Ultrasonographic guided ovarian stroma hydrocoagulation for ovarian stimulation in polycystic ovary syndrome

Objective. To evaluate the safety and effectiveness of transvaginal ultraso und guided injection of hot saline into the ovarian stroma in polycystic ov ary syndrome (PCOS) cases in an office based gynecology practice under loca l anesthesia. Setting. Outpatient gynecologic clinic. Study design. Pilot study. Participants. Fifty-two anovulatory infertile females diagnosed as PCOS by clinical, chemical and ultrasound criteria were recruited for the study. Al l cases were resistant to clomiphene citrate for more than 6 months. Intervention. Injection of warm sterile saline (75C) into the ovarian strom a under transvaginal monitoring using ovum pickup needle. Outcome measures. Cycle regularity, ovulation rate and safety were primary outcomes. Pregnancy rate and patient convenience were our secondary outcome s. Results. Ovulation has been achieved in 73.1% of clomiphene citrate resista nt PCOS cases and resulted in pregnancy in 26.9% of these cases. No adverse effects were recorded and the procedure was tolerable in most cases. Conclusion. Transvaginal ultrasound guided ovarian stroma hydrocoagulation (TOSH) in an office setting seems to be a safe, economic and practical proc edure that is acceptable by the patients. If larger studies confirm its eff ectiveness it may be an attractive alternative to conventional ovarian dril ling.