Laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome. Laparoscopic ovarian drilling LOD is an alternative to ovulation induction with gonadotropins for polycystic ovarian syndrome PCOS patients unresponsive to clomiphene.
It is quick and easy to perform, although the number of punctures and energy doses has not been standardized.
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The mechanism of LOD is unclear, but it is likely mediated by a reduction in intraovarian androgen production. Serum luteinizing hormone and testosterone levels are rapidly normalized, and these changes are sustained over long-term follow-up.
Studies have shown that ovulation and pregnancy rates are comparable between ovulation induction with gonadotropins and LOD, but LOD avoids the risks of multiple pregnancy and ovarian hyperstimulation syndrome.
LOD is also more cost effective and better tolerated than gonadotropin therapy. Concerns regarding clinically significant adhesion formation and premature ovarian failure are not supported by the available data.
Transvaginal hydrolaparoscopy and ultrasound guidance are less invasive techniques for performing ovarian drilling and may encourage LOD earlier in the course of treatment for PCOS. This was a prospective controlled study to compare the beneficial effects of office microlaparoscopic ovarian drilling OMLOD under augmented local Adam and ninos first dril, as a new modality treatment option, compared to those following ovarian drilling with the conventional traditional mm laparoscope laparoscopic ovarian drillingLOD under general anesthesia.
Transvaginal ultrasound scan and blood sampling to measure the serum concentrations of LH, FSH, testosterone and androstenedione were performed before and after the procedure.
Intraoperative and postoperative pain scores in candidate women were evaluated during the office microlaparoscopic procedure, in addition to the number of candidates who needed extra analgesia. The number of patients discharged within 2 h after the office procedure was significantly higher, without the need for postoperative analgesia in Adam and ninos first dril patients. The mean ovarian volume decreased significantly P ovarian drilling by microlaparoscopy without general anesthesia.
The high pregnancy rate, the simplicity of the method and the faster discharge time offer a new option for patients with PCOS who are resistant to clomiphene citrate. Moreover, ovarian drilling could be performed simultaneously during the routine diagnostic microlaparoscopy and integrated into the fertility workup of. Pregnancy following laparoscopic ovarian drilling for clomiphene resistant polycystic ovarian syndrome. We present a case of a 29 year old nulliparous woman with clomiphene resistance polycystic ovarian syndrome.
She achieved a pregnancy four months later following clomiphene citrate ovulation induction. The pregnancy was complicated with 1st trimester threatened abortion, pre-term PROM and later pre-term labour at 34 weeks gestation with breech presentation. She had a successful caesarean delivery of a 1. Changes in ovarian reserve and ovarian blood Adam and ninos first dril in patients with polycystic ovary syndrome following laparoscopic ovarian drilling.
This prospective cohort study was conducted on 80 patients with clomiphene citrate CC -resistant polycystic ovary syndrome undergoing laparoscopic ovarian drilling LOD.
Pre- and post-LOD ovarian reserve parameters anti-Mullerian hormone: OV, and antral follicle count: AFC and ovarian stromal blood flow indices Vascularization index: FI, and vascularization flow index: VFI were measured to explore the effect of LOD and to find out the correlation between serum AMH Adam and ninos first dril different clinical, hormonal, and ultrasonic variables. An alternative but not the ultimate in the management Adam and ninos first dril polycystic ovary syndrome.
Since its introduction inlaparoscopic ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with polycystic ovary syndrome PCOSunresponsive to clomiphene citrate. It is as effective as gonadotropins in terms of pregnancy and live birth rates, but without the risks of ovarian hyperstimulation syndrome and multiple pregnancies.
It improves ovarian responsiveness Adam and ninos first dril successive ovulation induction agents. Its favorable reproductive and endocrinal effects are sustained long. Despite its advantages, its use Adam and ninos first dril unselected cases of PCOS or for non-fertility indications is not prudent owing to the potential risks of iatrogenic adhesions and ovarian insufficiency.
