Preoperative luteinizing hormone levels predict the ovulatory response to laparoscopic ovarian drilling in patients with clomiphene citrate-resistant polycystic ovary syndrome

Abstract

Objective: Laparoscopic ovarian drilling (LOD) is a treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS), but appropriate indications for this procedure are lacking. The aim of this study was to analyze preoperative factors affecting the efficacy of LOD in producing ovulation in CC-resistant PCOS patients.

Design: Retrospective cohort study.

Patients and methods: We studied 40 infertile Japanese women with CC-resistant PCOS who received LOD using argon-beam electrocoagulation. These patients satisfied the diagnostic criteria of the revised European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine PCOS consensus.

Results: After LOD, ovulation occurred in 33 (83%) patients; pregnancy occurred in 22 patients (55%). Preoperative serum luteinizing hormone (LH) levels were significantly higher in women who ovulated after LOD than in those who did not ovulate. The area under the receiver operator characteristic curve for ovulation using preoperative LH levels was 0.81 (95% confidence interval: 0.67-0.96). After LOD, follicle-stimulating hormone levels increased significantly in the non-ovulating group but were unchanged in the ovulating group.

Conclusions: Preoperative serum LH levels may be a good predictor of LOD efficacy in patients with PCOS. Therefore, eligibility criteria for LOD should be strictly applied, since LOD for patients with inadequate LH levels is not only ineffective, but also may impair ovarian reserve.