Laparoscopic ovarian drilling in polycystic ovary syndrome: efficacy of adjusted thermal dose based on ovarian volume

ObjectiveTo compare reproductive outcome of adjusted thermal dose on the basis of ovarian volume versus fixed-puncture dosage in laparoscopic ovarian drilling.DesignRandomized controlled trial.SettingUniversity Women’s Health Center.Patient(s)One hundred twenty patients with polycystic ovary syndrome and clomiphene citrate resistance.Intervention(s)Patients were assigned randomly to two groups of 60 women each. Group A received an adjusted thermal dose based on ovarian volume with use of a new model for dose calculation (60 J/cm3 of ovarian tissue), and group B received 600 J per ovary through four ovarian holes regardless of size. One month afterward, the hormonal profile was reevaluated, and second-look laparoscopy was performed in patients who had not conceived by 6 months to evaluate adnexal adhesions.Main Outcome Measure(s)Ovulation, conception, and early abortion rates, cycle rhythm, and adnexal adhesions.Result(s)More patients resumed regular cycles in group A than in group B (87.9% vs. 75.4%). The ovulation and pregnancy rates were significantly higher in group A than in group B (81.8% vs. 62.2% and 51.7% vs. 36.8%, respectively). There was no significant difference between groups in early miscarriage rate or postdrilling adhesions.Conclusion(s)Adjusted diathermy dose based on ovarian volume for laparoscopic ovarian drilling of polycystic ovary syndrome has a better reproductive outcome compared with fixed thermal dosage.