Laparoscopic Ovarian Drilling in Metformin and Clomiphene Resistant Women with Polycystic Ovarian Syndrome

The study aimed to evaluate the effectiveness of laparoscopic ovarian drilling (LOD) on ovulation and restoration of menstrual cycles and pregnancy. This cross sectional study was conducted on 81 consecutive Polycystic Ovarian Syndrome (PCO) patients whom were referred to Avesina Infertility clinic during 2003-2006. Exclusion criteria were tubal and male factor infertility, hyperprolactinemia, thyroid disease and diabetes mellitus. Patients with the age range of 20-35, body mass index of less than 35 kg/m2, failure to ovulate during at least three cycles of Clomiphene Citrate (CC) consumption and more than 12 months of ovulatory factor infertility entered the study. Metformin was used for at least 8 weeks in combination with CC. Forty four PCO women who had not ovulated after medical therapy with combination of CC and Metformin were selected for LOD. The data was analyzed with SPSS software using t- test and logistic regression analysis. P<0.05 was considered statistically significant. Patients aged 28.9±2.3 years with infertility duration of 4.8±2.3years and BMI of 28±3.3 kg/m2. Effectiveness of medical therapy significantly was related to BMI (P<0.001). After LOD, ovulation occurred in 14 cases (31.8%), restoration of menstrual cycle in 18 women (40.9%), and spontaneous pregnancy in 5 cases (11.3%). LOD is a good method for restoration of ovulatory cycles in anovulatory PCOS women who were resistant to the combination of CC and Metformin. LOD may avoid or reduce the need to gonadotropins for ovulation induction.