Laparascopic Ovarian Drilling and Demedullation- Different Approaches of Surgical Treatment in PCOS Patients
Ramaz Charekishvili (GE), Lali Pkhaladze (GE)
[Charekishvili] Medical Center "Caraps Medline" , [Pkhaladze] Arcil Khomasuridze Institute of Reproductology
Context: PCOS is responsible for 80% of anovulatory infertility. Laparascopic surgery with ovarian drilling (LOD) is second-line treatment for ovulation induction. Different modification of surgical techniques are used, like drilling or wedge resection. In the patients with classic Stein- Leventhal Syndrome (SLS) the wide resection of ovarian medulla, so called “Demedullation”, are practisized. ObJective: To compare the effectiveness of laparascopic ovarian drilling and demedullation in patients with SLS in terms of clinical improvement and reproductive outcome . Patients and Interventions: 63 women, aged 20-35 years, with SLS and infertility underwent laparascopy. In 32 patients were used drilling with electrocautery (I gr), In 31 patients- ovarian demedullation technique (II gr). Ovarian volume , AMH, clinical and reproductive outcomes were evaluated before and after 6 month of surgical intervention. Results: The volume of ovaries varies from 12 to 22 ml, AMH -from 12 to 30 ng/ml in both groups before treatment. After LOD ovarian volume and AMH normalized in 83% and 75% , vs 94% and 89.4% after demedullation. In I gr. ovulatory cycle was restored in 80.7%, pregnancy rate reached 50.3%, intraovarian hematoma occurred in 23% vs 92. 1%, 71.05% , 5.7% respectively in II gr. The results after ovarian demedullation were significantly better compare to ovarian drilling. The ovarian medulla is a main source of androgens, total resection of it leads to normalization of gonadotropins, AMH and induces ovulation. Conclusion: Laparascopic ovarian demedullation can be considered as a highly effective surgical approach in patients with classic SLS as a the second-line treatment. Methods of surgical intervention should be chosen individually, it depends on the type of PCOS and defined by ovarian size and AMH level.