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Practice exam 5: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Weight reduction.Anti-oestrogen.Ovarian drilling.Metformin with or without anti-oestrogen.Gonadotrophins.
Knowledge Area 11: Subfertility
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
The ovarian drilling will reduce the excessive ovarian stroma in women with PCOS. This in turn will reduce the amount of ovarian androgen that is produced and hence reduction in LH, which will therefore allow ovulation to occur.
EMQ Answers
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
T Ovarian drillingWomen with WHO group II ovulation disorders who are known to be resistant to clomifene citrate should be offered second-line treatments depending on the clinical circumstances and the women’s preferences. These second-line treatment options include ovarian drilling, combined treatment with clomifene citrate and metformin if not already offered as first line or gonadotrophins. The effectiveness of pulsatile gonadotrophin-releasing hormone in women with clomifene citrate-resistant PCOS is uncertain and is therefore not recommended outside research. This patient is not overweight; therefore, ovarian drilling is preferred. (Fertility Problems: Assessment and Treatment. NICE CG156, First published: February 2013, Last updated: September 2017)
Polycystic ovarian syndrome and infertility: overview and insights of the putative treatments
Published in Gynecological Endocrinology, 2021
Julie Collée, Marie Mawet, Linda Tebache, Michelle Nisolle, Géraldine Brichant
An alternative treatment is laparoscopic or transvaginal ovarian drilling, also called ovarian diathermy or electrocoagulation. It acts as a second line of treatment. Indeed, this technique can be proposed after 4 to 6 cycles of CC and before treatment with gonadotrophins [5]. Ovarian drilling is a technique consisting of puncturing the ovaries. The aim of the technique is to penetrate the ovarian capsule with an electrosurgical probe at a number of points (3 to 6 punctures). Each point measuring 4 mm in diameter and 5–7mm in-depth and the duration of the penetration is 5 s. This technique replaces cuneiform resection of the ovaries. Cuneiform resection leads to adherences and surgical complications and was performed before the beginning of the ovarian drilling technique. [37] (Figure 1).
Current and experimental drug therapy for the treatment of polycystic ovarian syndrome
Published in Expert Opinion on Investigational Drugs, 2020
Luigi Della Corte, Virginia Foreste, Fabio Barra, Claudio Gustavino, Franco Alessandri, Maria Grazia Centurioni, Simone Ferrero, Giuseppe Bifulco, Pierluigi Giampaolino
Laparoscopic ovarian surgery is another second-line option for women with PCOS, who are resistant to pharmacological therapies. Laparoscopic techniques that can successfully trigger ovulation include ovarian biopsy and electrocautery, laparoscopic ovarian drilling, transvaginal hydro laparoscopy, ultrasound-guided transvaginal ovarian needle drilling, or laparoscopic ovarian multi-needle intervention [38,39]. According to the Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, when laparoscopic ovarian surgery is performed by appropriately trained personnel, the risks are minimal and include the risks of laparoscopy, adhesion formation, and destruction of healthy ovarian tissue [40]. The effectiveness and safety of laparoscopic ovarian drilling compared with ovulation induction for subfertile women with clomiphene-resistant PCOS has been evaluated in the review by Farquhar et al. [41]. They concluded that there was no evidence of a significant difference in rates of clinical pregnancy, live birth, or miscarriage in women with clomiphene-resistant PCOS undergoing laparoscopic drilling compared to other medical treatments. Concerning adhesion formation, although the risk is real, there is insufficient evidence to favor a surgical technique over another [41]. In the presence of failure of therapies for inducing ovulation and inability to overcome other concomitant causes of infertility, the assisted reproductive technology (ART) therapies, such as in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), are a valid option in this category of patients; thus, IVF should be considered third-line medical therapy.
Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome
Published in Gynecological Endocrinology, 2018
Pierluigi Giampaolino, Nicoletta De Rosa, Luigi Della Corte, Ilaria Morra, Antonio Mercorio, Carmine Nappi, Giuseppe Bifulco
The aim of this study was to evaluate the feasibility and the efficacy of THL ovarian drilling in terms of ovulation rate and pregnancy rate in PCOS CC-resistant patients. From our study, these techniques have shown to be a feasible and efficacy option for ovarian drilling which allows an improvement of ovulation rate, evaluated by mid-luteal progesterone level and ultrasound monitoring, in CC-resistant PCOS patients. To the best of our knowledge, this is the first study that evaluates ovulation rate after THL ovarian drilling (THLOD) in those patients, by measurement of serum progesterone levels and US monitoring. Previously, studies have reported the effects of LOD on ovulation rate, demonstrating a value between 60 and 80% and evaluating ovulation rate by ovarian ultrasound and by measurement of progesterone on 21 day [16–18]. Zahiri Sorouri et al. (2014) evaluated the ovulation rate in CC-resistant PCOS patients who undergone LOD using serum progesterone levels. The authors showed an ovulation rate after LOD between 60% and 64.4% six mount follow up, on day 21 by measurement of progesterone, considering the level of Pg > 3 ng/mL as sign of ovulation [15]. Our study has shown an ovulation rate of 80%, six months after THLOD treatment in CC-resistant PCOS and without hormonal stimulation, comparable with LOD. Many authors have reported not only high ovulation rates (80%), but also high pregnancy rates (60–70%) following LOD [16–20]. We have shown a pregnancy rate of 70% in patients undergone THLOD, comparable to these data. This data are in agreement with the work by Fernandez et al. [6] that have shown a cumulative pregnancy rate of 70% after 6 months, and Gordts et al. [9] that reported a pregnancy rate of 85% after the procedure.