Impact of Laparoscopic Ovarian Drilling on Ovarian Reserve and Ovarian Stromal Blood Flow Using three-Dimensional Power Doppler in Women with Anovulatory Polycystic Ovary Syndrome

Abstract

Polycystic ovarian syndrome is a very common reproductive disorder, affecting approximately 5-10% of women in their child bearing years PCOS is described as a complex associated with amenorrhea, hirsutism and enlarged polycystic ovaries. In 2003, Rotterdam consensus group revised the diagnostic criteria of PCO, and set the diagnosis based on presence of any 2 of the following parameters: 1- Oligomenorrhia and/ or anovulation. 2- Clinical and/or biochemical signs of hyperandrogenism. 3- Polycystic ovaries should have at least one of the following: either 12 or more follicles measuring 2-9 mm in diameter, or increased ovarian volume (>10cm3). PCOS can be diagnosed only after the exclusion of related disorders (e.g., severe insulin resistance, androgen-secreting neoplasms, Cushing’s syndrome, hyperprolactinemia and thyroid abnormalities. Ovarian reserve (OR) refers to the number and quality of oocytes that, at any given age, are available to produce a dominant follicle late in the follicular phase of the menstrual cycle.. Markers which are related to the ovarian reserve include age, sonographic variables (such as ovarian volume), Antral Follicle Count (AFC), ovarian stromal blood flow, hormonal parameters (for instance Follicle-Stimulating Hormone (FSH), estradiol (E2), Anti-Müllerian Hormone (AMH) and day 3 E2/ FSH ratio. The recent innovation of three-dimensional (3-D) ultrasound, as well as colour- and pulsed-Doppler ultrasound, may further enhance the detection of polycystic ovaries, and may be more commonly employed in time. Increased ovarian stromal blood flow has been considered to be a new parameter to assist in the ultrasound diagnosis of polycystic ovaries The aim of the present study was to discuss the impact of laparoscopic ovarian drilling in women with PCOS on serum (E2, LH and FSH levels), AFC, ovarian volume and ovarian stromal blood flow indices. In order to achieve this objective, 30 women with PCOS fulfilling the (Rotterdam Criteria, 2003) were recruited from infertility clinic of Ain Shams University maternity Hospital. Venous blood samples were withdrawn from each patient in the 2nd day of menstruation to assess serum (FSH, LH and E2 levels). 3D transvaginal power Doppler ultrasound was done for each patient to assess the ovarian volume (ml), morphology and the mean antral follicle number in both ovaries (measuring 2-9mm) and three indices quantifying the power Doppler signal were determined namely, vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Bilateral laparoscopic ovarian drilling was carried out postmenstrual in Laparoscopy Unit at Ain Shams University Maternity Hospital. Venous blood samples were recollected from each patient in the 2nd day of menstruation to assess serum (FSH, LH and E2 levels) after LOD by 3 month. 3D transvaginal power Doppler parameters were repeated on 2nd day of the menstruation after LOD by 3 month. The vascularizaton index (VI) represents the ratio of power Doppler information within the total data set relative to both colour and grey information, providing an indication of the number and/or size of vessels within the volume of interest and therefore the degree of vascularity. The mean power Doppler signal intensity is reported as the flow index (FI), and because the intensity of the signal, or its ‘hue’, is dependent on the number of erythrocytes within a given volume at any time, this value is considered to reflect volume flow rate. Finally, the vacularization flow index (VFI) is calculated by multiplying the other two indices and therefore provides a single value for both vascularity and volume flow and is suggested as being representative of tissue perfusion therefore. Although the exact relationship of these indices to true vascularity and blood flow remains unclear, they have been shown to be reliable and reproducible and to correlate with vessel number and volume flow rate in vitro. In the present study, serum E2 and FSH level was compared before and after laparoscopic ovarian drilling by 3 months and the results showed that there was no statistical significant difference after LOD (p>0.05). In the current study, serum LH level, AFC, ovarian volume and ovarian stromal blood flow indices were compared before and after laparoscopic ovarian drilling by 3 months and the results showed that there was statistical significant decrease after drilling (p<0.05).