PCOS: Laparoscopic Laparoscopic ovarian drilling or ... - eshre

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Mechanism of action of LOD : unclearLOD destroy ovarian LH androgen-producing tissue ( effect on theTheca cellCholesterolovarian steroidogenesis reductions in intraovarianandrogens production )Pregnenolone3 beta17 alfa1987) hydroxilase17 OH3 betaPregnenoloneDysregulation of 17-hydroxilase and 17,20-lyaseThe local effect is followed by a fall in the serum levels ofandrogens and luteinsingProgesteronehormone (LH) and an increase infollicle-stimulating hormone (FSH) levels (Armar 1990; Greenblatt17- 20IVF ?? lyase )Dehydroepiandrosterone3 beta17 alfahydroxilase17 OHProgesteroneThus both local and systemic effects are thought to promotefollicular recruitment, maturation and subsequent ovulation17- 20lyaseAndrostenedione17-beta HSD P450 aromataseTestosteroneFSHLOD is able to restore CC sensitivity ( and to preventi OHSS inChanges in blood flow?Stimulation of ovariannerves?P450 aromataseOestroneOestradiolThe beneficial effect may continue for years ( few data )GranulosacellLow aromatase activity (multiple small follicles)
Gn stimulation( PCOS women are specifically prone to execessive follicledevelopment)Conventional protocol ( starting dose of 150 IU) : high rate of ovulationbut unacceptable rate of multiple follicular development (23%) and highrisk of severe OHSS ( > 4%) . No longer recommended.Since early 90’, low-dose protocols have been used for PCOS patients.Currently , two low dose regimens are used:- Step-up regimen : FSH starting dose of 37.5 – 50 IU/day for 14 daysand small weekly dose increment ( 50%) .- Step-down regimen : FSH starting dose of 75-100 IU and stepwisereduction as soon as follicular developmentis observed Intense ovarian response
Page 1 and 2: PCOS: Laparoscopic ovarian drilling
Page 3 and 4: PCOSDiagnostic criteria :- National
Page 5 and 6: Consensus on Infertility treatment
Page 7 and 8: Infertility treatment of PCOSRecomm
Page 9 and 10: Factors to guide for patient-tailor
Page 11 and 12: Factors to guide for patient-tailor
Page 13 and 14: 2009The aim of this study was to te
Page 15 and 16: Clomiphene CitrateStarting dose 50
Page 17 and 18: Clomiphene CitrateGhobadi et al tes
Page 20 and 21: CC + lwo FSH doses (± IUI )Ovulati
Page 22 and 23: Oocyte competenceMeiotic maturation
Page 24 and 25: High level of LeptinLeptin is a Pro
Page 26 and 27: Ovarian surgical treatment for PCOS
Page 28 and 29: Laparoscopic Ovarian Drilling (LOD)
Page 32 and 33: Low -dose Gn protocolsStep - up( 3
Page 34 and 35: PCOS in ARTGnRH antagonistSingle do
Page 36 and 37: LOD vs Gn?EfficacyLODGnOvulatory cy
Page 38 and 39: LOD vs Gn?SpecificindicationsAmer e
Page 40 and 41: LOD or Gn stimulation ?Second - lin
Page 42 and 43: IVF LITE in PCOSCycles 42Patients 2
Page 44 and 45: Ovarian drilling : different approa
Page 46 and 47: PCOS patients undergoing ART vs Con
Page 48 and 49: Results ( 24 PCOS)Before TVODAfter
Page 50 and 51: US guided transvaginal ovarian dril

PCOS: Laparoscopic Laparoscopic ovarian drilling or ... - eshre

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