الفهرس 
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Abstract
SUMMARY
SUMMARY
This study was conducted to evaluate the ovarian volume and ovarian stroma by use of transvaginal ultrasound before and after laparoscopic drilling in cases of clomiphene-resistant PCOS, follow up of the cases for 6 months for occurrence of ovulation and pregnancy and also to define factors affecting treatment outcome in an attempt to define selection crtieria of patients suitable for laparoscopic ovarian drilling.
Thirty five patients with PCOS were selected for this study, from those attending the outpatient clinics of Benha University hospital where laparoscopic ovarian cauterization was done for them.
The mean age of the selected women was 24.8 ± 2.9 years and the duration of infertility was 5.4 ± 3.6 year. All patients had irregular menstruation either ammenorrhic (28.6%) or oligomenorrheic (71.4%). Primary infertility was present in (82.9%) while secondary infertility was present in only (17.1%).
All cases have failed to respond to clomiphene citrate for 6 successive cycles detected by failure of ovulation.
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The following investigations were done:
■HSG: Patent both tubes with no evidence of peritubal adhesion.
■PCT: Satisfactory.
■Semen analysis: Satisfactory
■Ultrasound: ultrasonographic criteria including the presence of more than ten small peripheral follicles and increased echogenic stroma.
Laparoscopy was performed by three puncture technique. Using the monopolar point coagulator, multiple points of cauterization ranging from 4 to 10 points, 2 to 4 seconds duration, 3 to 4 mm diameter and 3-4 mm depth were done in each ovary followed by washing with lactated ringer solution and reaspiration.
Vaginal ultrasonography was done using New sonics 11Q-1r 2000 to evaluate ovarian volume and stroma 2 weeks before laparoscopic drilling. Then patient was subjected to vaginal ultrasound, one week and 3 weeks after surgery to estimate the changes in the ovarian volume and stromal volume.
All patients were followed up for 6 months after the operation to document:
■Occurrence of ovulation by transvaginal ultrasound starting from day 10 of the menstrual cycle and every other day till a follicle reached 20 mm.
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SUMMARY
■ Occurrence of pregnancy by doing pregnancy test one week and U/S 2 weeks after the missed period.
All patient showed that there is temporary increase of the ovarian volume and stromal volume after laparoscopic ovarian cauterization of the polycystic ovaries, then followed by a significant reduction of the ovarian volume and stromal volume to a size smaller than the pre-operative volume.
Ovulation was successful in (63.6%) of patients. Evidence of ovulation was encountered in 9 patients (42.9%), 7 patients (33.3%), 4 patients (19%) and one patient (4.8%) in 1’1, 2nd, 3rd and 4th months respectively. In 5th & 6th months no ovulation was recorded. So that 95.2% of ovulation occurred in the first three months after laparoscopic drilling.
Pregnancy occurred in 7 patients out of 33 patients (21.2%), one had twin pregnancy and one aborted during the first trimester.
We found that the BMI could not be used to define treatment outcome. However, poor treatment response was associated with increased ovarian volume, increased stromal volume. Success rate increased in women whom duration of infertility was 3.6 years.
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