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Re: Lap, Ovarian Drilling, Etc. (VERY LONG, SORRY!)From: anonymous@obgyn.netTue, 25 Mar 2003 14:56:22 +0000
It's good that your doctor is making sure your tubes are not blocked. However, if you have PCOS putting you on Met can make a big difference in your fertility. I was unsure from your email as to why you are having a laparoscopy done. I apologize if you have emailed the list earlier and I have missed your posts. I would like to leave a few thoughts with you: I have had three laparoscopic procedures, including ovarian drilling. There is an article that you may find helpful. I found it at this URL: http://www.inciid.org/fertinews/drilling.html It states that if ovarian drilling is done with an insulated needle, it can greatly reduce the adhesions that might occur with this procedure. It also gives the success rates of the ovarian drilling, which were very high. I myself had ovarian drilling done in 1994 in an effort to conceive a second child. After two years of failed fertility treatments with Clomid (200 mg. at the highest dose) and then Clomid with HCG, I had only ovulated once and had not become pregnant. Because I was unwilling to consider reducing a pregnancy, I was not comfortable with the thought of using injectibles. Therefore, my only personal choice was the drilling. The good news is, it worked. The bad news is, it didn't work the first time we did it. My bowel ended up adhering to my ovaries, and 6 weeks later I was back in surgery to "unstick" everything. However, two weeks after the second surgery I had my first menstrual cycle on my own in 2 years. 8 weeks after that I had another one, and I conceived my son (who is now 7) during that cycle. I know it is ironic but I chose to then have my tubes tied after that pregnancy due to the fact that I am diabetic when I am pregnant, have to have c- sections to deliver, and am severely post-partumly depressed. The TRULY ironic thing is, I have had almost perfectly regular cycles since I had this ovarian drilling done (and I have to say I do wonder about the irony of it all). I would ask your doctor what percentage of scarring and adhesions women have after undergoing ovarian drilling; what success rate he personally has had with women who have undergone this procedure, and if he would recommend anything else before this surgical point. Also ask him if he has read this article, and ask him if he will use an insulated needle. Because my surgery was done so long ago, I am sure an insulated needle was not used (my dr. used a laser cautery). Please feel free to email me directly at dmirabile@att.net if I can relate anything else to you. I'm going to cut and paste the article after my signature so people who don't want to read it can just skip it. Best wishes, Donna in Utah Ovarian Drilling for Clomiphene Citrate-Resistant PCOS Patients Article Title: Laparoscopic treatment of polycystic ovaries with insulated needle cautery: A reappraisal Authors and Affiliations: Afaf Felemban, Seang Lin Tan, and Togas Tulandi; Department of Obstetrics and Gynecology, McGill University (Montreal, Quebec, Canada). Journal: Fertility and Sterility, Volume 73, Number 2, pp. 266-269. Summarized by Christine M. Schroeder, Ph.D. Polycystic ovarian syndrome (PCOS) is characterized by anovulation and infertility. The first treatment choice of many physicians for these patients is clomiphene citrate (CC). Over eighty percent of PCOS patients will ovulate on CC; however, the pregnancy rates among treated patients are not commensurately high (40 to 50 percent), and, among those patients who do conceive, the spontaneous miscarriage rate is quite high (30 to 40 percent). For many PCOS patients, the next course of treatment after CC may be injectible gonadotropins or other medical treatment. Another mode of treatment, however, is surgical. The surgical technique most commonly used for treatment of PCOS is ovarian drilling via laparoscopy. Ovarian drilling is designed to reduce LH, testosterone, and other hormone concentrations which are characteristically elevated in PCOS patients. The means by which drilling works is as of yet unknown; one theory hypothesizes that drilling is effective through its destruction of ovarian stromal cells, which produce androgens. Others focus upon increased blood flow to the ovary area and reductions in the level of circulating inhibin after surgery. A number of approaches to drilling have been used, including laser, unipolar cautery, and bipolar cautery. Past studies regarding the efficacy of ovarian drilling, however, have had numerous inconsistencies and weakness, including: Small numbers of patients Inconsistent duration of follow-up Varying definitions of PCOS Inconsistent histories of CC treatment The current study evaluated the outcome of ovarian drilling treatment on 112 PCOS patients who had all failed on conceive on CC treatment of up to 200 mg for five days (some of the patients had also failed to conceive on injectible gonadotropin therapy). All ovarian drilling was carried out via laparoscopy, using insulated needle unipolar cautery. Another ovarian drilling-related concern is the possibility of post-surgical scarring, or adhesion formation. Insulated needles were used to minimize this possibility. Additionally, 15 patients who had not conceived within one year of surgery underwent "second look" laparoscopy for the purposes of evaluating scarring and adhesion formation. The average participant age was 30.2 years, and participants had experienced infertility for an average duration of 3.6 years. The mean body mass index for participants was in the overweight range (28.1 kg/meters-squared). Comparison of the baseline hormonal profiles of the patients before and after ovarian drilling indicated that: LH levels declined significantly, from 12.7 to 7.6 IU/L. Correspondingly, the LH/FSH ratio declined significantly from 2.8 to 1.4. Testosterone levels declined significantly from 2.8 to 2.1 pmol/L. DHEAS levels declined significantly, from 7.2 to 4.4 nmol/L. DHEA levels declined significantly, from 23.3 to 10.2 nmol/L. Androstenedione levels declined significantly from 7.5 to 5.2 nmol/L. There was no significant change in FSH or 17 alpha-OH progesterone concentrations. Prior to ovarian drilling, 92 percent of the participants had irregular periods and the remainder were completely amenorrheic. After ovarian drilling, 80 percent of patients had regular menstrual cycles for at least 12 months, and the remainder had irregular periods. None were amenorrheic. Additionally, after ovarian drilling, 73.2 percent of the patients ovulated spontaneously, 24.1 percent ovulated with CC, and the remainder ovulated with injectible medications. At 12 months' follow-up, 54 percent of the patients had achieved pregnancy, at 18 months, 68 percent had, and at 24 months, 82 percent had. At one year post- surgery, fifteen patients who had not yet conceived underwent a second laparoscopy to examine the ovaries. Of the 15 women, four had a mild degree of filmy adhesions, which were removed. Within six months of the second-look surgery, six of these 15 women had conceived. Based on these results, the authors concluded that ovarian drilling with insulated needle cautery is an effective treatment for CC-resistant PCOS patients and is associated with very minimal adhesion formation.
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