshops/2012/pcos/resourc-es.aspx.
- 8. Dunaif A, Segal KR, Shelley DR, Green G, Dobrjansky A, Licholai T. Evidence for
distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes 1992;
41: 1257–66.
- 9. Moran LJ, Brinkworth G, Noakes M, Norman RJ. Eff ects of lifestyle modifi cation in
polycystic ovarian syndrome. Reprod Biomed Online 2006; 12: 569–78.
- 10. Huber-Buchholz MM, Carey DG, Norman RJ. Restoration of reproductive potential by
lifestyle modifi cation in obese polycystic ovary syndrome: role of insulin sensitivity and
luteinizing hormone. J Clin Endocrinol Metab 1999; 84: 1470–74.
- 11. Evidence-based guidelines for the assessment and management of polycystic ovary
syndrome. Jean Hailes for Women’s Health on behalf of the PCOS Australian Alliance;
Melbourne. https:// jeanhailes.org.au/contents/documents/Resources/Tools/PCOS_ evidence
based_guideline_for_assessment_and_management_ pcos.pdf. 2015.
- 12. Amer SA, Smith J, Mahran A, Fox P, Fakis A. Double-blind randomized controlled trial
of letrozole versus clomiphene citrate in subfertile women with polycystic ovarian syndrome.
Hum Reprod. 2017; 32(8): 1631-1638.
- 13. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E, et al. american
association of clinical endocrinologists, american college of endocrinology, and androgen
excess and pcos society disease state clinical review: guide to the best practices in the
evaluation and treatment of polycystic ovary syndrome--part 2. Endocr Pract. 2015; 21(12):
1415-1426.
- 14. Imani B, Eijkemans MJ, Te Velde ER, Habbema JD, Fauser BC.Predictors of patients
remaining anovulatory during clomiphenecitrate induction of ovulation in
normogonadotropicoligomenorrheic infertility. J Clin Endocrinol Metab 1998; 83:2361–2365.
11
- 15. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility
inwomen with polycystic ovary syndrome: an analysis of the evidence to support
thedevelopment of global who guidance. Hum Reprod Update 2016;22:687–708.
- 16. Imani B, Eijkemans MJC, te Velde ER, et al. A nomogram to predict the probabilityof live
birth after clomiphene citrate induction of ovulation in normogonadotropicoligoamenorrheic
infertility. Fertil Steril 2002;77:91–7.
- 17.Nahuis MJ, Oude Lohuis EJ, Bayram N, et al. Pregnancy complications and
metabolicdisease in women with clomiphene citrate-resistantanovulation randomized
toreceive laparoscopic electrocautery of the ovaries or ovulation induction withgonadotropins:
a 10-yearfollow-up.Fertil Steril 2014;101:270–4.
- 18. Gjönnaess H , Polycystic ovarian syndrome treated by ovarian electrocautery through the
laparoscope. Fertil. Steril. 1984, 41, 20–25.
- 19. Stein, I.F.; Leventhal, M.L. Amenorrhea associated with bilateral polycystic ovaries. Am.
J. Obstet. Gynecol. 1935, 29, 181–191.
- 20. Abu Hashim, H.; Foda, O.; El Rakhawy, M. Unilateral or bilateral laparoscopic ovarian
drilling in polycystic ovary syndrome: A meta-analysis of randomized trials. Arch. Gynecol.
Obstet. 2018, 297, 859–870
- 21. Yu, Y.; Fang, L.; Zhang, R.; He, J.; Xiong, Y.; Guo, X.; Du, Q.; Huang, Y.; Sun, Y.
Comparative effectiveness of 9 ovulation-induction therapies in patients with clomiphene
citrate-resistant polycystic ovary syndrome: A network meta-analysis. Sci. Rep. 2017, 7,
3812.
- 22. Sun, H.D.; Horng, H.C.; Liu, C.H.; Hsiao, S.M.; Chen, Y.J.; Chang, W.H.; Wang, P.H.
Comparison of single-port and three-port laparoscopic salpingectomy in the management of
tubal pregnancy. J. Chin. Med. Assoc. 2018, 81, 469–474.
- 23. Yang, J.; Song, Y.J.; Na, Y.J.; Kim, H.G. Two-port myomectomy using bag-contained
manual morcellation: A comparison with three-port myomectomy using power morcellation.
Taiwan J. Obstet. Gynecol. 2019, 58, 423–427.
- 24. Lee, Y.L.; Hsu, T.F.; Jiang, L.Y.; Chao, H.T.; Wang, P.H.; Chen, Y.J. Transvaginal
natural orifice transluminal endoscopic surgery for female-to-male transgender men. J.
Minim. Invasive Gynecol. 2019, 26, 135–142.
- 25. Amer, S.A.; Li, T.C.; Cooke, I.D. A prospective dose-finding study of the amount of
thermal energy required for laparoscopic ovarian diathermy. Hum. Reprod. 2003, 18,
1693–1698.
- 26. Balen, A.H.; Morley, L.C.; Misso, M.; Franks, S.; Legro, R.S.; Wijeyaratne, C.N.; Stener-
Victorin, E.; Fauser, B.C.; Norman, R.J.; Teede, H. The management of anovulatory
infertility in women with polycystic ovary syndrome: An analysis of the evidence to support
the development of global WHO guidance. Hum. Reprod. Update 2016, 22, 687–708.
12
- 27. Tsai, H.W.; Wang, P.H.; Yen, M.S.; Chao, K.C.; Hsu, T.F.; Chen, Y.J. Prevention of
postlaparoscopic shoulder and upper abdominal pain: A randomized controlled trial. Obstet.
Gynecol. 2013, 121, 526–531.
- 28. Tsai, H.W.; Chen, Y.J.; Ho, C.M.; Hseu, S.S.; Chao, K.C.; Tsai, S.K.; Wang, P.H.
Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: A
randomized controlled study. Arch. Surg. 2011, 146, 1360–1366.
- 29. Hafizi, L.; Amirian, M.; Davoudi, Y.; Jaafari, M.; Ghasemi, G.H. Comparison of
laparoscopic ovarian drilling success between two standard and dose-adjusted methods in
polycystic ovary syndrome: A randomized clinical trial. Int. J. Fertil. Steril. 2020, 13,
282–288.
- 30.Gordts, S., Campo, R., Rombauts, L., Brosens, I., 1998. Transvaginal hydrolaparoscopy as
an outpatient procedure for infertility investigation. Hum. Reprod. 13, 99–103.
- 31.Watrelot, A., Dreyfus, J.M., Andine, J.P., 1999. Evaluation of the performance of
fertiloscopy in 160 consecutive infertile patients with no obvious pathology. Hum. Reprod.
14, 707–711.
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of thermal energy required for laparoscopic ovarian diathermy. Hum. Reprod. 18, 1693–1698.
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