Assessment of Ovarian Reserve using FSH, Inhibin-B Hormone and Antral Follicle Count after Laparoscopic Ovarian Drilling in Polycystic Ovary Syndrome

Abstract

Polycystic ovary syndrome (PCOS) constitutes the most common endocrinopathy of women of reproductive age. It has gained a great deal of public attention over the last few decades, as this is reflected in over 1,500,000 Internet sites dedicated to the syndrome. However, although widespread, PCOS is a very complex endocrine condition making its diagnosis a difficult and challenging task in everyday clinical practice. These difficulties in diagnosis, as well as the heterogeneity of the disease and its nebulous nature, were made evident from the very first description of PCOS by Stein and Leventhal. Laparoscopic ovarian drilling is one of the treatments of choice for clomiphene citrate resistant PCOS women. Not only does it have good results with ovulation and pregnancy rates of 83-89% and 70-80% respectively, but it also has several advantages including having a long-term effect after one operation inducing one follicle ovulation, not needing extensive monitoring and having no ovarian hyperstimulation syndrome. The aim of this study was to evaluate the effect of laparoscopic ovarian drilling on FSH, inhibin B hormone and antral follicle count as ovarian reserve markers. This study was conducted at Ain Shams University Maternity Hospital included 38 patients of polycystic ovary syndrome candidate for laparoscopic ovarian drilling (clomiphene citrate resistant patients).Polycystic ovary syndrome was diagnosed according to Rotterdam criteria as ovulatory disturbance, hyperandrogenism and presence of >10 follicles, 2-9mm in diameter in each ovary by ultrasound examination. Patients with age< 19 and >35 years, pre-existing endocrine disease, previous pelvic surgery or previous ovarian cystectomy were excluded from the study. All patients included in the study were subjected to; detailed history taking, full examination (general examination, abdominal examination and gynecological examination), transvaginal ultrasound and hormonal profile (inhibin B and FSH) done before laparoscopic ovarian drilling at follicular phase (second day of the cycle)and at the follicular phase (second day of the cycle)of first menstruation after laparoscopic ovarian drilling(or after progesterone challenge withdrawal bleeding if no menstruation occurs for six weeks). Sample size was calculated using OpenEpi version 2.3.1. Data from a previous relevant study showed that the mean no. of antral follicles was 16.5 ± 1.3 before ovarian drilling and 14.9 ± 2.1 after drilling; this difference was statistically significant (p=0.007). Calculation according to these values produced a minimal sample size of 38 cases. Statistical analysis was performed using Microsoft® Excel® Version 2010 and statistical Package for social sciences (SPSS® )for Windows® Version 15.0.Continous data were presented as range ,mean and standard deviation. Dichotomous or categorical data were presented as number and percentage. Difference between two paired groups was estimated using the paired student's t-test (for parametric continous variables). Significance level was set at 0.05. There was a significant reduction in the ovarian volume and AFC on both sides when post-LOD values were compared to the pre-LOD values. There was a significant rise in serum FSH and a significant reduction in serum inhibin B when post-LOD values were compared to the pre-LOD values.