ULTRASONIC OVARIAN DRILLING AS A FIRST CHOICE IN INFERTILE WOMEN WITH POLYCYSTIC OVARY SYNDROME

Objective : To evaluate the results of laparoscopic ovarian drilling using harmonic scalpel in infertility patients with PCOS as a first choice as regard to ovulation rate, pregnancy rate, hormonal profile and ultrasonographic changes which reflect the ovarian reserve and reproductive outcome.
Patients and Methods: 90 patients presented by infertility due to PCOS were randomly allocated into three equal groups. Group (I) were subjected to ovulation induction by clomiphene citrate (50 mg twice/day) started from the 3 day of normal or induced cycle for 5 days for six consecutive cycles, Group (II) subjected to laparoscopic ovarian drilling using electrocautery and Group (III) was subjected to laparoscopic ovarian drilling using harmonic scalpel, all patients were assessed twice; one before the induction procedure and the 2n was three months after if pregnancy did not occur. Patients were assessed clinically (to determine menstrual regularity, body mass index and degree of hirsulism), sonographically (to measure ovarian volume and antral follicle count at time of ovarian quiescence) and laboratory (to measure basal serum LH, FSH, LH/FSH ratio, total testosterone and estradiol). Also, 2 look laparoscopy was performed in those patients who failed *o conceive within six months of the initial laparoscopic procedure.
Results: Laparoscopic ovarian drilling using harmonic scalpel alone resolved infertility within 4-6 months in 579r of couples with significantly higher ovulation and pregnancy rates over clomiphene citrate and electrocautery groups with significantly more regular menstrual pattern and minimal incidence of post operative adhesions.
Conclusion: Laparoscopic ovarian drilling using harmonic scalpel is a minimally invasive procedure, leads to Monofollicular development which eliminates the need for cycle monitoring and risk of multiple pregnancies or ovarian hyperstimulation that may occur with medical induction of ovulation. It has significantly higher ovulation and pregnancy rates, more regular menstrual pattern and with minimal effect on ovarian reserve with minimal incidence of post operative adhesions.