Women with clomiphene citrate resistant polycystic ovarian disease: To evaluate the role of different clinical, biochemical and sonographic factors as predictors of spontaneous ovulation after laparoscopic ovarian drilling LOD in women with clomiphene citrate resistant polycystic ovarian disease CCR-PCOD.
Several clinical, biochemical and sonographic criteria were tested as possible predictors of spontaneous ovulation after LOD using multivariate analysis. Other factors including age, BMI, type of infertility, duration of infertility, menstrual pattern, testosterone level, ovarian volume and SHBG were insignificant predictors.
Receiver-operating characteristic ROC curves derived from FSH, LH, androstenedione, and a logistic regression model showed that the best cut-off values were 4. An extended follow up 9 months after LOD was conducted for the anovulatory and the non-pregnant ovulatory women, who were treated individually according to their clinical situation. Of these women, This study aimed to evaluate the efficacy of unilateral laparoscopic ovarian drilling versus bilateral laparoscopic ovarian drilling with thermal dose adjusted according to ovarian volume in clomiphene citrate CC -resistant PCOS patients in terms of endocrine changes, menstrual cycle resumption, ovulation and pregnancy rates.
This study was conducted in the Department of Obstetrics and Gynecology, Zagazig university hospitals. As regards menstruation cycle resumption After drillingthere were highly statistically significant decrease in the mean serum levels of luteinizing hormone LH and significant decrease in the mean serum levels of testosterone in both groups. Mean serum level of follicle stimulating hormone FSH did not change significantly in both groups after drilling. Bilateral laparoscopic ovarian drilling with thermal dose adjusted according to ovarian volume is more effective than the right-sided unilateral technique with thermal dose adjusted according to ovarian volume in terms of menstrual cycle resumption, ovulation and cumulative pregnancy rates in CC-resistant PCOS patients.
Impact of laparoscopic ovarian drilling on serum anti-mullerian hormone levels in patients with anovulatory Polycystic Ovarian syndrome. Anti-mullerian hormone AMH is a marker of the activity of recruitable ovarian follicles. It is useful in the prediction of ovarian reserve.
Laparoscopic ovarian drilling LOD in patients with PCOS destroys ovarian androgen-producing tissue and reduces their peripheral conversion to estrogens. Identifying factors that determine the response of patients with PCOS to LOD will help in selecting the patients who would likely benefit from this treatment. LOD was not associated with a risk of diminished ovarian reserve. LOD has no negative effect on ovarian reserve.
Clomiphene citrate plus tamoxifen versus laparoscopic ovarian drilling in women with clomiphene-resistant polycystic ovary syndrome. To compare the efficacy of clomiphene citrate CC plus tamoxifen with that of laparoscopic ovarian drilling in clomiphene-resistant women with polycystic ovary syndrome PCOS.
We randomly allocated women with CC-resistant PCOS to a combined medication group group 1 or a laparoscopic surgery group group 2.
The primary outcome was the live birth rate in each group; secondary outcomes were the rates of ovulation, clinical pregnancy and miscarriage. There were no significant differences Adam and ninos first dril the groups regarding rates of ovulation Unilateral or bilateral laparoscopic ovarian drilling in polycystic ovary syndrome: This systematic review and meta-analysis aimed to compare the effectiveness of unilateral vs.
BLOD for improving fertility outcomes in infertile women with clomiphene-resistant polycystic ovary syndrome PCOS as well as its effect on ovarian reserve. Main outcomes were ovulation and clinical Adam and ninos first dril rates per woman randomized. Secondary outcomes were; live birth and miscarriage rates as well as postoperative serum anti-mullerian hormone AMH concentration and antral follicle count AFC.
Quality assessment was performed by the Cochrane Collaboration risk of bias tool. Eight eligible trials women were analyzed. No significant difference was found in rates of ovulation OR 0.
After carefully weighing up the well-known benefits of BLOD against a potential risk to ovarian reserve, clinicians could be advised to offer the fixed-dose ULOD to their infertile patients with clomiphene-resistant PCOS.
This is concordant with the "primum non nocere" principal if LOD will be envisaged. Tumor necrosis factor alpha versus LH and androstendione as a reliable predictor of spontaneous ovulation after laparoscopic ovarian drilling for women with clomiphene citrate resistance polycystic ovarian disease.
