rFSH Versus Transvaginal Hydrolaparoscopic Ovarian Drilling in Patients with Polycystic Ovary Syndrome Resistant to Ovulation Induction

OBJECTIVE: To compare outcomes of recombinant follicle-stimulating hormone (rFSH) treatment with transvaginal hydrolaparoscopic ovarian drilling (THLOD) procedure in patients with polycystic ovary syndrome (PCOS) resistant to ovulation induction with clomiphene citrate (CC). STUDY DESIGN: A total of 156 patients were eligible for inclusion in the present study, of whom 76 were allocated to the THLOD strategy and 80 were allocated to the rFSH strategy. For the THLOD group, each ovary was randomly ablated at 10-15 points at the anterolateral side, depending on its size, and if anovulation per-sisted for 8 weeks after electrocautery or the patient became anovulatory again, treatment was started with 50 mg clomiphene citrate. For the rFSH group, ovulation induction was started on cycle day 3 using 75 IU rFSH daily. RESULTS: The rate of live birth in the rFSH strategy was 67.5%, and the rate of live birth in the THLOD strategy was 63.2% (p= 0.6). However, time to first successful ovulation and conception were found to be significantly shorter in the rFSH strategy arm. There was no major complication related to surgical procedure, and minor complications occurred in 8 patients (5%). CONCLUSION: The THLOD procedure, as compared to rFSH therapy, appears to be an unfavorable option for the treatment of patients with CC-resistant PCOS. Since THLOD procedure has many disadvantages, we recommend rFSH therapy as the treatment of first choice in this patient subgroup.