Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-25T01:21:40.278Z Has data issue: false hasContentIssue false

Chapter 14 - Polycystic Ovary Syndrome: Controlled Ovarian Stimulation

from Section 3 - Difficulties and Complications of Ovarian Stimulation and Implantation

Published online by Cambridge University Press:  14 April 2022

By
Lina El-Taha ,
Botros Rizk ,
William Ledger ,
Raja Sayegh  and
Johnny Awwad
Edited by
Mohamed Aboulghar  and
Botros Rizk
Mohamed Aboulghar
Affiliation:
University of Cairo IVF Centre
Botros Rizk
Affiliation:
University of South Alabama
Get access

Summary

Surgical methods of ovulation induction for women with clomiphene (clomifene) citrate-resistant polycystic ovary syndrome (PCOS) include laparoscopic ovarian drilling with diathermy. This technique has replaced the more invasive and damaging technique of ovarian wedge resection first introduced by Gjønnaess in the early 1980s [1]. Laparoscopic ovarian surgery is free from the risks of multiple pregnancy and ovarian hyperstimulation, which makes it an attractive procedure for PCOS women, but surgery is not without risks. The techniques of laparoscopic ovarian diathermy have been described previously [2;3]. Studies suggest that four punctures per ovary with application of diathermy current via needle cautery set at 30 watts for 5 seconds per puncture (i.e., no more than 600 J per ovary) should produce an optimal response. The greater the damage to the surface of the ovary the greater the risk of peri-ovarian adhesions estimated at 60 percent (ranging from 0 to 100 percent) in treated women.

