Objective: Although laparoscopic ovarian drilling (LOD) has been widely used to induce ovulation in infertile women with polycystic ovarian syndrome (PCOS), predicting the clinical response to this treatment remains unclear in Japanese women. This study aimed to determine the clinical responses to LOD calculated as total thermal doses per ovarian unit volume.
Material and Methods: This retrospective study included 47 patients with anovulatory infertility due to PCOS, which was diagnosed by criteria from the Japanese Society of Obstetrics and Gynecology in 2007, and who underwent LOD between 2008 and 2017.
This study evaluated the influence of patients’ pre-operative characteristics and the number of drillings (thermal doses) per ovarian unit volume (cm3) on ovulation, which occurred spontaneously or with up to 150 mg/day clomiphene citrate, after LOD. Multiple logistic regression analysis was used to identify independent predictors of ovulation after LOD.
Results: Thirty-eight patients (81%) had spontaneous or clomiphene citrate-induced ovulation after LOD.
The luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio, serum anti-Müllerian hormone and testosterone concentrations, antral follicle counts, and ovarian volume were significantly decreased, whereas serum concentrations of FSH increased (P<0.05) following LOD.
Multiple logistic regression analysis showed that a pre-operative LH/FSH ratio <1.5 and total drillings ≥1.8per ovarian unit volume (cm3) were independently associated with higher ovulation rates (P<0.05).
There were no major adverse peri-operative effects, such as blood transfusion, extension of hospitalization, and insufficiency of ovarian function.
Conclusion: LOD may be performed effectively and safely by evaluation of pre-operative bio-markers and total thermal doses per ovarian unit volume.
