I-33: Transvaginal Ultrasound-Guided Ovarian Interstitial Laser Treatment in Anovulatory Women with Polycystic Ovary Syndrome: A Randomized Clinical Trial on The Effect of Laser Dose Used on The Outcome

Background: In 2005, we designed and evaluated the effectiveness of the transvaginal ultrasound-guided ovarian interstitial laser treatment in twenty-three anovulatory women with clomifene citrate (CC)-resistant polycystic ovary syndrome (PCOS) as a new method of ovulation induction in infertile PCOS women, with a more than 80% ovulation rate and 36% pregnancy rate during six postoperative months. Objective of this study was to explore an optimal laser dose for this new treatment protocol. Materials and Methods: Eighty infertile PCOS patients with CC-resistant were enrolled between January 2006 and June 2008. All women presented with oligo-/amenorrhea and anovulation for at least 2 years and were seeking pregnancy. The mean (± SD) age was 29.1 ± 3.1 years and the mean duration of infertility 3.3 ± 2.0 years. The mean body mass index (BMI) was 22.9 ± 3.5 kg/m2. PCOS was diagnosed referring The Rotterdam criteria. Serum concentrations of FSH (6.5 ± 1.4 IU/L), LH (13.7 ± 4.6IU/L) and T (2.9 ± 0.75nmol/L) were assessed at the third day of progesterone-induced bleeding. TVS examination revealed 10-30 subcapsular follicles of 2-8 mm in diameter in unilateral ovary. Any contraindications to surgery, previous treatment with LOD and the presence of tubal or male factors for infertility were considered as exclusion criteria. All subjects were randomly divided into group A, B, C, D and laser coagulation points were as follows: group A, one coagulation point per ovary; group B, two points; group C, three points; group D, four to five points. The procedure of laser treatment has been detailed previously. Briefly, it was location and puncture, laser coagulation and the fibre-optic withdrawal and relocation. Postoperative monitoring include the serum hormone concentrations, follicle development and ovulation, pregnancy and miscarriage and adverse effects. Statistical significance was set at p<0.05. Results: The ovulation rates of group C (75%,15/20) and D (80%,16/20) were significantly higher than of group A (5%,1/20) (p<0.001) and B (15%, 3/20) (p<0.001). The conception rates were significantly higher in group C (45%, 9/20) and D (40%, 8/20 ) than in group A (5.%, 1/20) and B (15%, 3/20) (p<0.05). The mean postoperative serum testosterone levels were significantly lower in group C (2.08 ± 0.62 nmol/l) and D (2.07 ± 0.42 nmol/l) compared with group A (3.10 ± 0.63 nmol/l) (p<0.001) and B (2.98 ± 0.63 nmol/l) (p<0.001). The mean LH value and LH/FSH ratio in group C and D were also significantly lower than in group A and group B. Each increase of dose with one point, would decrease the mean LH level 2.238 IU/l (y=14.175- 2.238x, R square=0.918), the mean serum T level 0.671 nmol/l (y=4.55-0.671x, R square=0.925) and LH/FSH ratio value 0.411(y=2.585-0.411x, R square=0.834). There were no adverse events. Conclusion: Three coagulation points per ovary seems to be the plateau dose sufficient to produce an optimal outcome for ovarian interstitial laser treatment in anovulatory PCOS women. Reducing the laser dose below that level is associated with poorer results and increasing the dose above it does not improve the outcome. Keywords: Anovulation, Dose Laser, Ovarian Interstitial, Polycystic Ovary Syndrome, Transvaginal, Ultrasoundguided