COMPARISON OF THE EFFECTS OF OVARIAN CAUTERIZATION AND GONADOTROPIN-RELEASING-HORMONE AGONIST AND ORAL-CONTRACEPTIVE THERAPY COMBINATION ONENDOCRINE-CHANGES IN WOMEN WITH POLYCYSTIC OVARY DISEASE

Objective: To study the effects of laparoscopic ovarian cauterization and combination of long-acting GnRH agonist (GnRH-a) and oral contrace ptive (OC) therapy on endocrine changes in women with clomiphene citra te (CC)-resistant polycystic ovary disease (PCOD). Design: Prospective , randomized. Setting: University-based infertility clinic. Patients: Seventeen women with CC-resistant PCOD were included randomly in the s tudy to either laparoscopic ovarian cautery or GnRH-a and OC therapy f or 3 months. Main Outcome Measures: Serum concentrations of LH, FSH, a ndrostenedione (A), T, and sex hormone-binding globulin (SHBG) were de termined before each therapeutic approach and during the follicular ph ase of first menstrual cycle after the cessation of each treatment. Re sults: The mean. serum concentrations and the clinical profiles were s imilar in both groups. Both groups showed significant changes in LH, F SH, A, T, and SHBG compared with pretreatment levels. There were no si gnificant differences in the final concentrations of LH, FSH, and A be tween the two study groups after each treatment, whereas T and SHBG le vels were significantly different in the goserelin and OC group. The d ecrease in LH and increase in SHBG serum concentrations were greater i n the goserelin and CC-treated women [-59% and +5.9% versus -70% and 13.5%, respectively]. Although the SHBG concentration increased in bot h groups, the serum SHBG concentration of the goserelin and OC group w as significantly higher than the other group. Conclusion: Both therape utic modalities revealed similar effects on the endocrine profiles in women with CC-resistant PCOD. Considering the invasiveness, cost, and potential complications of laparoscopic ovarian cauterization, noninva sive medical treatment with GnRH-a and OC combination may be more effe ctive in restoring the optimal follicular environment in women with PC OD.