OVARIAN STROMAL BLOOD FLOW AFTER LAPAROSCOPIC OVARIAN DRILLING IN WOMEN WITH POLYCYSTIC OVARY SYNDROME

Background: Women with polycystic ovary syndrome have significant difference in their ovarian stromal blood flow indices when compared to women with normal ovaries. The intra-ovarian blood flow is assessed by studying small arteries in the ovarian stroma not close to the surface of the ovary or near the wall of the follicles.
Aim: To assess the value of changes in Doppler indices of ovarian stromal blood flow and hormonal profile in women with PCOS and previously described as being clomiphene citrate resistant in predicting the clinical outcome of laparoscopic ovarian drilling as regard ovulation.
Study design: This study is interventional study.
Setting: Department of Obstetrics and Gynecology (Ultrasound and Gynecologic endoscopy units), Faculty of Medicine, Zagazig University.
Patients' criteria: Women with PCOS according to Rotterdam criteria, 2003, aged 18-35 years. All women in the study were free of any medical illness and had not received any medications in the last 6 months before the study apart from incremental doses of clomiphene citrate with its failure to induce ovulation in them (clomiphene citrate resistant). Hysterosalpingography and husband semen analysis were normal in all subjects.
Sample size: 59 PCOS patients.
Procedures: After measuring peak systolic blood flow velocity (PSV), pulsatility index (PI) and resistance index (RI) within the ovarian stroma using two dimensional colour Doppler transvaginal sonography and measuring the serum concentrations of FSH, LH and total testosterone of 59 PCOS patients, laparoscopic ovarian drilling was done (4 punctures in each ovary using 40 watts monopolar electrocautery for 4 seconds). Ovulation was evaluated by serial ultrasound and mid luteal serum progesterone level in the first post-operative menstruation.
Results: Within 10 weeks of laparoscopic ovarian drilling (LOD), LH decreased significantly from (13.1 + 1.9) before LOD to (6 + 0.6) after LOD and total testosterone decreased significantly from (1.04+0.23) to (0.51 + 0.2). As regard FSH, it increased significantly from (6.16+ 0.34) before LOD to (7.6 + 0.8) after LOD. PSV decreased significantly from (11.9 + 1.8) before LOD to (7.44 + 1.5) after LOD. Also, PI increased significantly from (2.02 + 0.56) before LOD to (2.98 + 0.5) after LOD. As regard RI, it increased significantly from (0.75 + 0.06) before LOD to (0.86 + 0.05) after LOD. There was significant negative correlation between total testosterone and PI (r = 0.49, p. value < 0.01), highly significant negative correlation between total testosterone and RI (r = 0.41, p. value < 0.001) and significant positive correlation between total testosterone and PSV (r = o.32, p. value< 0.05). Conclusion(s): PCOS patients to whom Laparoscopic ovarian drilling was done usually experienced reduction in their blood flow within the ovarian stroma. There was statistically significant correlation between hormonal profile and changes in the blood flow within the ovarian stroma in those patients. This may be valuable in predicting the clinical outcome of LOD as regard ovulation and pregnancy.