A review of pregnancy outcomes following laparoscopic ovarian drilling for infertile women with clomiphene resistant polycystic ovarian syndrome (PCOS) at a public health facility in Ilorin, Nigeria.

Abstract

Background: Polycystic ovarian syndrome (PCOS) is the common endocrine disorder in women and its prevalence is on the increase due to availability of diagnostic tools. It is usually managed medically but for some resistant cases may require surgical intervention in the form of laparoscopic ovarian drilling (LOD). LOD is a one-off therapy avoids the need of medical therapy and its attendant complications.
Aim and Objectives: The objective of this study was to determine the impact of LOD on reproductive outcomes of infertile women with clomiphene resistance PCOS among clients attending the Assisted Reproduction Technology unit of University of Ilorin Teaching Hospital.
Materials and Methods: This is a prospective / longitudinal study of twenty three (23) patients of clomiphene resistant PCOS who underwent LOD between January and December 2012.
Results: The patients were aged 24-45years with a mean age of 31.7 ± 5.2 years. Twenty (87%) out of twenty three were nulliparous and majority (87%) belong to middle social class. Eleven (47.8%) had primary infertility while 12 (52.2%) had secondary infertility. The mean duration of infertility is 4.5 ± 2.9 years and the number of drills per ovary ranged from 4 to 15 (mean, right ovary=8.6±3.24; left ovary=9.3±3.4). Majority (95.7%) had at least one patent tube. The mean age of patients' husbands is 38.8 ± 5.7 years with majority (82.6%) having normozoospermia. In the follow-up period, all 23 patients (100%) resumed menstruation and achieved ovulation (ovulation rate= 100%). The mean time of menstruation and ovulation were 4.1± 1.9 days and 5.3 ± 3.2 weeks respectively. Seven pregnancies were recorded from 23 patients giving a cumulative pregnancy rate of 30.4%. Of the remaining four pregnancies, one of the patients had successfully delivered, giving a live birth rate of 14.3%, while others are on-going. The mean time interval from LOD to pregnancy was 4.7 ± 1.6 months. The pregnancy outcomes had no significant association with age of the women, parity, duration of infertility and types of infertility with p > 0.05. 
Conclusion: LOD is a safe and effective one-off treatment for PCOS related infertility in patients who failed to respond to CC with efficacy equal to gonadotrophins and metformin. We recommend the need for its domestication in our locality.

Keywords: Anovulatory infertility, Laparoscopic ovarian drilling, Polycystic ovarian syndrome, Live birth