Laparoscopic ovarian drilling in polycystic ovary syndrome: efficacy of adjusted thermal dose based on ovarian volume.

OBJECTIVE

To compare reproductive outcome of adjusted thermal dose on the basis of ovarian volume versus fixed-puncture dosage in laparoscopic ovarian drilling.

DESIGN

Randomized controlled trial.

SETTING

University Women's Health Center.

PATIENT(S): One hundred twenty patients with polycystic ovary syndrome and clomiphene citrate resistance.

INTERVENTION(S): Patients were assigned randomly to two groups of 60 women each. Group A received an adjusted thermal dose based on ovarian volume with use of a new model for dose calculation (60 J/cm(3) of ovarian tissue), and group B received 600 J per ovary through four ovarian holes regardless of size. One month afterward, the hormonal profile was reevaluated, and second-look laparoscopy was performed in patients who had not conceived by 6 months to evaluate adnexal adhesions.

MAIN OUTCOME MEASURE(S): Ovulation, conception, and early abortion rates, cycle rhythm, and adnexal adhesions.

RESULT(S): More patients resumed regular cycles in group A than in group B (87.9% vs. 75.4%). The ovulation and pregnancy rates were significantly higher in group A than in group B (81.8% vs. 62.2% and 51.7% vs. 36.8%, respectively). There was no significant difference between groups in early miscarriage rate or postdrilling adhesions.

CONCLUSION(S): Adjusted diathermy dose based on ovarian volume for laparoscopic ovarian drilling of polycystic ovary syndrome has a better reproductive outcome compared with fixed thermal dosage.