Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate resistant polycystic ovary syndrome.

摘要

Clomiphene citrate (CC), an antiestrogen, is first-line treatment for polycystic ovary syndrome (PCOS), but up to one fourth of treated women fail to ovulate. Induction with gonadotropins is an option in CC-resistant women but is costly, requires extensive monitoring, and entails a risk of multiple pregnancies. Another option, laparoscopic electrocautery of the ovaries, causes minimal morbidity, precludes the need to monitor cycles, and has a low risk of multiple pregnancies. In this prognostic study, 83 women having CC-resistant PCOS who were participating in a randomized multicenter trial underwent laparoscopic electrocautery, followed by CC if anovulation persisted. Treatment failure was defined as lack of ovulation within 8 weeks after the procedure or lack of an ongoing pregnancy with or without CC treatment. Ovarian volume was estimated by transvaginal ultrasonography.One third of women, 27 of the 83 who were treated, failed to ovulate within 8 weeks and were designated as nonresponders. The luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio was the strongest predictor of anovulation. Multivariable logistic regression analyses, including clinical, endocrinologic, and ultrasound parameters, showed that women who were younger at menarche had a lower LH/FSH ratio, and/or had a lower glucose level were relatively likely not to ovulate. Using these variables, it was possible to distinguish between women with a greater than 70% chance of remaining anovulatory from those with less than a 10% chance. In all, 76 of 83 women in the study ovulated at least once, and 49% achieved an ongoing pregnancy. There were no multiple pregnancies, and all ongoing pregnancies ended in a live birth. The cumulative rate of ongoing pregnancy after electrocautery is shown in .(Figure is included in full-text article.)Laparoscopic electrocautery of the ovaries is now accepted as the preferred first-line treatment of women with PCOS who are resistant to CC. All affected women should be considered for this treatment.