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11 - Laparoscopic surgical treatment of infertility related to PCOS revisited

Published online by Cambridge University Press:  29 September 2009

By
Jean Cohen
Edited by
Gabor T. Kovacs  and
Robert Norman
Jean Cohen
Affiliation:
France
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
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Summary

Introduction

Polycystic ovarian syndrome (PCOS) – characterized by chronic anovulation, and/or androgen excess, hypersecretion of luteinizing hormone (LH), obesity, and infertility – is a relatively common condition in women during reproductive years. The consistent morphologic feature is a peripheral ring of small follicles in association with increased ovarian stroma. It remains an incompletely understood entity with varying degrees of severity and partial symptomatologies.

Wedge resection of ovaries has been proposed by Stein in 1935 (Stein and Leventhal 1935). For long it has been the only treatment of polycystic ovaries (PCO). When treatments by antiestrogens (clomiphene citrate) became available (Greenblatt 1961) and when the good results of these treatments were known, the surgical technique which had the inconvenience of periovarian adhesion formation disappeared. Subsequently numerous publications have indicated the interest of laparoscopic techniques (biopsy, cauterization, multi-electrocoagulation, laser, etc.) in cases of non-response to the medical treatments. The first attemps were tried in France thanks to Raoul Palmer's ovarian biopsy forceps (Palmer and Cohen 1965, Cohen et al. 1972a, b).

Techniques

Electrocautery

Biopsy

The first publication concerning pregnancies obtained after laparoscopic ovarian biopsies with cauterization with Palmer forceps date back to 1972. At this time, Cohen and colleagues (Cohen et al. 1972a) reported 21 pregnancies after 51 successive ovarian biopsies. They came to the conclusion that this procedure has a therapeutic effect on some ovarian infertilities (Cohen et al. 1972b).

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Chapter
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Polycystic Ovary Syndrome , pp. 159 - 176
Publisher: Cambridge University Press
Print publication year: 2007

