Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.
Reprod Biol Endocrinol. 2010 May 13;8:45. doi: 10.1186/1477-7827-8-45.
Ovarian stimulation in women with polycystic ovary syndrome (PCOS) increases the risk for perinatal complications. Ovulation induction by laparoscopic ovarian drilling (LOD) might improve the overall pregnancy outcomes. The aim of our study was to assess the adverse events or effects on pregnancy of LOD and clomiphene citrate (CC) stimulation in patients who received metformin.
Academic research institution. We retrospectively analyzed the courses of 40 spontaneous pregnancies after LOD for CC-resistance, 40 pregnancies after CC stimulation, and 40 pregnancies after metformin treatment alone. Patients in the LOD and the CC groups had been pre-treated with Metformin. Primary outcome parameters were: the rate of multiple pregnancies; the rate of early pregnancy losses/miscarriages; the development of gestational diabetes, pregnancy-induced hypertension, and preeclampsia/HELLP-syndrome; premature delivery; and birth weight.
The rate of twin pregnancies did not differ between the CC group (12.5%), the LOD group (7.5%), and the metformin only group (2.5%, p=0.239). Seventeen women suffered an early miscarriage. There were no differences with regard to the rates of gestational diabetes, pregnancy-induced hypertension, preeclampsia, and preterm delivery. By analyzing all pregnancy complications together, the overall pregnancy complication rate was highest in the CC group (70.0%, 28/40), followed by the LOD group (45.0%, 18/40), and the metformin only group (47.5%, 19/40; p=0.047).
CC, but not LOD, increases the complication rate in pregnant patients who received metformin.
多囊卵巢综合征（PCOS）女性的卵巢刺激会增加围产期并发症的风险。腹腔镜卵巢打孔术（LOD）诱导排卵可能会改善整体妊娠结局。我们的研究目的是评估接受二甲双胍治疗的患者中，LOD 和枸橼酸氯米酚（CC）刺激的不良事件或对妊娠的影响。
学术研究机构。我们回顾性分析了 40 例因 CC 耐药而行 LOD 后的自发妊娠、40 例 CC 刺激后的妊娠和 40 例单独接受二甲双胍治疗后的妊娠。LOD 和 CC 组的患者均接受二甲双胍预处理。主要结局参数为：多胎妊娠率；早期妊娠丢失/流产率；妊娠糖尿病、妊娠高血压和子痫前期/HELLP 综合征的发生率；早产；和出生体重。
CC 组（12.5%）、LOD 组（7.5%）和仅用二甲双胍组（2.5%，p=0.239）的双胞胎妊娠率无差异。17 名妇女发生早期流产。妊娠糖尿病、妊娠高血压、子痫前期和早产的发生率无差异。综合分析所有妊娠并发症，CC 组的总体妊娠并发症发生率最高（70.0%，28/40），其次是 LOD 组（45.0%，18/40）和仅用二甲双胍组（47.5%，19/40；p=0.047）。
CC 而非 LOD 会增加接受二甲双胍治疗的孕妇的并发症发生率。
