Ultrasound-guided transvaginal ovarian needle drilling (UTND) for treatment of polycystic ovary syndrome: a randomized controlled trial

Abstract

Objective: To evaluate the outcome of ovarian needle drilling using transvaginal ultrasound guidance as an alternative to the traditional laparoscopic electrosurgical drilling for patients with polycystic ovary syndrome (PCOS).

Design: A randomized controlled study.

Setting: University teaching hospital and private practice setting.

Patient(s): The study comprised 163 patients with clomiphene-resistant PCOS.

Intervention(s): Patients were randomly allocated to either treatment with ultrasound-guided transvaginal needle ovarian drilling (UTND; n = 82) or laparoscopic electrosurgery ovarian drilling (n = 81).

Main outcome measure(s): Hormonal changes (FSH, LH, T), ovulation and pregnancy.

Result(s): There were no significant differences between the two groups with regard to body mass index, hormonal profiles, clinical manifestations, and ultrasound findings of PCOS. The duration of UTND was 15.3 +/- 5.61 minutes (10.5-22.3 minutes), while it was 25.6 +/- 8.2 minutes (20.3-38.1 minutes) in laparoscopic drilling, with a statistically significant difference between the two groups. There were no significant differences between the two groups with regard to resumption of normal menstruation, hirsutism, acne, ovulation, and pregnancy. UTND resulted in significant improvement in the ovulation, pregnancy, hirsutism, and acne. There were significant decreases in the serum LH and T levels but not in the FSH or LH/FSH levels after UTND as well.

Conclusion(s): UTND can be adopted as an outpatient office procedure. The ease of scheduling, reduced costs, and rapid recovery suggest it as a first-line treatment for PCOS cases resistant to clomiphene citrate.