Type
Chapter
Information
Ovarian Stimulation , pp. 132 - 140
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Gjønnaess, H. Ovarian electrocautery in the treatment of women with polycystic ovary syndrome (PCOS): factors affecting the results. Acta Obstet Gynecol Scand 1994;73(5):407–412.Google Scholar
Li, TC, Saravelos, H, Chow, MS, Chisabingo, R, Cooke, ID. Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovary syndrome in women with anovulatory infertility. Br J Obstet Gynaecol 1998;105:338–344.Google Scholar
Armar, NA, McGarrigle, HHG, Honour, J, et al. Laparoscopic ovarian diathermy in the management of anovulatory infertility in women with polycystic ovaries: endocrine changes and clinical outcome. Fertil Steril 1990;53:45–49.Google Scholar
Balen, AH, Jacobs, HS. A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome. Fertil Steril 1994;62:921–925.Google Scholar
Bordewijk, EM, Ng, KY, Rakic, L, et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev 2020;2:CD001122.Google Scholar
Api, M, Gorgen, H, Cetin, A. Laparoscopic ovarian drilling in polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 2005;119:76–81.Google Scholar
Amer, SA, Li, TC, Metwally, M, Emarh, M, Ledger, WL. Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome. Hum Reprod 2009;24:219–225.Google Scholar
Amer, S, Banu, Z, Li, TC, Cooke, ID. Long-term follow-up of patients with polycystic ovary syndrome after laparoscopic ovarian drilling: endocrine and ultrasonographic outcomes. Hum Reprod 2002;17(11):2851–2857.CrossRefGoogle ScholarPubMed
Amer, SA, El Shamy, TT, James, C, Yosef, AH, Mohamed, AA. The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis. Reproduction 2017;154(1):R13–R21.Google Scholar
Amer, S, Li, TC, Ledger, WL. Ovulation induction using laparoscopic ovarian drilling in women with polycystic ovarian syndrome: predictors of success. Hum Reprod 2004;19(8):1719–1724.Google Scholar
Balen, AH, Morley, LC, Misso, M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016;22(6):687–708.CrossRefGoogle ScholarPubMed
Weiss, NS, Nahuis, MJ, Bordewijk, E, et al. Gonadotrophins versus clomifene citrate with or without intrauterine insemination in women with normogonadotropic anovulation and clomifene failure (M-OVIN): a randomised, two-by-two factorial trial. Lancet 2018;391(10122):758–765.Google Scholar
Weiss, NS, Kostova, E, Nahuis, M, et al. Gonadotrophins for ovulation induction in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019;1:CD010290.Google ScholarPubMed
Pardo, M, Bancells, N. Artificial insemination with husband’s sperm (AIH). Techniques for sperm selection. Arch Androl 1989;22:15–27.CrossRefGoogle ScholarPubMed
Tan, SL, Child, TJ. In-vitro maturation of oocytes from unstimulated polycystic ovaries. Reprod Biomed Online 2002;4:18–23.Google Scholar
Heijnen, E, Eijkemans, M, Hughes, E, et al. A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome. Hum Reprod Update 2006;12(1):13–21.Google Scholar
Sha, T, Wang, X, Cheng, W, Yan, Y. A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing in vitro fertilization. Reprod Biomed Online 2019;39(2):281–293.Google Scholar
Devroey, P, Polyzos, NP, Blockeel, C. An OHSS-free clinic by segmentation of IVF treatment. Hum Reprod 2011;26(10):2593–2597.CrossRefGoogle ScholarPubMed
Trounson, A, Wood, C, Kausche, A. In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril 1994;62(2):353–362.Google Scholar
Barnes, FL, Crombie, A, Gardner, DK, et al. Blastocyst development and birth after in-vitro maturation of human primary oocytes, intracytoplasmic sperm injection and assisted hatching. Hum Reprod 1995;10(12):3243–3247.Google Scholar
Benkhalifa, M, Demirol, A, Ménézo, Y, et al. Natural cycle IVF and oocyte in-vitro maturation in polycystic ovary syndrome: a collaborative prospective study. Reprod Biomed Online 2009;18(1):29–36.CrossRefGoogle ScholarPubMed
Siristatidis, CS, Maheshwari, A, Vaidakis, D, Bhattacharya, S. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. Cochrane Database Syst Rev 2018;11:CD006606.Google Scholar
Albano, C, Felberbaum, RE, Smitz, J, et al. Ovarian stimulation with HMG: results of a prospective randomized phase III European study comparing the luteinizing hormone-releasing hormone (LHRH)-antagonist cetrorelix and the LHRH-agonist buserelin. Hum Reprod 2000;15(3):526–531.Google Scholar
Borm, G, Mannaerts, B. Treatment with the gonadotrophin-releasing hormone antagonist ganirelix in women undergoing ovarian stimulation with recombinant follicle stimulating hormone is effective, safe and convenient: results of a controlled, randomized, multicentre trial. The European Orgalutran Study Group. Hum Reprod 2000;15(7):1490–1498.Google Scholar
Lambalk, CB, Banga, FR, Huirne, JA, et al. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type. Hum Reprod Update 2017;23(5):560–579.Google Scholar
Shin, JJ, Park, KE, Choi, YM, et al. Early gonadotropin-releasing hormone antagonist protocol in women with polycystic ovary syndrome: a preliminary randomized trial. Clin Exp Reprod Med 2018;45(3):135–142.Google Scholar
Olivennes, F, Fanchin, R, Bouchard, P, et al. Triggering of ovulation by a gonadotropin-releasing hormone (GnRH) agonist in patients pretreated with a GnRH antagonist. Fertil Steril 1996;66:151–153.CrossRefGoogle ScholarPubMed
Fauser, BC, de Jong, D, Olivennes, F, et al. Endocrine profiles after triggering of final oocyte maturation with GnRH agonist after cotreatment with the GnRH antagonist ganirelix during ovarian hyperstimulation for in vitro fertilization. J Clin Endocrinol Metab 2002;87:709–715.Google Scholar