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References

Almeida, O. D. and Risk, B. (1998) Microlaparoscopic ovarian drilling under local anaesthesia. Mid. East Fertil. Soc. J. 3:189–191.Google Scholar
Amer, S. A. K. S., Banu, Z., Li, T. C., and Cooke, I. D. (2002) Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes. Hum. Reprod. 17:2851–2857.CrossRefGoogle ScholarPubMed
Amin, A. F., Aal, Abd El E. M., Darwish, A. M., and Meki, A.-R. M. A. (2003) Evaluation of the impact of laparoscopic ovarian drilling on Doppler indices of ovarian stromal blood flow, serum vascular endothelial growth factor, and insulin-like growth factor, and insulin-like growth factor-1 in women with polycystic ovary syndrome. Fertil. Steril. 79:938–941.CrossRefGoogle Scholar
Armar, N. A. and Lachelin, G. (1993) Laparoscopic ovarian diathermy: an effective treatment for anti oestrogen resistant anovulatory infertility in women with PCOS. Br. J. Obstet. Gynaecol. 100:161–164.CrossRefGoogle Scholar
Balen, A. and Jacobs, H. (1994) A prospective study comparing unilateral laparoscopic ovarian diathermy in patients with PCO. Fertil. Steril. 62:921–925.CrossRefGoogle Scholar
Campo, S., Felli, A., et al. (1993) Endocrine changes and clinical outcome after laparoscopic ovarian resection in women with PCO. Hum. Reprod. 8:359–363.CrossRefGoogle Scholar
Chassagnard N. (1974) Analyse de 92 biopsies d'ovaire per-coelioscopique. D. M. thesis, University of Paris VI.
Cohen, B. M. (1989) Laser laparoscopy for poycystic ovaries. Fertil. Steril. 52:167–168.Google ScholarPubMed
Cohen, J. and Audebert, A. J. M. (1989) De la “mécanique” au fonctionnel: place des traitements chirurgicaux in endoscopiques dans les dystrophies ovariennes. In Editor A. (ed.) Dystrophies Ovariennes, pp. 183–192. Paris: Masson.Google Scholar
Cohen, J. and Leal de Meirelles, H. (1983) Fertilité après biopsie ovarienne percoelioscopique: à propos de 477 cas en stérilité. J. Gynaecol. Obstet. Reprod. 12:73–79.Google Scholar
Cohen, J., Audebert, A., Brux, J., and Giorgi, H. (1972a) Biopsie ovarienne et survenue d'une grossesse. Nouv. Presse Med. 1:1294.Google Scholar
Cohen, J., Audebert, A., Brux, J., and Giorgi, H. (1972b) Les stérilités par dysovulation: rôle pronostique et therapeutique de la biopsie ovarienne percoelioscopique. J. Gynaecol. Obstet. Reprod. 1:657–671.Google Scholar
Costa A. P., Sousa S., Another A., et al. (2004) Laparoscopic ovarian diathermy treatment in anovulatory patients after unsuccessful medical therapy. – European Society for Human Reproduction and Embryology Congress, Berlin, Poster 517.
Dabirashrafi, H., Mohamad, K., Behjatnia, Y., et al. (1991) Adhesion formation after ovarian electrocauterization on patients with PCO syndrome. Fertil. Steril. 55:1200–1201.CrossRefGoogle Scholar
Daniell, J. F. and Miller, R. (1989). Polycystic ovaries treated by laparoscopic laser vaporization. Fertil. Steril. 51:232–236.CrossRefGoogle ScholarPubMed
Devaut F. (1977) Intérêt de la biopsie d'ovaire per-coelioscopique à propos de 69 cas. D. M. thesis, University of Paris.
Diquelou, J. Y., Boyer, S., and Cicquel, J. M. (1988) Therapeutic role of ovarian biopsy done by laparoscopoy in polycystic ovarian and unexplained infertility. Hum. Reprod. 3(Suppl.): Abs. 80.Google Scholar
Donesky, B. and Adashi, E. (1995) Surgically induced ovulation in the PCO syndrome wedge ovarian electrocauterization on patients with PCO syndrome. Fertil. Steril. 63:439–463.Google Scholar
Duleba, A. J., Banaszewska, B., Spaczynski, R. Z., and Pawelczyk, L. (2003) Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels. Fertil. steril. 79:1008–1014.CrossRefGoogle ScholarPubMed
El Helw, B., Ghorab, M. N., and Elattar, E. (1996) Surgical induction of ovulation in women with polycystic ovary syndrome: a critical analysis of published data. Mid. East Fertil. Soc. J. 1:101–115.Google Scholar
El-Saeed, M., Hasan, M., and Aboulmaaty, Z. (2000) High incidence of pelvic adhesions detected by second-look laparoscopy after laparoscopic ovarian drilling. Mid. East Fertil. Soc. J. 5:219–225.Google Scholar
Farhi, J., Soule, S., and Jacobs, H. (1995) Effect of laparoscopic ovarian electrocautery on ovarian response and outcome of treatment with gonodotrophins in clomiphene citrate resistant patients with PCOS. Fertil. Steril. 64:930–935.CrossRefGoogle Scholar
Farquhar, C. M. and Lilford, R. (2001) Laparoscopic “drilling” by diathermy or laser for ovulation induction in anovulatory PCOS. Cochrane Database Syst. Rev. 4:CD001122.CrossRefGoogle Scholar
