Surgical Ovulation Induction in Women with Polycystic Ovary Syndrome: A Systematic Review

Background: currently clomiphene citrate is the first-linetreatment to induce ovulation in women with polycystic ovariansyndrome (pcos). surgical therapy with laparoscopicovarian drilling (lod) may avoid or reduce the need for gonadotropins.objective: to determine the effectiveness and safety of lod compared with ovulation induction in subfertile women withclomiphene-resistant pcos.search strategy: a systematic search was performed on pub-med (1966 to august 2007), the ovid database (1966 to august2007), and embase (1974-2007). the search terms included:infertility, menstrual disorder, hirsutism, pcos, surgical intervention,electrocautery, electrocoagulation, diathermy, drilling,and laparoscopic ovarian drilling, ovulation, pregnancy rate,post operation adhesions and ovarian blood flow.selection criteria: randomized controlled trials of womenwith clomiphene-resistant pcos who were treated with lodto induce ovulation were included.data collection and analysis: 3141 patients from 35 trials preformed in different geographic settings were included. alltrials were assessed for quality criteria. we included those trialswhich followed hormonal changes, ovulation, and pregnancyrates after lod. the primary outcomes measured were hormonal changes, ovulation, and pregnancy rates as well asovarian artery blood flow, and the secondary outcome was rateof pelvic organ adhesion.main results: the overall ovulation rate after lod was79.2% (74.9%-83.5% 95% ci). of all women who ovulatedonly 66.6% (60.8%-72.4% 95% ci) conceived. the mean periadnexaladhesion rate was 22.7% (21.4%-24% 95% ci).conclusion: compared with medical therapy, lod has many advantages including: to be done once, no need for intensivemonitoring, no chance of multiple pregnancy or ovarianhyperstimulation syndrome. lod effectively decreases ovarian androgens and improves folliculogenesis and increases chanceof ovulation and pregnancy rate. finally, in vitro fertilisationshould be considered as the last resort.