الفهرس 
PCO overviewOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome (PCOS) constitutes the most
common endocrinopathy of women of reproductive age. It has
gained a great deal of public attention over the last few
decades, as this is reflected in over 1,500,000 Internet sites
dedicated to the syndrome. However, although widespread,
PCOS is a very complex endocrine condition making its
diagnosis a difficult and challenging task in everyday clinical
practice. These difficulties in diagnosis, as well as the
heterogeneity of the disease and its nebulous nature, were
made evident from the very first description of PCOS by Stein
and Leventhal.
Laparoscopic ovarian drilling is one of the treatments of
choice for clomiphene citrate resistant PCOS women. Not only
does it have good results with ovulation and pregnancy rates of
83-89% and 70-80% respectively, but it also has several
advantages including having a long-term effect after one
operation inducing one follicle ovulation, not needing
extensive monitoring and having no ovarian hyperstimulation
syndrome.
The aim of this study was to evaluate the effect of
laparoscopic ovarian drilling on FSH, inhibin B hormone and
antral follicle count as ovarian reserve markers.
This study was conducted at Ain Shams University
Maternity Hospital included 38 patients of polycystic ovary
syndrome candidate for laparoscopic ovarian drilling
(clomiphene citrate resistant patients).Polycystic ovary
syndrome was diagnosed according to Rotterdam criteria as
ovulatory disturbance, hyperandrogenism and presence of >10
follicles, 2-9mm in diameter in each ovary by ultrasound
examination. Patients with age< 19 and >35 years, pre-existing
endocrine disease, previous pelvic surgery or previous ovarian
cystectomy were excluded from the study.
All patients included in the study were subjected to;
detailed history taking, full examination (general examination,
abdominal examination and gynecological examination),
transvaginal ultrasound and hormonal profile (inhibin B and
FSH) done before laparoscopic ovarian drilling at follicular
phase (second day of the cycle)and at the follicular phase
(second day of the cycle)of first menstruation after
laparoscopic ovarian drilling(or after progesterone challenge
withdrawal bleeding if no menstruation occurs for six weeks).
Sample size was calculated using OpenEpi version
2.3.1. Data from a previous relevant study showed that the
mean no. of antral follicles was 16.5 ± 1.3 before ovarian
drilling and 14.9 ± 2.1 after drilling; this difference was
statistically significant (p=0.007). Calculation according to
these values produced a minimal sample size of 38 cases.
Statistical analysis was performed using Microsoft® Excel®
Version 2010 and statistical Package for social sciences
(SPSS® )for Windows® Version 15.0.Continous data were
presented as range ,mean and standard deviation. Dichotomous
or categorical data were presented as number and percentage.
Difference between two paired groups was estimated using the
paired student’s t-test (for parametric continous variables).
Significance level was set at 0.05.
There was a significant reduction in the ovarian volume
and AFC on both sides when post-LOD values were compared
to the pre-LOD values.
There was a significant rise in serum FSH and a
significant reduction in serum inhibin B when post-LOD
values were compared to the pre-LOD values.
Presence of amenorrhea was significantly associated
with higher difference between pre- and post-LOD AFC of the
right ovary, and a higher difference between pre- and post-
LOD serum inhibin B level.
There was no significant correlation between age or
BMI and other differences between pre- and post-LOD
sonographic or biochemical markers of ovarian reserve.
There was no significant association between obesity or
clinical hyperandrogenism (hirsutism and/or acne vulgaris) and
any of the differences between pre- and post-LOD values for
sonographic or biochemical markers of ovarian reserve.