Impact of transvaginal hydrolaparoscopy ovarian drilling on ovarian stromal blood flow and ovarian volume in clomiphene citrate-resistant PCOS patients: a case-control study

Abstract

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in gynecology. In PCOS patients vascularization parameters are altered. Transvaginal hydrolaparoscopy (THL) is a mini-invasive approach for ovarian drilling in PCOS patients. In this study, we assessed the effect of ovarian drilling using THL on ovarian volume (OV) and vascularization index (VI) using 3D power Doppler ultrasonography in CC-resistant PCOS patients. A case-control study on 123 CC-resistant PCOS women who underwent THL ovarian drilling was performed. Patients underwent 3D ultrasound and power Doppler to measure VI, flow index (FI), vascularization flow index (VFI) and to evaluate OV before and after the procedure, at six months, and on the early follicular phase of the menstrual cycle. After THL ovarian drilling, OV and power Doppler flow indices were significantly reduced compared to pre-operative values (OV: 7.85 versus 11.72 cm³, p < 0.01; VI: 2.50 versus 4.81, p < 0.01; VFI: 1.10 versus 2.16, p < 0.01; FI: 32.05 versus 35.37, p < 0.01). In conclusion, THL ovarian drilling seems to reduce OV and 3D power Doppler indices, and could therefore be a viable alternative to LOD in PCOS patients resistant to medical therapy.

Chinese abstract

在妇科学中, 多囊卵巢综合征（PCOS）是最常见的内分泌紊乱, PCOS患者血管形成指数是变化的。经阴道注水腹腔镜探查术（THL）是PCOS患者卵巢打孔的一个微小创伤性手术的方法。这项研究, 我们评估对枸橼酸氯米芬（CC）抵抗的PCOS患者用THL方法行卵巢打孔术对卵巢体积（OV）和血管形成指数（VI）（用3D彩色多普勒超声检查）的影响。我们进行了一项针对接受过THL卵巢打孔术的123例CC耐药的PCOS患者的病例对照研究。在术前、术后6个月随访, 在月经周期的早卵泡期, 对患者行3D超声和彩色多普勒检查VI、流动指数（FI）、血管流动指数(VFI)以及评估OV。在THL下行卵巢打孔术后, OV和彩色多普勒检查的指数与术前数值相比显著降低（OV：7.85 vs.11.72cm³, p < 0.01；VI：2.50 vs.4.81, p < 0.01 ；VFI：1.10 vs.2.16, p < 0 .01；FI：32.05 vs.35.37, p < 0.01）。总之, THL下行卵巢打孔术似乎减小了OV和3D彩色多普勒指数, 因此也可以成为耐药物PCOS患者腹腔镜下卵巢打孔术的有价值的方案选择。

Keywords:

• 3D power Doppler index
• ovarian drilling
• ovarian volume
• PCOS
• transvaginal hydrolaparoscopy

Acknowledgements

Ethical approval: All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

Declaration of interest

No potential conflict of interest was reported by the authors.