Vaginal ultrasound-guided ovarian needle puncture compared to laparoscopic ovarian drilling in women with polycystic ovary syndrome

Abstract

Study objective: To compare pregnancy outcomes in PCOS women undergoing transvaginal ovarian injury (TVOI) and laparoscopic ovarian drilling (LOD) Design: 126 infertile patients with PCOS were included in this prospective cohort study Canadian task force classification of level of evidence: IIA. Setting: University-affiliated fertility center. Patients: Sixty-seven infertile patients with the history of failed in vitro maturation underwent follow-up as the TVOI group. Fifty-nine infertile women who underwent LOD acted as controls. All subjects had PCOS with menstrual irregularity and were anovulatory by repetitive serum progesterone levels. Interventions: The LOD group underwent six cauterizations of a single ovary with 30W for 4–6 s. Failed IVM subjects with 20–30 needle punctures per ovary acted as the TVOI group. Subjects were followed for six months. Measurements and main results: There was not a significant difference between the groups when the cases were evaluated in terms of spontaneous pregnancy or miscarriage rates. BMI levels decreased in both the TVOI and the LOD groups in a similar fashion. However, serum AMH and AFC decreased greater after LOD than they did with TVOI over the six-month duration of the study (p < 0.001 in both cases). Conclusions: Preliminary data suggest that TVOI likely represents a safer, less costly and equally effective manner of surgical ovulation induction in anovulatory PCOS women when compared to LOD.