Griesinger, G, Diedrich, K, Devroey, P, Kolibianakis, EM. GnRH agonist for triggering final oocyte maturation in the GnRH antagonist ovarian hyperstimulation protocol: a systematic review and meta-analysis. Hum Reprod Update 2006;12:159–168.Google Scholar
Engmann, L, DiLuigi, A, Schmidt, D, et al. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril 2008;89(1):84–91.Google Scholar
Kummer, N, Benadiva, C, Feinn, R, et al. Factors that predict the probability of a successful clinical outcome after induction of oocyte maturation with a gonadotropin-releasing hormone agonist. Fertil Steril 2011;96(1):63–68.CrossRefGoogle ScholarPubMed
Griffin, D, Benadiva, C, Kummer, N, et al. Dual trigger of oocyte maturation with gonadotropin-releasing hormone agonist and low-dose human chorionic gonadotropin to optimize live birth rates in high responders. Fertil Steril 2012;97(6):1316–1320.Google Scholar
Humaidan, P, Bredkjær, HE, Westergaard, LG, et al. 1,500 IU human chorionic gonadotropin administered at oocyte retrieval rescues the luteal phase when gonadotropin-releasing hormone agonist is used for ovulation induction: a prospective, randomized, controlled study. Fertil Steril 2010;93(3):847–854.Google Scholar
Seyhan, A, Ata, B, Polat, M, et al. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum Reprod 2013;28(9):2522–2528.CrossRefGoogle ScholarPubMed
O’Neill, KE, Senapati, S, Maina, I, et al. GnRH agonist with low-dose hCG (dual trigger) is associated with higher risk of severe ovarian hyperstimulation syndrome compared to GnRH agonist alone. J Assist Reprod Genet 2016;33(9):1175–1184.CrossRefGoogle ScholarPubMed
Fatemi, HM, Popovic-Todorovic, B. Implantation in assisted reproduction: a look at endometrial receptivity. Reprod Biomed Online 2013;27(5):530–538.Google Scholar
Garcia-Velasco, JA. Agonist trigger: what is the best approach? Agonist trigger with vitrification of oocytes or embryos. Fertil Steril 2012;97(3):527–528.CrossRefGoogle ScholarPubMed
Doronzo, G, Russo, I, Mattiello, L, et al. Insulin activates vascular endothelial growth factor in vascular smooth muscle cells: influence of nitric oxide and of insulin resistance. Eur J Clin Invest 2004;34:664–673.CrossRefGoogle ScholarPubMed
Palomba, S, Falbo, A, La Sala, GB. Effects of metformin in women with polycystic ovary syndrome treated with gonadotrophins for in vitro fertilisation and intracytoplasmic sperm injection cycles: a systematic review and meta‐analysis of randomised controlled trials. BJOG 2013;120(3):267–276.Google Scholar
Palomba, S, Falbo, A, Carrillo, L, et al. Metformin reduces risk of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during gonadotropin-stimulated in vitro fertilization cycles: a randomized, controlled trial. Fertil Steril 2011;96(6):1384–1390.Google Scholar
Abdalmageed, OS, Farghaly, TA, Abdelaleem, AA, et al. Impact of metformin on IVF outcomes in overweight and obese women with polycystic ovary syndrome: a randomized double-blind controlled trial. Reprod Sci 2019;26(10):1336–1342.Google Scholar
Tso, LO, Costello, MF, Albuquerque, LE, Andriolo, RB, Macedo, CR. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2014;11:CD006105.Google Scholar
Bevilacqua, A, Bizzarri, M. Inositols in insulin signaling and glucose metabolism. Int J Endocrinol 2018;2018:1968450.Google Scholar
Genazzani, AD, Lanzoni, C, Ricchieri, F, Jasonni, VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol 2008;24(3):139–144.Google Scholar
Costantino, D, Minozzi, G, Minozzi, E, Guaraldi, C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci 2009;13(2):105–110.Google Scholar
Minozzi, M, Nordio, M, Pajalich, R. The combined therapy myo-inositol plus D-chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients. Eur Rev Med Pharmacol Sci 2013;17(4):537–540.Google Scholar
Gateva, A, Unfer, V, Kamenov, Z. The use of inositol (s) isomers in the management of polycystic ovary syndrome: a comprehensive review. Gynecol Endocrinol 2018;34(7):545–550.Google Scholar
Facchinetti, F, Orrù, B, Grandi, G, Unfer, V. Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gynecol Endocrinol 2019;35(3):198–206.Google Scholar
Taieb, J, Grynberg, M, Pierre, A, et al. FSH and its second messenger cAMP stimulate the transcription of human anti-Müllerian hormone in cultured granulosa cells. Mol Endocrinol 2011;25(4):645–655.Google Scholar
Ciotta, L, Stracquadanio, M, Pagano, I, et al. Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci 2011;15(5):509–514.Google Scholar
Unfer, V, Porcaro, G. Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Expert Rev Clin Pharmacol 2014;7(5):623–631.Google Scholar
Colazingari, S, Fiorenza, MT, Carlomagno, G, Najjar, R, Bevilacqua, A. Improvement of mouse embryo quality by myo-inositol supplementation of IVF media. J Assist Reprod Genet 2014;31(4):463–469.Google Scholar
Papaleo, E, Unfer, V, Baillargeon, JP, et al. Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Fertil Steril 2009;91(5):1750–1754.Google Scholar
Laganà, AS, Vitagliano, A, Noventa, M, Ambrosini, G, D’Anna, R. Myo-inositol supplementation reduces the amount of gonadotropins and length of ovarian stimulation in women undergoing IVF: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2018;298(4):675–684.Google Scholar
Zheng, X, Lin, D, Zhang, Y, et al. Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Medicine (Baltimore) 2017;96(49):e8842.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×