多嚢胞性卵巣症候群に対する腹腔鏡下卵巣多孔術の治療成績と効果予測因子の検討

抄録

Objective: Polycystic ovary syndrome (PCOS) is one of the causes of ovulatory disorders and infertility. Clomiphene citrate is the first-line treatment for PCOS patients. Gonadotropin therapy or laparoscopic ovarian drilling (LOD) is recommended as the second-line treatment for clomiphene resistant PCOS. Which cases respond to LOD remain unclear. In this study, we examined predictors of successful LOD to clarify the position of LOD in the treatment strategy for PCOS.

Materials and Methods: This study included 19 anovulatory women with clomiphene-resistant PCOS who underwent LOD between September 2012 to June 2016. We retrospectively examined patients in an ovulatory group (n = 15) and a non-ovulatory group (n = 4) in terms of age, luteinizing hormone level, follicle-stimulating hormone level, body mass index, anti-Müllerian hormone level, and number of drillings.

Results: Fifteen (78.9%) of 19 patients regained spontaneous ovulation after LOD. The pregnancy rate was 63.2% (12/19). After LOD, ovulatory group had a significantly lower preoperative AMH than the non-ovulatory group (9.71 ng/ml vs 20.70 ng/ml, p = 0.0227). At a cutoff of 12.7 ng/ml, AMH had a sensitivity of 76.9% and a specificity of 100% in the prediction of non-ovulation after LOD.

Conclusion: Laparoscopic ovarian drilling is an effective treatment for clomiphene-resistant PCOS. AMH is suggested to be a useful predictor of ovulation after LOD.