LAPAROSCOPIC OVARIAN TREATMENT IN INFERTILE PATIENTS WITH POLYCYSTIC OVARIAN SYNDROME (PCOS) - ENDOCRINE CHANGES AND CLINICAL OUTCOME

During the years 1991-1994, 97 anovulatory infertile women with polycy stic ovarian syndrome (PCOS) were treated with laparoscopic electrocau tery of the ovarian surface after they had failed to ovulate under ova rian stimulation. To assess the endocrinological and clinical outcome and in an attempt to determine the mechanism of action, the serum leve ls of luteinizing hormone (LH), follicle-stimulating hormone (FSH), an drostenedione, testosterone and dehydroepiandrosterone sulfate (DHEAS) were determined before and after laparoscopic ovarian cautery. Fifty regularly cycling women undergoing laparoscopy for investigation of in fertility or tubal ligation served as controls. In patients with PCOS but not in controls, the reduction of androgen levels and normalizatio n of cycle length were highly significant. In contrast, LH and FSH lev els rose during the first 2 days after the operation. These results re semble those reported after ovarian wedge resection. Ovulation was obt ained in 90% (81 of 90) and pregnancy in 81.1% (73 of 90) of the patie nts; that increased to 84.4%, including the non-responders (nine patie nts) treated with clomiphene citrate (CC), after electrocautery. The r esponse to ovarian electrocautery was influenced by body weight, with an ovulation rate of 95-96% in the slim and moderately obese women, de creasing to 81-82% in the really obese ones. When ovulation was establ ished, the pregnancy rate was independent of body weight. However, a s triking relationship was detected between smoking habits and pregnancy rate subsequent to ovarian electrocautery, ranging from 24% in smoker s to 92% in non-smoking couples. In 30 second-look operation, de novo adhesions were found in 23.3% of the patients (7 of 30). Therefore, ov arian electrocautery is an effective procedure to improve the intraova rian mechanism of selecting a dominant follicle for patients with PCOS in whom initial medical management fails, and it appears to be one of the possible treatments for this disease. A possible postoperative co mplication may be adhesion formation that seem to be lower than after ovarian wedge resection.