Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome

• Published in: Cochrane database of systematic reviews 2020-02, Vol.2 (2), p.CD001122-CD001122
• Main Authors: Bordewijk, Esmée M, Ng, Ka Ying Bonnie, Rakic, Lidija, Mol, Ben Willem J, Brown, Julie, Crawford, Tineke J, van Wely, Madelon
• Format: Article
• Language: English
• Subjects: Anovulation - etiology; Anovulation - surgery; Birth Rate; EVALUATION OF SUBFERTILITY TREATMENTS RELATING TO THE FEMALE PARTNER; Female; Fertility Agents, Female - therapeutic use; Gynaecology; Humans; Infertility, Female - etiology; Infertility, Female - surgery; Laparoscopy; Ovulation Induction - methods; Polycystic Ovary Syndrome - complications; Polycystic Ovary Syndrome - surgery; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD001122.pub5

Polycystic ovary syndrome (PCOS) is a common condition affecting 8% to 13% of reproductive-aged women. In the past clomiphene citrate (CC) used to be the first-line treatment in women with PCOS. Ovulation induction with letrozole should be the first-line treatment according to new guidelines, but the use of letrozole is off-label. Consequently, CC is still commonly used. Approximately 20% of women on CC do not ovulate. Women who are CC-resistant can be treated with gonadotrophins or other medical ovulation-induction agents. These medications are not always successful, can be time-consuming and can cause adverse events like multiple pregnancies and cycle cancellation due to an excessive response. Laparoscopic ovarian drilling (LOD) is a surgical alternative to medical treatment. There are risks associated with surgery, such as complications from anaesthesia, infection, and adhesions. To evaluate the effectiveness and safety of LOD with or without medical ovulation induction compared with medical ovulation induction alone for women with anovulatory polycystic PCOS and CC-resistance. We searched the Cochrane Gynaecology and Fertility Group (CGFG) trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers up to 8 October 2019, together with reference checking and contact with study authors and experts in the field to identify additional studies. We included randomised controlled trials (RCTs) of women with anovulatory PCOS and CC resistance who underwent LOD with or without medical ovulation induction versus medical ovulation induction alone, LOD with assisted reproductive technologies (ART) versus ART, LOD with second-look laparoscopy versus expectant management, or different techniques of LOD. Two review authors independently selected studies, assessed risks of bias, extracted data and evaluated the quality of the evidence using the GRADE method. The primary effectiveness outcome was live birth and the primary safety outcome was multiple pregnancy. Pregnancy, miscarriage, ovarian hyperstimulation syndrome (OHSS), ovulation, costs, and quality of life were secondary outcomes. This updated review includes 38 trials (3326 women). The evidence was very low- to moderate-quality; the main limitations were due to poor reporting of study methods, with downgrading for risks of bias (randomisation and allocation concealment) and lack of blinding. Laparoscopic ovarian drilling with or without medical ovulation induction versus medical ovulatio