Effect of Laparoscopic Ovarian Drilling on Ovarian and Uterine Doppler Flow Indices Using 3-Dimensional Power Doppler in Clomiphene Resistant PCOS

Background: It is assumed in polycystic ovary syndrome (PCOS) that follicular development, maturation, ovulation and implantation are impaired due to hormonal imbalance and vascular impairment of the ovarian and uterine vasculatures. The mechanism of action of laparoscopic ovarian drilling (LOD) is largely unexplained. To date, only limited studies have been conducted utilizing 3D ultrasonography to investigate the 3D ultrasound features of PCOS in relation to this fertility treatment. Objective: To determine the effect of LOD on ovarian and uterine blood flow and vascularity as assessed by 3Dimensional power Doppler ultrasonography in Clomiphene citrate (CC) resistant women with PCOS. Study Design: Prospective study. Patients and Methods: 60 CC resistant women with PCOS were scheduled for LOD. Three ovarian Doppler indicesvascularization index, flow index, and vascularization flow index, in addition to the resistance index of the uterine arterywere measured before and a month after LOD. All patients were followed-up through 6 months after the operation to detect the outcome of the laparoscopic drilling. Results: Doppler indices of ovarian blood flow showed a highly significant decrease in the PCOS group after LOD. Decrease in uterine artery Doppler indices following LOD failed to reach statistical significance. Conclusion: LOD is shown to reduce ovarian vascularization in CC resistant women with PCOS. The data could contribute greatly to our knowledge on ovarian physiology, resumption of menstrual cyclicity and fertility after the commonly used ovarian surgery.