The impact of laparoscopic ovarian drilling in patients with anovulatory polycystic ovary syndrome and high serum levels of Anti-Mullerian Hormone

Background: Female infertility, inability to conceive with normal means within 12 months, in women could be due to anovulatory polycystic ovary syndrome (PCOS) with high serum levels of Anti-Mullerian Hormone (AMH), a PCOS-diagnostic marker for the use of laparoscopic ovarian drilling (LOD) to treat PCOS and for the detection of ovarian reserve; especially after using LOD in the treatment of PCOS women failed to response to drug interventions. The current clinical trial was carried out to evaluate the response of PCOS women to LOD intervention via the assessment of AMH serum levels and the ability of the treated women to adopt normal physiological menstrual cycle and conceiving.Patients and methods: Here, 75 (24-41 years old) infertile women with body mass index (BMI) at 19.6-25kg/m2 for 28 patients, 25-30kg/m2 for 32 patients, and 30-35kg/m2 for 15 patients were volunteered to be included in the current study. These women suffered primary infertility (57 women) and secondary infertility (18 women) for (8.6 +/- 4.4 years). The serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and AMH were evaluated for baseline (FSH, LH, and AMH) levels and after LOD (LH and AMH) levels. Menstrual cycle regularity was evaluated before and after LOD.Results: The findings of the current work revealed that the FSH serum baseline level before LOD was 5.2-1.6IU/L. For LH and AMH, the serum levels significantly (p<0.05) reduced in LOD-treated women from 14.3 +/- 4.1 to 7.8 +/- 2.8 IU/L and from 13.7 +/- 5.9 to 7.7 +/- 3.9IU/L, respectively. The LOD significantly (p<0.05) decreased the menstrual cycle irregularity, such as oligomenorrhea and amenorrhea from 55 (73.3%) to 22 (29.3%) women and from 2 (2.7%) to 0 (0%) women, respectively. Moreover, regular cycle significantly (p<0.05) increased in LOD-treated women from 18 (24%) to 53 (70.7%) women. Therefore, 51/75 (68%) LOD-treated women showed significant (p<0.05) increased pregnancy rate in 27/51 (52.9%), 18/51 (35.3%), and 6/51 (11.8%) women within 3, 6, and 9 months after LOD, respectively. Moreover, spontaneous ovulation was observed in 7/75 (9.3%) women within 90 days after LOD, in which 5/7 (71.4%) of them got pregnant.Conclusion: The presented data reveal that laparoscopic ovarian drilling is a successful treatment intervention for PCOS, and that Anti-Mullerian Hormone is a confirming test to detect the response of PCOS to the LOD treatment.