Ovulatory cycles, pregnancy outcome and complications after surgical treatment of polycystic ovary syndrome.

The purpose of this review is to survey the literature on the various laparoscopic surgical techniques for ovulation induction in polycystic ovary syndrome (PCOS) patients (multiple biopsies, electrocauterization, laser vaporization, ovarian resection), compared with traditional ovarian resection by laparotomy. Relevant studies were identified through a search of a computerized bibliographic database and cross-referencing of relevant medical journals. Data regarding 1803 anovulatory PCOS patients have been analyzed, 679 of them treated by classical ovarian resection after laparotomy, 720 by laparoscopic electrocauterization, 322 by laparoscopic laser vaporization, and 82 by laparoscopic multiple biopsies. The percentages of miscarriages, twin pregnancies, and ectopic pregnancies have been calculated analyzing 1076 pregnancies achieved spontaneously or after medical therapy after failure of various surgical attempts. The percentage of adhesions has been calculated among 343 patients submitted to second-look surgery. All of the surgical techniques proved equally effective, with an average ovulation rate of 78.8 percent, a cumulative pregnancy rate of 58.5 percent, a miscarriage rate of 15.9 percent, a twin pregnancy rate of 2.1 percent, and an ectopic pregnancy rate of 1.6 percent. Hormone variations after surgery consisted in a remarkable fall in serum androgen levels (androstenedione and testosterone), in an FSH increase, reduced biological activity and reduced amplitude of LH pulses, and an LH/FSH ratio trending toward normal levels. Moreover, after surgery, the ovaries showed higher responsiveness to drug-induced ovulation. Adhesions were less frequent after laparoscopic multiple biopsies, but they were observed in about 90 percent of patients after resection by laparotomy, in 30 percent of patients after laparoscopic electrocauterization, and in 50 percent after laparoscopic laser vaporization. In conclusion, at present laparoscopic methods for inducing ovulation can be performed in PCOS infertile patients if medical treatment fails to give the desired results. However, additional controlled trials are required to assess the long-term effects of these procedures.