Page 7 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
The Outcome of Laparoscopic Ovarian Drilling in Patients

with Clomiphene-resistant Polycystic Ovarian Syndrome in

Ogbmoso, Nigeria: A Prospective Evaluation

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Akintunde O Fehintola , Olufemi T Awotunde , Olumuyiwa A Ogunlaja , Samuel E Akinola , Sunday A Oladeji ,
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Olurotimi I Aaron , Funmito O Fehintola 7
AbstrAct
Background: Polycystic ovary syndrome (PCOS) is commonly encountered in women with anovulatory infertility. The surgical ovarian drilling
procedure aims to restore spontaneous ovulatory cycles. This function is similar to the goal of clomiphene citrate and/or metformin.
Objective: We conducted this study to determine the outcome of laparoscopic ovarian drilling (LOD) among patients who presented with
clomiphene-resistant PCOS.
Materials and methods: The study was prospective in design. We studied 43 patients with clomiphene-resistant PCOS who had laparoscopic
ovarian drilling (LOD) using monopolar diathermy at the Bowen University Teaching Hospital, Ogbomoso. The study took place between
January 2014 and June 2016. Clinical data recorded at different intervals of follow-up included the menstrual pattern and reproductive history.
Results: We successfully performed laparoscopic ovarian drilling without any complication. Four (9.3%) of the patients were lost to follow-up.
Thirty (76.9%) of the remaining 39 patients resumed regular menstrual cycles with spontaneous ovulation, while 23 (59.1%) patients achieved
spontaneous pregnancy within 6 and 18 months following LOD. No record of multiple pregnancies. Factors associated with failed LOD treatment
included obesity and a long duration of infertility.
Conclusion: LOD is a feasible and effective first-line treatment option in patients with clomiphene-resistant PCOS in sub-Saharan Africa. Emphasis
should be on weight reduction with early application of LOD to treat patients with clomiphene-resistant PCOS. This will reduce the time to
achieve pregnancy and the need for gonadotropins to induce ovulation.
Keywords: Clomiphene-resistant polycystic ovary syndrome, Laparoscopic ovarian drilling, Treatment outcome.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1418

IntroductIon
1 Department of Obstetrics and Gynaecology, Faculty of Clinical
The most common endocrinopathy in women within the Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
reproductive-age group is polycystic ovary syndrome (PCOS). It 2–5 Department of Obstetrics and Gynaecology, Bowen University
affects about 6–8% of this age-group. 1–4 PCOS forms a spectrum of Teaching Hospital, Ogbomoso, Oyo, Nigeria
disorders from a heterogeneous collection of signs and symptoms. 6 Department of Anaesthesia, Faculty of Clinical Sciences, Obafemi
Its presentation may be mild in some, while reports show severe Awolowo University, Ile-Ife, Osun, Nigeria
disturbance of reproductive, endocrine, and metabolic functions in 7
Community Health Department, Faculty of Clinical Sciences, Obafemi
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others. The prevalence of PCOS varies among races and ethnicities Awolowo University, Ile-Ife, Osun, Nigeria
with a range between 5 and 10% 3
Previous data reported the highest prevalence rate of 52% Corresponding Author: Akintunde O Fehintola, Department of
Obstetrics and Gynaecology, Faculty of Clinical Sciences, Obafemi
among the South Asian immigrants in Britain, of whom 49.1% had Awolowo University, Ile-Ife, Osun, Nigeria, Phone: +2348037998247,
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menstrual irregularity. About 10% of the diagnosis of PCOS is made e-mail: akintunds@yahoo.com
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during gynecologic visits. Approximately 30–75% are obese, while How to cite this article: Fehintola AO, Awotunde OT, Ogunlaja OA,
50% of patients have hirsutism 3 et al. The Outcome of Laparoscopic Ovarian Drilling in Patients with
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In Nigeria, Ugwu et al. and Omokanye et al. reported Clomiphene-resistant Polycystic Ovarian Syndrome in Ogbmoso,
prevalence rates of 18.1% and 31%, respectively. In their series, Nigeria: A Prospective Evaluation. World J Lap Surg 2020;13(3):101–107.
the majority of the patients presented with infertility and oligo- Source of support: Nil

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menorrhea. PCOS is responsible for about 75% of anovulatory Conflict of interest: None
infertility. 6
PCOS predisposes women to diabetes mellitus, endometrial
carcinoma, and cardiovascular disease. 7–9
The exact pathophysiology in PCOS is unknown. However, a PCOS based on the history and examination findings. According to
genetic component is likely, since the condition tends to run in families. an international consensus, the syndrome can be diagnosed using
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Also, the pattern of inheritance is X-linked dominance. Furthermore, the “Rotterdam criteria (presence of at least two of the following
studies have shown the occurrence of PCOS in approximately 50% conditions): Oligomenorrhea or amenorrhea, hyperandrogenism,
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of first-degree relatives. We can make a presumptive diagnosis of and polycystic ovaries on ultrasound. Researchers defined the
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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