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

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Low –dose Gn protocolsStep – up( 3 trials ,1991-1994)Step-down( 1 trial , 1995 )Ovulation rate 68- 74% 91%Monofollicular cycles 73% 62%Pregnancy rate/ cycle 16-20%% 17%Cumulative PR in 3- 6cycles55- 73% 47%Multiple PR 4-18% 8%OHSS 1% 2%Preventing all multiple gestation and OHSS is not possible at this timeConsensus on infertility treatment related to PCOS,2008
Gn stimulation in PCOSIntense monitoring ( US and E2 ) is required to reduce complications and cycle has to becancelled when more two follicles > 14 mmThe duration of gonadotropin therapy generally should not exceed six ovulatory cycles. Nopregnancy with 6 cycles signifies resistanceDifferent Gn preparationuFSH vs rFSH : no differencesFHS vs HMG : similar results ( LH exogenous administration in PCOS has not detrimentaleffects, )FSH different isoforms ( to reproduce normovulatory cycles ) : no tested in PCOSSequential protocols ( FSH LH/HCG) to drive selective maturation of one singlefollicle and atresia of small follicles ( tested by Hugues et al 2005 in normogonadotropicoligo- anovulation)GnRH analogues to normalize LH secretion :The addition of Gn RH agonist increases the OHSS risk and does not increases the PR. Itsuse is not justify in PCOSGnRH antagonist : no data in ovulation induction for PCOS
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 30 and 31: Mechanism of action of LOD : unclea
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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