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Volume 5, Issue 3 (Summer 2020)                   J Obstet Gynecol Cancer Res 2020, 5(3): 84-87 | Back to browse issues page


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Rezaei Z, Valadan M, Shojaee Asl P. The Effect of Laparoscopic Ovarian Electrocautery in Pregnancy Rate in Metformin- and Clomiphene Citrate-Resistant Infertile Women. J Obstet Gynecol Cancer Res. 2020; 5 (3) :84-87
URL: http://jogcr.com/article-1-280-en.html
1- Department of Obstetrics and Gynecology, Yas Women General Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Obstetrics and Gynecology, Yas Women General Hospital, Tehran University of Medical Sciences, Tehran, Iran. , shojaee.pooneh@yahoo.com
Abstract:   (397 Views)

Background & objective:  Insulin resistance can be seen in most overweight women with polycystic ovary syndrome (PCOS). Insulin resistance seems to play a key role in the pathophysiology of PCOS and infertility. This study aimed to evaluate the effects of insulin resistance on pregnancy rate and regulation of the menstrual cycle following laparoscopic ovarian electrocautery (LOE).
Materials & Methods:  This prospective cohort study was conducted on 54 infertile metformin- and clomiphene citrate-resistant women with PCOS at Yas Hospital in 2007. These patients initially took a glucose tolerance test and then classified into two groups (i.e., insulin-resistant and non-insulin-resistant) based on the obtained results. Both groups, then, underwent LOE. Patients were evaluated for pregnancy rate and regulation of the menstrual cycle up to six months.
Results:  Out of 54 patients, 37 patients (68.5%) were non-insulin-resistant, and 17 patients (31.5%) were insulin-resistant. In the insulin-resistant group, after six months, menstrual cycles were less regular than those of the non-insulin-resistant group (OR=0.2; 95%CI, 0.07-0.87). Fifteen (40.5%) women in the non-insulin-resistant group became pregnant; in contrast, three (17.6%) women in the insulin-resistant group became pregnant. In the logistic regression analysis, the results demonstrated that age, duration of infertility, body mass index (BMI), and insulin resistance had no significant effects on pregnancy rate.
Conclusion:  Insulin resistance can be an important marker of the poor outcomes of PCOS infertility treatment, and LOE significantly improves insulin resistance in women with PCOS.

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Systematic Review: Original Research | Subject: Reproductive Medicine
Received: 2020/09/8 | Accepted: 2020/10/11 | Published: 2020/12/2