Laparoscopic ovarian drilling LOD is still a controversial decision; due to the long term hazards; so short and long term predictors after the procedure should be taken in consideration. Logistic regression showed that the best cut-off values for spontaneous ovulation after LOD were Therapeutic effects of metformin and laparoscopic ovarian drilling in treatment of clomiphene and insulin-resistant polycystic ovary syndrome.
A total of patients were randomly divided into two groups. Rates of ovulation, pregnancy, and abortion were compared between both groups. Rates of normal menstruation, ovulation, and pregnancy in the LOD group were higher than in the Met group: GnRH antagonist Cetrotide 0. To critically evaluate and summarize the current body of literature regarding the role of LOD for the management of PCOS entailing its different Adam and ninos first dril, operative and postoperative aspects.
In addition, long-term efficacy, cost-effectiveness, patient preference and health-related quality of life issues will be evaluated together with other available alternatives of ovulation induction treatments.
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It is as effective as gonadotrophin treatment but without the risk of multiple pregnancy or ovarian hyperstimulation and does not require intensive monitoring. Increased responsiveness of the ovary to CC especially in patients who remain anovulatory following LOD is another advantage.
Recent evidence suggests that relatively novel oral methods of ovulation induction, e. A Retrospective Cost-Effectiveness Analysis. The current evidence of the cost-effectiveness of both treatments is scarce, conflicting and performed from different health-economic perspectives.
Data were collected until the patients were pregnant, with a time limit of 6 months after the onset of treatment. Outcomes were expressed as ongoing pregnancy Adam and ninos first dril and number of live-born children. Could transvaginal, ultrasound-guided ovarian interstitial laser treatment replace laparoscopic ovarian drilling in women with polycystic ovary syndrome resistant to clomiphene citrate?
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A number of novel surgical modalities that destroy or remove some ovarian tissue to restore ovarian function in patients with polycystic ovary syndrome have been described in the most recent literature. Although these modalities were reported to have Adam and ninos first dril applicability and low cost with shorter hospital stay, the efficacy and safety concerns need to be discussed extensively.
Laparoscopic management of large ovarian cysts: Laparoscopic management of three cases, each with a large ovarian cyst, is reported.
Appropriate preoperative assessment, patient counselling, and good laparoscopic skills are the cornerstones of successful laparoscopic management in such patients.
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An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate-resistant polycystic ovarian syndrome.
Women with polycystic ovarian syndrome are typically anovulatory and require ovulation induction. Ovarian wedge resection was the first treatment for anovulation but was eventually abandoned because of the increased risk of postsurgical adhesions and as medical ovulation induction with clomiphene and gonadotrophins was introduced.
However, with the advent of laparoscopy, there has been a return to surgical approaches.
The potential advantages of laparoscopic surgery include avoidance of hyperstimulation and the lowered costs make ovarian surgery an attractive alternative to gonadotrophins. Clinical trials in New Zealand and the Netherlands have compared costs of laparoscopic ovarian drilling with gonadotrophins.
The total cost of treatment in the Netherlands study for the ovarian drilling group was euro and for the gonadotrophins group was euro Because XL Gay Tube is truly about nino gay videos and nothing else. Adam Adam and ninos first dril Nino Xxl wang Bb.
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Intraoperative and postoperative pain scores in candidate women were evaluated during the office microlaparoscopic procedure, in addition to the number of candidates who needed extra analgesia. Illustration of equipment is provided. Both rotary-drag and rotary-percussive drills are targeted. Randomized controlled trial comparing laparoscopic ovarian diathermy with clomiphene citrate as a first-line method of ovulation induction in women with polycystic ovary syndrome.
The purpose of this study was to determine the effect and validity of an intensive laboratory-based laparoscopic skills training curriculum on operative proficiency in obstetrics and gynecology residents. A highly compressed development schedule dictated a modular design architecture that satisfies the functional and load requirements while allowing independent development and testing of the Drill subassemblies.
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