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Ovarian reserve and LOD in PCOS
1. SUPERVISIORS
SUPERVISIORS
Ovarian Volume Prof.Dr.
Prof.Dr.
Thesis
Basal Safaa Kamal Submitted for partial
FSH Level Maraie the
fulfillment of fulfillment of the
Professor of Obstetrics and Gynecology
And Professor of Obstetrics and Gynecology
Faculty of Medicine requirements of
Faculty of Medicine
Antral Follicles Tanta University
Tanta University
Prof.Dr.
Prof.Dr.
the M.S. Degree
In
Count
بسم ا الرحمن الرحيم
Naglaa Mohammad Lotfy Dabees
Obstetrics and Gynecology
Assistant professor of Diagnostic Radiology
Assistant professor of Diagnostic Radiology
before and after By Faculty of Medicine
Faculty of Medicine
Laparoscopic Ahmed Sameh
Tanta University
Tanta University
Dr.
Dr.
Ovarian Drilling Talat Ghoubara
Mohamed Ahmed El-Sharawy
in Women with of Obstetrics and Gynecology
Lecturer of Obstetrics and Gynecology
Lecturer
(M.B.B.CH.)
Faculty of Medicine
Faculty of Medicine
PCOS Tanta University
Tanta University
2012
2012
2. Aim of the Work
This study aims to evaluate
ovarian volume
basal follicular stimulating hormone level
and
antral follicles count
as predictors of
ovarian reserve
before and after
laparoscopic ovarian drilling
in women with
polycystic ovarian syndrome.
7. x GnRH
E2 -ve FB on
hypothalamus
The idea of bFSH
as an ORT
x FSH
E2/Inhibin-B -ve FB on
pituitary
Decreased –ve FB of
E2 on FSH
E2/ rise in FSH
Inhibin-B
8. FSH is most common used ORT in
clinical practice, it can diagnose:
Normal ovarian function
Premature ovarian failure
Perimenopause and menopause
DOR
9. Some studies concluded that
bFSH > 20 mIU/ml
Marked decrease in Marked decrease in succeeded
spontaneous pregnancy IVF pregnancy
10. Because of the test variability and false +ve
results
bFSH is just a screening test
for the purpose of counselling
11. x x x
we cannot exclude patients from IVF cycles
on the basis of bFSH alone
34. We selected our
The present
patients
Study was
according to the
conducted on
following inclusion
30 patients
criteria:
35. 1. Primary infertility
2. Less than 35 years old
3. BMI < 30
4. Rotterdam Criteria of PCOS
5. No ovulation induction for 3 months
6. Indicated for LOD
??
36. We DRILL when there
is:
1. Anovulatory infertility with CC resistance
2. Persistent hyper-secretion of LH
3. Repeated overresponse to Gonadotropins or
CC
4. Patients who found it difficult to keep
attendance for close monitoring of folliculo-
metry
37. We excluded patients with:
1.More than 35 years old
2.BMI of Equal to or more than 30 kg/m2
3.History of pelvic surgery
4.History of ovarian disease (Tumors, Cysts,
TOA)
5.History of ovulation induction within 3 months
prior to the procedure
6.+ve pregnancy test during the study
38. To fulfill the inclusion and exclusion criteria:
History taking
special comments on marital, husband and sexual
history
Examination
special comments on local gynecological
examination
Investigations
Routine investigations e.g. CBC, LFTs, ….
43. Before we count
Measuring the
the antral follicles,
average diameter:
Only follicles that
identification of
2 perpendicular
range from 2-9
them is required
diameters divided
mm were counted
first
by 2
44. Because the ovary
is prolate rather
than ovoid
We used the prolate
ellpsoid formula of
volume
51. LOD
Bilateral
4 punctures per each
ovary
4 seconds per each
puncture
40 Watt diathermy
52. bFSH
bFSH bFSH
bFSH bFSH
bFSH
AFC
AFC AFC
AFC AFC
AFC
OVVOL
OVVOL OVVOL
OVVOL OVVOL
OVVOL
Preoperative
Preoperative
First PO cycleSecondPO cycleThirdPO cycle
Second PO cycle
First PO cycle Third PO cycle
cycle
cycle
LOD
57. P value of
ANOVA
was
0.89
FSH
No Significant
difference
between the
preoperative
and
postoperative
basal FSH
mean values
58. Student’s t- test
P value of 0.001 0.476
ANOVA Significant
difference
No significant
was difference
0.001
AFC
Significant
difference
Preoperative
Preoperative
cycle
cycle
First PO cycle Second PO Third PO cycle
First PO cycle Second PO Third PO cycle
cycle
cycle
between the
preoperative LOD
and
postoperative
mean AFC 0.001
Significant
difference
59. P value of
Student’s t- test
0.001 0.787
ANOVA Significant No significant
was difference difference
0.001
OVSignificant
difference
Preoperative
Preoperative
cycle
cycle
First PO cycle Second PO Third PO cycle
First PO cycle Second PO Third PO cycle
cycle
cycle
VOL
between the
preoperative
and
LOD
postoperative
mean ovarian
volume 0.001
Significant
difference
62. According to this study:
there is no decrease in ovarian reserve
after using LOD
HOWEVER
studies with long term follow up
may be required for
clinical
assessment of DOR after LOD
by using other ovarian reserve markers and
different techniques of LOD with or without ovulatory stimulants
in relation
to IVF and pregnancy outcomes
63. It was an Honor to work under my supervisors
Special thanks to
The professor Dr. Safaa Marie
for 2 reasons :
Supreme supervision and guidance
She was the one that had
managed my labor when I was a
newborn on 1984