References
1. Adams J, Polson DW, Franks S. Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br Med J (Clin Res Ed). 1986;293(6543):355-9. [DOI:10.1136/bmj.293.6543.355] [PMID] [PMCID]
2. Nardo LG, Patchava S, Laing I. Polycystic ovary syndrome: pathophysiology, molecular aspects and clinical implications. Panminerva Med. 2008 Dec;50(4):267-78.
3. Mortada R, Williams T. Metabolic Syndrome: Polycystic Ovary Syndrome. FP Essent. 2015 Aug;435:30-42.
4. Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. Predictors of patients remaining anovulatory during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab. 1998;83(7):2361-5. [DOI:10.1210/jc.83.7.2361] [PMID]
5. Shoham Z, Weissman A. Polycystic ovarian disease: obesity and insulin resistance. In: Kempers RD, Cohen J, Haney AF, Younger JB, eds. Fertility and reproductive medicine. Amsterdam, New York, Oxford, Shannon, Singapore, Tokyo: Elsevier, 1998:263-72.
6. Franks S. Polycystic ovary syndrome. N Engl J Med 1995;333:853-61.[Erratum, N Engl J Med 1995;333:1435.] [DOI:10.1056/NEJM199509283331307] [PMID]
7. Franks S, Adams J, Mason H, Polson D. Ovulatory disorders in women with polycystic ovary syndrome. Clin Obstet Gynecol 1985;12:605-32
8. van Wely M, Bayram N, van der Veen F, Bossuyt PM. Predictors for treatment failure after laparoscopic electrocautery of the ovaries in women with clomiphene citrate resistant polycystic ovary syndrome. Hum Reprod. 2005;20(4):900-5. [DOI:10.1093/humrep/deh712] [PMID]
9. Dale PO, Tanbo T, Djoseland O, Jervell J, Abyholm T. Persistence of hyperinsulinemia in polycystic ovary syndrome after ovarian suppression by gonadotropin-releasing hormone agonist. Acta Endocrinol (Copenh). 1992;126(2):132-6. [DOI:10.1530/acta.0.1260132] [PMID]
10. Dale PO, Tanbo T, Haug E, Abyholm T. The impact of insulin resistance on the outcome of ovulation induction with low-dose follicle stimulating hormone in women with polycystic ovary syndrome. Hum Reprod. 1998;13(3):567-70. [DOI:10.1093/humrep/13.3.567] [PMID]
11. Gjonnaess H. Ovarian electrocautery in the treatment of women with polycystic ovary syndrome (PCOS). Factors affecting the results. Acta Obstet Gynecol Scand. 1994 May; 73(5): 407-12. [DOI:10.3109/00016349409006253] [PMID]
12. Gjonnaess H, Norman N. Endocrine effects of ovarian electrocautery in patients with polycystic ovarian disease. Br J Obstet Gynaecol. 1987; 94(8): 779-83. [DOI:10.1111/j.1471-0528.1987.tb03726.x] [PMID]
13. Gadir AA, Khatim MS, Mowafi RS, Alnaser HM, Alzaid HG, Shaw RW. Hormonal changes in patients with polycystic ovarian disease after ovarian electrocautery or pituitary desensitization. Clin Endocrinol (Oxf). 1990; 32(6): 749-54. [DOI:10.1111/j.1365-2265.1990.tb00921.x] [PMID]
14. Barbieri RL, Makris A, Randall RW, Daniels G, Kistner RW, Ryan KJ. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab. 1986; 62(5): 904-10. [DOI:10.1210/jcem-62-5-904] [PMID]
15. Tiitinen AE, Laatikainen TJ, Seppala MT. Serum levels of insulin-like growth factor binding protein-1 and ovulatory responses to clomiphene citrate in women with polycystic ovarian disease. Fertil Steril. 1993; 60(1): 58-62. [DOI:10.1016/S0015-0282(16)56036-1]
16. Barbieri RL, Makris A, Ryan KJ. Insulin stimulates androgen accumulation in incubations of human ovarian stroma and theca. Obstet Gynecol. 1984; 64(3 Suppl): 73S-80S. [DOI:10.1097/00006250-198409001-00019] [PMID]
17. Suikkari AM, Ruutiainen K, Erkkola R, Seppala M. Low levels of low molecular weight insulin-like growth factor-binding protein in patients with polycystic ovarian disease. Hum Reprod. 1989; 4(2): 136-9. [DOI:10.1093/oxfordjournals.humrep.a136858] [PMID]
18. Hernandez ER, Resnick CE, Holtzclaw WD, Payne DW, Adashi EY. Insulin as a regulator of androgen biosynthesis by cultured rat ovarian cells: cellular mechanism(s) underlying physiological and pharmacological hormonal actions. Endocrinology. 1988; 122(5): 2034-43. [DOI:10.1210/endo-122-5-2034] [PMID]
19. Dale PO, Tanbo T, Ertzeid G, Bjercke S, Oldereid N, Fedorcsak P, et al. The impact of insulin resistance on the outcome of laparoscopic ovarian electrocautery in infertile women with the polycystic ovary syndrome. Gynecol Endocrinol. 2004; 19(4): 182-9. [DOI:10.1080/09513590400012093] [PMID]
20. Seow KM, Juan CC, Hsu YP, Hwang JL, Huang LW, Ho LT. Amelioration of insulin resistance in women with PCOS via reduced insulin receptor substrate-1 Ser312 phosphorylation following laparoscopic ovarian electrocautery. Hum Reprod. 2007; 22(4): 1003-10. [DOI:10.1093/humrep/del466] [PMID]
21. Kriplani A, Manchanda R, Agarwal N, Nayar B. Laparoscopic ovarian drilling in clomiphene citrate-resistant women with polycystic ovary syndrome. J Am Assoc Gynecol Laparosc. 2001;8(4):511-8. [DOI:10.1016/S1074-3804(05)60613-5]

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