Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

Jing Zhang; Kunyan Zhou; Xiaoyan Luo; Meina Yang; Xiaoyang Shen; Liangzhi Xu

doi:10.1016/j.jmig.2019.06.022

Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis

J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1048-1058. doi: 10.1016/j.jmig.2019.06.022. Epub 2020 Apr 11.

Authors

Jing Zhang¹, Kunyan Zhou², Xiaoyan Luo², Meina Yang³, Xiaoyang Shen³, Liangzhi Xu²

Affiliations

¹ Department of Obstetrics and Gynecology (Drs. Zhang, Zhou, Xu, and Ms. Luo, Shen, and Yang); Reproductive Endocrinology and Regulation Laboratory (Drs. Zhang, Zhou, Xu, and Ms. Luo); West China Second University Hospital and the Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education (Drs. Zhang, Zhou, Xu, and Ms. Luo), Sichuan University, Chengdu, Sichuan, China.. Electronic address: jingzhang110914@126.com.
² Department of Obstetrics and Gynecology (Drs. Zhang, Zhou, Xu, and Ms. Luo, Shen, and Yang); Reproductive Endocrinology and Regulation Laboratory (Drs. Zhang, Zhou, Xu, and Ms. Luo); West China Second University Hospital and the Key Laboratory of Birth Defects and Related Diseases of Women and Children Ministry of Education (Drs. Zhang, Zhou, Xu, and Ms. Luo), Sichuan University, Chengdu, Sichuan, China.
³ Department of Obstetrics and Gynecology (Drs. Zhang, Zhou, Xu, and Ms. Luo, Shen, and Yang).

PMID: 32289557
DOI: 10.1016/j.jmig.2019.06.022

Abstract

Objective: To evaluate novel surgical variations of laparoscopic ovarian drilling (LOD) and compare with standard bilateral LOD.

Data sources: Electronic databases were searched, including Cochrane database, CENTRAL, Ovid MEDLINE, Embase, PsycINFO, PubMed, Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, ISRCTN, and The Chinese Clinical Trial Register in February 2019.

Methods of study selection: Randomized controlled trials (RCTs) evaluating LOD for patients with clomiphene citrate-resistant polycystic ovary syndrome and infertility and reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by 2 authors, respectively.

Tabulation, integration, and results: A total of 20 RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study's limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation and found to be moderate to very low. Live births were only reported by 4 studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I² = 75%), ovulation (p = .08, I² = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (1 RCT) and micro-LOD (3 RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and antimüllerian hormone or antral follicle numbers following LOD were inconclusive.

Conclusion: Unilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant polycystic ovary syndrome, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted.

Keywords: Bilateral laparoscopic ovarian drilling; Randomized controlled trials; Unilateral laparoscopic ovarian drilling.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adolescent
Adult
Clomiphene / therapeutic use
Drug Resistance
Female
Humans
Infertility, Female / drug therapy
Infertility, Female / etiology
Infertility, Female / surgery*
Laparoscopy / methods*
Laser Therapy / methods
Ovary / pathology
Ovary / surgery*
Ovulation Induction / adverse effects
Ovulation Induction / methods*
Polycystic Ovary Syndrome / complications
Polycystic Ovary Syndrome / drug therapy
Polycystic Ovary Syndrome / surgery*
Pregnancy
Treatment Outcome
Young Adult

Substances

Clomiphene