Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial.(Papers)

Abstract

Objective To compare the effectiveness of an electrocautery strategy with ovulation induction using recombinant follicle stimulating hormone in patients with clomiphene resistant polycystic ovary syndrome.

Design Randomised controlled trial.

Setting Secondary and tertiary hospitals in the Netherlands.

Participants 168 patients with clomiphene citrate resistant polycystic ovary syndrome: 83 were allocated electrocautery and 85 were allocated recombinant follicle stimulating hormone.

Intervention Laparoscopic electrocautery of the ovaries followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted, or induction of ovulation with recombinant follicle stimulating hormone.

Main outcome measure Ongoing pregnancy within 12 months.

Results The cumulative rate of ongoing pregnancy after recombinant follicle stimulating hormone was 67%. With only electrocautery it was 34%, which increased to 49% after clomiphene citrate was given. Subsequent recombinant follicle stimulating hormone increased the rate to 67% at 12 months (rate ratio 1.01, 95% confidence interval 0.81 to 1.24). No complications occurred from electrocautery with or without clomiphene citrate. Patients allocated to electrocautery had a significantly lower risk of multiple pregnancy (0.11, 0.01 to 0.86).

Conclusion The ongoing pregnancy rate from ovulation induction with laparoscopic electrocautery followed by clomiphene citrate and recombinant follicle stimulating hormone if anovulation persisted, or recombinant follicle stimulating hormone, seems equivalent to ovulation induction with recombinant follicle stimulating hormone, but the former procedure carries a lower risk of multiple pregnancy.

Introduction

Polycystic ovary syndrome is characterised by oligomenorrhoea or amenorrhoea, infertility, hirsutism, acne, and bilaterally enlarged, cystic ovaries. (1 2) The syndrome affects 4-9% of women of childbearing age. (3) Infertility due to chronic anovulation is the most common reason for women seeking counselling or treatment. The drug of first choice for inducing ovulation is clomiphene citrate, taken orally, although 20% of women fail to ovulate. (4)

Ovulation induction with gonadotrophins is well established in patients resistant to clomiphene citrate, but extensive monitoring is necessary because of the high sensitivity of polycystic ovaries to exogenous gonadotrophins, with the risk of multiple follicle development leading to termination of the cycle, ovarian hyperstimulation syndrome, or multiple pregnancy. (5) To reduce these…