الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In 1935, Stein and Leventhal described an association among polycystic ovaries, oligo-anovulation, and hirsutism, which was called polycystic ovary syndrome (PCOS). PCOS is defined using the Rotterdam criteria. PCOS affects 5%–15% of women of reproductive age and is the first cause of infertility due to anovulation. The first-line treatment for PCOS-related infertility is medical, using clomiphene citrate (CC). CC induces ovulation in 75%–80% of women. Hyperandrogenism, obesity, high ovarian volume, and anovulation are predictive factors for the failure of CC. In CC-resistant infertility, there is no gold standard for management. Aromatase inhibitor has been shown to be effective in restoring ovulation and pregnancy instead of the CC. Nerveless it has not proved its efficiency for CC-resistant infertility compared with placebo (OR 3.17, 95% CI 0.12–83.17) or with ovarian drilling (OR 1.19, 95% CI 0.76–1.86). The two principal options available are a medical treatment by gonadotropin or a surgical management by ovarian drilling. There is no significant difference in birth rate between these two options. Ovarian drilling leads to a lower risk of multiple pregnancies (OR 0.21, CI 95% 0.08–0.58) and avoids hyperstimulation syndrome. Medical treatment requires biological and ultrasound follow-ups, which can be extended over a long period due to the low-dose protocol used. A Laparoscopic or transvaginal hydrolaparoscopic drilling involves surgery and anesthesia. The duration during which the ovarian drilling allows to restore an ovulation and thus to obtain a spontaneous pregnancy in case of isolated PCOS is unknown. Published data on the efficacy of recurrent ovarian drillings are scarce. Long-term efficacy, allowing more than one pregnancy through the recovery of spontaneous ovulation, may be a significant advantage over the medical treatment. The possibility of repeating this surgery after a couple of months or years should also be assessed. This observational study was carried out on 50 female patients in child bearing period attending outpatient clinic and/or inpatient department of obstetrics and gynecology at Tanat University Hospital and the study conducted directly after approval in the period from January 2020 till October 2021. All women were subjected to laparoscopic ovarian drilling. Follow up, induction of ovulation and folliculometry were done for 6 months. If no pregnancy was achieved, re-drilling was done. Regarding rate of spontaneous pregnancy; statistical analysis of current results showed that there were 17 (34%) patients with spontaneous pregnancy after 1st drilling and 15 (45.5%) patients in the 2nd drilling. Regarding ovarian reserve parameters “AMH (ng/mL), antral follicular count and ovarian volume”; statistical analysis of current results showed that AMH was significantly decreased after 1st and 2nd drilling as compared to before 1st and 2nd drilling; 10.06 ± 3.10 and 7.9 ± 3.42 versus 5.84 ± 3.62 and 4.1 ± 3.58 respectively (P <0.001). Antral follicle count in right ovary was significantly decreased after 1st and 2nd drilling as compared Summary and Conclusions 49 to before 1st and 2nd drilling respectively (P <0.001). Ovarian volume in right ovary was significantly decreased after 1st and 2nd drilling as compared to before 1st and 2nd drilling respectively (P = 0.002 and <0.001 respectively). Antral follicle count in left ovary was significantly decreased after 1st and 2nd drilling as compared to before 1st and 2nd drilling (P = 0.002 and <0.001 respectively). Ovarian volume in left ovary was significantly decreased after 1st and 2nd drilling as compared to before 1st and 2nd drilling (P = 0.002 and <0.001 respectively). The strengths of current study were due to every effort was made to ascertain that all follow-up data were documented, and only complete information was included in data analysis and all clinical assessment, ovarian drillings and assessment of study outcomes were done by the same team. The limitations of current study were due to COVID 19 pandemic, side effects of surgical interventions mainly decreased ovarian reserve and relatively small sample size regarding accuracy of study outcomes. In conclusion, if no spontaneous pregnancy occurred in infertile women with PCOs after first laparoscopic ovarian drilling, other methods rather than re-electro-cautery should be considered for enhancement of pregnancy rates as aromatase inhibitors, gonadotropin or even IVF to avoid re-drilling adverse effects.