Study objective: To analyze the efficacy of laparoscopic ovarian drilling using monopolar diathermy in women with anovulatory infertility with clomiphene-resistant polycystic ovary syndrome (PCOS), and to determine factors influencing pregnancy rate and pregnancy outcomes.
Design: Prospective study (Canadian Task Force classification II-2).
Setting: Infertility clinic in a tertiary referral teaching hospital.
Patients: Seventy women with clomiphene-resistant PCOS.
Intervention: Laparoscopic ovarian drilling, with follow-up for 4.5 years.
Measurements and main results: Follow-up data, which were available for 66 patients, showed a spontaneous ovulation rate of 81.8%, cumulative ovulation rate of 93.9%, and pregnancy rate of 54.5%. Successful pregnancies were commonly complicated by gestational diabetes mellitus and pregnancy-induced hypertension. Pregnancy rates (23.5%) were low in women with tuboperitoneal disease and those whose partners had subfertile male factors. Statistical evaluation using a proportion test (Z test) and multivariable logistical regression analysis showed that elevated luteinizing hormone levels (>10 IU/L), short duration of infertility (<3 yrs), and absence of preexisting tubal disease were associated with better outcomes.
Conclusion: Laparoscopic ovarian drilling is an effective surgical procedure in women with clomiphene-resistant PCOS.