Farquhar, C. M., Williamson, K., Gudex, G., et al. (2002) A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome. Fertil. Steril. 78:401–411.CrossRefGoogle ScholarPubMed
Farquhar, C. M., Williamson, K., Brown, P. M., and Garland, J. (2004) An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate resistant polycystic ovary syndrome. Hum. Reprod. 19:1110–1115.CrossRefGoogle ScholarPubMed
Fouquet A. (1978) Intérêt diagnostique et therapeutique de lap biopsie d'ovaire. D. M. thesis, University of Paris.
Gadir, A., Mowafi, R., Alnaser H. M. et al. (1990) Ovarian electrocautery versus human menopausal gonadotrophins and pure FSH therapy in the treatment of PCOS. Clin. Endocrinol. (Oxf.) 33:585–592.CrossRefGoogle Scholar
Gjoanness, H. (1984) Polycystic ovarian syndrome treated by ovarian electrocautery through the laparascope. Fertil. Steril. 41:20–25.CrossRefGoogle Scholar
Gjoanness, H. (1989) The course and outcome of pregnancy after ovarian electrocautery with PCOS: the influence of body weight. Br. J. Obstet. Gynaecol. 96:714–719.CrossRefGoogle Scholar
Gjoanness, H. (1994) Ovarian electrocautery in the treatment of women with PCOS. Acta Obstet. Gynaecol. Scand. 73:407–412.CrossRefGoogle Scholar
Graf, M. A., Bielfed, P., Graf, C., and Distler, W. (1994) Pattern of gonadotrophin secretion in patients with hyperandrogenaemic amenorrhea before and after ovarian wedge resection. Hum. Reprod. 9:1022–1026.Google ScholarPubMed
Greenblatt, E. and Casper, R. F. (1987) Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome. Am. J. Obstet. Gynecol. 42:517–518.Google Scholar
Greenblatt, E. and Casper, R. F. (1993) Adhesion formation after laparoscopic ovarian cautery for PCOS: lack of correlation with pregnancy rate. Fertil. Steril. 60:766–769.CrossRefGoogle ScholarPubMed
Greenblatt, R. B. (1961) Chemical induction of ovulation. Fertil. Steril. 12:402–404.CrossRefGoogle ScholarPubMed
Grochmal, S. (1988) Contact ND : YAG laser superior to CO2 for the treatment of ovarian disease. Laser Practice Rep. 3:IS.Google Scholar
Gurgan, T., Kisnisci, H., Another, A., et al. (1991) Evaluation of adhesions formation after laparoscopic treatment of PCOD. Fertil. Steril. 56:1176–1178.CrossRefGoogle Scholar
Gurgan, T., Urman, B., Another A., et al. (1992) The effect of short internal laparoscopic lysis of adhesions in pregnancy rates following ND : YAG laser photocoagulation of PCO. Obstet. Gynecol. 80:45–47.Google Scholar
Gurgan, T., Yarali, H., and Urman, B. (1994) Laparoscopic treatment of PCO disease. Hum. Reprod. 9:573–577.CrossRefGoogle Scholar
Heylen, S. M., Puttemans, P. J., and Brosens, I. A. (1994) Polycystic ovarian disease treated by laparoscopic argon laser capsule drilling comparison of vaporization versus perforation technique. Hum. Reprod. 9:1038–1042.CrossRefGoogle ScholarPubMed
Huber, J., Hosmann, J., and Spona, J. (1988) Polycystic ovarian syndrome treated by laser through the laparoscope. Lancet ii:215.CrossRefGoogle Scholar
Kamel, M., Abdel-Rahim, M., and El-Din, A. (2004) Laparoscopic ovarian re-electrocautery. Mid. East Fertil. Soc. J. 9:70–78.Google Scholar
Keckstein, J. (1989) Laparoscopic treatment of PCOS. Baillière's Clin. Obstet. Gynaecol. 3:563–581.CrossRefGoogle Scholar
Kovacs, G. T., Buckler, H., Another, A., et al. (1991) Treatment of anovulation due to PCOS by laparoscopic ovarian cautery. Br. J. Obstet. Gynaecol. 98:30–35.CrossRefGoogle Scholar
Kurtz, B. R. and Daniell, J. F. (1993) The role of lasers in the laparoscopic treatment of infertility and endometriosis. Reprod. Med. Rev. 2:85–94.CrossRefGoogle Scholar
Lyles, R., Goldzieher, J. W., Another, A., et al. (1989). Early second look laparoscopy after the treatment of PCO. Fertil. Steril. 54:526.Google Scholar
Mintz, M. and Brux, J. (1971) La biopsie per-coelioscopique de l'ovaire dans les aménorrhées, spanioménorrhées et troubles ovulatoires: étude critique de ses indications en fonction des suites proches et lointaines de 157 cas. C. R. Soc. Fr. Gynécol. 8:609–629.Google Scholar
Mio, Y., Toda, T., Another, A., et al. (1991) Transvaginal ultrasound guided follicular aspiration in the management of anovulatory infertility associated with polycystic ovaries. Fertil. Steril. 56:1060–1065.CrossRefGoogle ScholarPubMed
Naether, O. G. J. and Fischer, R. (1993) Adhesion formation after laparoscopic electrocoagulation of the ovarian surface in polycystic ovary patients. Fertil. Steril. 60:95–99.CrossRefGoogle ScholarPubMed
