Transvaginal ovarian drilling in infertile women with polycystic ovary syndrome resistant to minimal stimulation

Abstract

Polycystic ovary syndrome (PCOS) is the commonest cause of anovulatory infertility. Treatment modes available are numerous mainly relying on ovarian stimulation with FSH, a reduction in insulin concentrations and a decrease in LH levels as the basis of the therapeutic principles. Surgical management of anovulatory infertility also, has enjoyed a revival in recent years. The aim in present study was to evaluate the efficacy of transvaginal ovarian drilling (TVOD) in infertile women with PCOS resistant to minimal stimulation protocol. In this prospective study 30 infertile women with PCOS and resistant to clomiphene citrate and HMG were selected. After ovarian drilling, the number and size of dominant follicles was increased. Cumulative ovulation rate increased to 90.3% in the cycles after ovarian drilling. Cumulative pregnancy rate was 26.7% at 6 months after TVOD. Miscarriage rate in women who conceived after TVOD, was 6.7% in comparison with 12-20% in general population. With the excellent results after TVOD in difficult to treat patients with PCOS, routine use of this procedure is recommended in these patients before more expensive techniques such as IVF.