Improved cycle outcomes after laparoscopic ovarian diathermy in hyper-responder patients with previous ART failure

• Published in: Gynecological endocrinology 2014-12, Vol.30 (12), p.881-884
• Main Authors: Pabuccu, Recai, Pabuccu, Emre Goksan, Gursoy, Asli Yarci, Caglar, Gamze Sinem, Yilmaz, Muserref Banu, Ozdegirmenci, Ozlem
• Format: Article
• Language: English
• Subjects: Adult; Assisted reproductive technology; Diathermy; Female; folliculogenesis; Humans; Laparoscopy; Ovarian Hyperstimulation Syndrome - etiology; Ovarian Hyperstimulation Syndrome - prevention & control; ovary; Ovulation Induction - adverse effects; Pregnancy; Reproductive Techniques, Assisted - adverse effects; Treatment Outcome
• ISSN: 0951-3590; 1473-0766
• DOI: 10.3109/09513590.2014.943729

Abstract Excessive response to ovarian stimulation is common among hyper-responder patients undergoing assisted reproductive technology (ART). Cycle cancellations and severe ovarian hyperstimulation syndrome (OHSS) are all detrimental consequences observed within this cohort and several approaches have been proposed to enhance outcomes. The current study is designed to evaluate whether laparoscopic ovarian diathermy (LOD) improves ART outcomes and pregnancy rates by reducing Anti-mullerian hormone (AMH) levels in a group of patients who had a history of recurrent ART failure and high response. A total of 40 hyper-responder patients with history of previous ART failure were included. Group I consisted of 22 patients that underwent LOD prior to ART. Group II consisted of 18 patients that underwent only ART. Cycle outcomes of groups were compared. Following LOD, significant reduction in AMH levels were detected in group I (4.75 ng/mL to 2.25 ng/mL). Clinical pregnancies were similar among groups (40% versus 27.8% p = 0.65). There was no cycle cancellation in Group I, whereas there were three cycle cancellations observed due to OHSS in Group II. Our results indicate that LOD might offer enhanced fertility outcomes and may reduce the likelihood of cycle cancellations in hyper-responders with previous ART failures. Chinese abstract 高反应患者在辅助生殖过程(ART)中对卵巢刺激呈现过度反应是很常见的。在这些人群中，周期的终止和卵巢过度刺激综合征（OHSS）都属于已观察到的过度反应可导致的有害结果。为改善ART的结局已提出了一些方法。本研究被设计用于评估腹腔镜下卵巢打孔术（LOD）是否能通过降低抗苗勒氏管激素（AMH）而改善有ART反复失败史和高反应患者ART的结局和妊娠率。总计有40名高反应和ART失败史的患者被纳入了此项研究。一组包括22名患者，在ART前行LOD，二组包括18名患者，只进行了ART。两组的周期结局被拿来比较。在LOD后，一组观察到了AMH值的明显降低(4.75 ng/mL 到2.25 ng/mL)。两组临床妊娠率相似(40% versus 27.8% p=0.65)。一组无周期终止，而二组有三名患者由于OHSS而终止了周期。我们的研究表明LOD或可改善妊娠结局，减少有ART失败史的高反应患者终止周期的可能性。