Naether, O. G. J., Baukloh, V., Fischer, R., and Kowalczyk, T. (1994) Long-term follow-up in 206 infertility patients with polycystic ovarian syndrome after laparoscopic electrocautery of the ovarian surface. Hum. Reprod. 9:2342–2349.CrossRefGoogle ScholarPubMed
Ostrzenski, A. (1992) Endoscopic carbon dioxide laser wedge resection in resistant PCO. Int. J. Fertil. 37:295–299.Google Scholar
Palmer, R. and Cohen, J. (1965) Biopsies percoelioscopiques. Minerva Gynaecol. 17:238–239.Google Scholar
Pellicer, A. and Remohi, J. (1992) Management of the PCOS by Laparoscopy. Basel, Switzerland: Karger.Google Scholar
Pirwany, I. and Tulandi, T. (2003) Laparoscopic treatment of polycystic ovaries: is it time to relinquish the procedure?Fertil. Steril. 80:241–251.CrossRefGoogle ScholarPubMed
Portuondo, J., Melshor, J., Neyro, J., et al. (1984) Periovarian adhesions following ovarian wedge resections or laparoscopic biopsy. Endoscopy 16:143–145.CrossRefGoogle ScholarPubMed
Rimington, M. R., Walker, S. M., and Shaw, R. W. (1997) The use of laparoscopic ovarian electrocautery in preventing cancellation of in-vitro fertilization treatment cycles due to risk of ovarian hyperstimulation syndrome in women with polycystic ovaries. Hum. Reprod. 12:1443–1447.CrossRefGoogle ScholarPubMed
Velasco, Ruiz V. (1996) Laparoscopic management of the polycystic ovary. Proc. World Congress on Human Reproduction, Philadelphia, PA, Abstv. 00.Google Scholar
Sakata, M., Tasaka, K., Another, A., et al. (1990) Changes of bio-active LH laser laparoscopic ovarian cautery in patients with PCOS. Fertil. Steril. 53:610–613.CrossRefGoogle Scholar
Scarpa, F. and Malaponte, E. (1978) La laparoscopoia e la biopsia ovarica come studio dela funzione ovarica nelle amenorree primarie e secondarie. Minerva Gynaecol. 30:871–880.Google Scholar
Shawki, H., Shawki, O., Zaki, S., et al. (1998) Effect of laparoscopic ovarian drilling in PCO disease on ovarian blood flow. Egypt. J. Fertil. Steril. 2:5–58.Google Scholar
Stein, I. F. and Leventhal, M. L. (1935) Amenorrhea associated with bilateral polycystic ovaries. Am. J. Obstet. Gynaecol. 29:181–191.CrossRefGoogle Scholar
Sumioki H. and Utsunomiya T. (1998) Ovarian drilling. In Kempers, R., Cohen, J., Haney, A. F., and Youngers, J. B. (eds.) Fertility and Reproduction Medicine, pp. 000–000. Amsterdam: Elsevier Science.Google Scholar
Sumioki, H., Korencaga, M., Utsunomyiya, T., Kadota, T., and Matsuoka, K. (1988) Wedge resection revisited in the age of laparoscopy. Fertil. Steril. 50:567–572.CrossRefGoogle Scholar
Sykes, O. W. and Ginsburg, J. (1972) The use of laparoscopoic biopsy to assess gonadal function. Am. J. Obstet. Gynecol. 112:211–218.CrossRefGoogle Scholar
Szilagyi, A., Hole, R., Keckstein, J., and Rossmanith, W. (1993) Effect of ovarian surgery on the dopaminergic and opioidergic control of gonadotrohin and prolactin secretion in women with PCO disease. Gynecol. Endocrinol. 7:159–166.CrossRefGoogle Scholar
Tasaka, K., Sakata, M., Kurachi, H., et al. (1990) Electrocautery in PCOS. Horm. Res. 33:40–42.CrossRefGoogle Scholar
Tescher, M., Chassagnard, N., and Boury-Heyler, C. (1972) Intérêt therapeutique des biopsies ovariennes dans les stérilités par anovulation. C. R. Soc. Fr. Gynécol. 5:327–335.Google Scholar
Tozer, A. J., Al-Shawaf, T., Zosmer, A., et al. (2001) Does laparoscopic ovarian diathermy affect the outcome of IVF–embryo transfer in women with polycystic ovarian syndrome? A retrospective comparative study. Hum. Reprod. 16:91–95.Google ScholarPubMed
Tulandi, T., Other, O., Another, A., et al. (2000) Effects of laparoscopic ovarian drilling on serum vascular endothelial growth factor and on insulin responses to the oral glucose tolerance test in women with polycystic ovary syndrome. Fertil. Steril. 74:585–588.CrossRefGoogle ScholarPubMed
Utsonomya, T., Sumioki, T., and Taniguchi, I. (1990) Hormonal and clinical effects of multifollicular puncture and resection of PCOS. Horm. Res. 33(Suppl. 2):35–00.CrossRefGoogle Scholar
Watrelot, A. and Dreyfus, J. M. (1999) Evaluation of the performance of fertiloscopy in 160 patients. Hum. Reprod. 14:707–711.CrossRefGoogle Scholar
Zaidi, J., Campbell, S., Pittrof, R., et al. (1995) Ovarian stromal blood flow in women with PCO: a possible marker for diagnosis?Hum. Reprod. 10:1992–1996.CrossRefGoogle ScholarPubMed
Zullo, F., Pellicano, M., Zupi, E., et al. (2000) Minilaparoscopic ovarian drilling under local anesthesia in patients with polycycstic ovary syndrome. Fertil. Steril. 74:376–379.CrossRefGoogle Scholar

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