Objective: to evaluate the outcomes of endoscopic ovarian drilling (LOD) on the Anti Mullerian hormone (AMH)
plasma levels, potential changes of the stromal ovarian
blood flow, and antral follicular count by three-dimensional
power Doppler ultrasonography in an-ovulatory polycystic
ovarian disease (PCOD) and if this can explain the ovarian
drilling mechanism of action.
Methods: The prospective, comparative (case control) research was completed on fifty patients from Bab El-Shaarea
University Hospital (El Sayed Galal). They were selected
from infertility and family planning clinics. Women were
assigned into one of two equal groups (each 25 patients).
The first included infertile women, resistant to clomiphene
citrate and scheduled for drilling. The second included
healthy women from the family planning clinic, who were
seeking for contraception. The main outcomes were AMH
levels, Doppler indices and Antral follicular counts before
and after drilling. The secondary outcome in the study
group included occurrence of ovulation, chemical and clinical pregnancy rate within 6 months after drilling.
Results: The mean initial AMH, doppler indices and antral follicular counts were singingly higher among study
than control group. AMH and AFC significantly reduced in
cases after than before drilling [2.8 to 3.9], [13.9 to 15.8].
Ovarian FI, VI, and VFI significantly decreased after than
before drilling. In the study group, 20 (80%) had ovulation,
and 13 (52%) got pregnant within 6 months of the operation.
Regression analysis showed that initial AMH, initial AFC,
initial VFI, post-LOD AMH, post-LOD AFC, post-LOD VI,
post-LOD FI and post-LOD VFI were significant indicators
of successful ovulation and successful pregnancy within 6
months after drilling.
Conclusion: Endoscopic ovarian drilling had a significant
decreasing effect on serum AMH, AFC, and Ovarian Doppler indices in PCOD patient not responding to clomiphene
citrate. The initial values of AMH, AFC and VFI; besides
post-drilling values of AMH, AFC, VI, FI, and VFI were
significant indicators of ovulation after drilling.