Hossam O Hamed1, Asmaa F Hasan, Omyma G Ahmed, Marwa A Ahmed. 1. Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. Hossam_omar@yahoo.com
Abstract
OBJECTIVE: To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistantpatients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling. METHODS: A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n=55) or laparoscopic ovarian drilling (group 2, n=55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The chi(2) test was used for comparisons of ovulation, pregnancy, and abortion rates. RESULTS: Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P<0.001 vs P<0.001), and luteinizing hormone (P<0.05 vs P<0.001), while the glucose to insulin ratio was significantly increased (P<0.001 vs P<0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P<0.04; 50.8% [131/258] vs 33.5% [94/281], P<0.001; and 38.2% [21/55] vs 20.0% [11/55], P<0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant. CONCLUSION: Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
RCT Entities:
OBJECTIVE: To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling. METHODS: A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n=55) or laparoscopic ovarian drilling (group 2, n=55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The chi(2) test was used for comparisons of ovulation, pregnancy, and abortion rates. RESULTS: Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P<0.001 vs P<0.001), and luteinizing hormone (P<0.05 vs P<0.001), while the glucose to insulin ratio was significantly increased (P<0.001 vs P<0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P<0.04; 50.8% [131/258] vs 33.5% [94/281], P<0.001; and 38.2% [21/55] vs 20.0% [11/55], P<0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant. CONCLUSION: Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.
Authors: M F Costello; M L Misso; A Balen; J Boyle; L Devoto; R M Garad; R Hart; L Johnson; C Jordan; R S Legro; R J Norman; E Mocanu; J Qiao; R J Rodgers; L Rombauts; E C Tassone; S Thangaratinam; E Vanky; H J Teede Journal: Hum Reprod Open Date: 2019-01-04