Key words: laparoscopic ovarian multiple punch resection, laparoscopic ovarian electrocautery, infertility, polycystic ovarian syndrome, clomiphene citrate
1) Insler V, Zakut H, Serr M. Cycle pattern and pregnancy rate following combined clomiphene strogen therapy. Obstet Gynecol (1973) 41, 602. 2) Thompson CR, Hansen LM. Pergonal (menotropins): a summary of clinical experience in the induction of ovulation and pregnancy. Fertil Steril (1970) 21, 844-853. 3) Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovary. Am J Obstet Gynecol (1935) 29, 181. 4) Abdel GA, Mowafi RS, Alnaser HM, Alrashid AH, Alonezi OM, Shaw RW. Ovarian electrocautery versus human menopausal gonadotrophins and pure follicle stimulating hormone therapy in the treatment of patients with polycystic ovarian disease. Clin Endocrinol Oxf (1990) 33, 585-592. 5) Armar NA, McGarrigle HH, Honour J, Holownia P, Jacobs HS, Laparoscopic ovarian diathermy in the management of anovulatory in women with polycystic ovaries: endocrine changes and clinical outcome. Fertil Steril (1990) 53, 45-49. 6) Daniell JF, Miller W. Polycystic ovaries treated by laparoscopic laser vaporization. Fertil Steril (1989) 51, 232-236. 7) Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparos cope. Fertil Steril (1984) 41, 20-25. 8) Greenblatt E, Casper RF. Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome. Am J Obstet Gynecol (1987) 156, 279-85. 9) Adashi EY, Rock D, Wentz AC, Jones HJ. Fertility following bilateral ovarian wedge resection a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertil Steril (1981) 36, 320-325. 10) Buttram VJ, Vaquero C. Post-ovarian wedge resection adhesive disease. Fertil Steril (1975) 26, 874-876. 11) Judd HL, Rigg LA, Anderson DC, Yen SS. The effects of ovarian wedge resection on circulating gonadotropin and ovarian steroid levels in patients with polycystic ovary syndrome. J Clin Endo crinol Metab (1976) 43, 347-355. 12) Palatynski A, Majak J. Ovulation induction in stirile females with the polycystic ovary syndrome. Zentralbl Gynaekol (1985) 107, 208-212. 13) Ayala RA, Valenzuela S. Polycystic ovary syndrome: a hypothalamic or a gonadal anomaly?. Gac Med Mex (1990) 126, 108-113. 14) Homburg R, Jacobs HS. Etiology of miscarriage in polycystic ovary syndrome. Fertil Steril (1989) 51, 196-197. 15) Kazer R. The etiology of polycystic ovary syndrome (PCO). Med Hypotheses (1989) 30, 151-155. 16) Polycystic ovaries-disorder or sign?. Lancet (1990) 336, 1099-1100. 17) Goldzieher JW, Axelrod LR. Clinical and biochemical features of polycystic ovarian disease. Fert Steril (1963) 14, 631. 18) Adams J, Franks S, Poison DW, et al. Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin-releasing hormone. Lancet (1985) 2, 1375-1379. 19) Azziz R, Rafi A, Smith BR, Bradley EJ, Zacur HA. On the origin of the elevated 17-hydroxy-
progesterone levels after adrenal stimulation in hyperandrogenism. J Clin Endocrinol Metab (1990) 70, 431-436. 20) Balkin MS, Altchek A. Late-onset 21-hydroxylase deficiency and polycystic ovary disease. A case report. J Reprod Med (1986) 31, 517-519. 21) Ciovirnache M, Ionescu B, Dumitrache C, Milea E, Dumitrache M. Dermatoglyphics in the virilizing polycystic ovasy syndrome. Endocrinologie (1986) 24, 87-96. 22) Dunaif A, Hoffman AR, Scully RE, et al. Clinical, biochemical and ovarian morphologic features in women with acanthosis nigricans and masculinization. Obstet Gynecol (1985) 66, 545-552. 23) Lobo RA. Disturbances of androgen secretion and metabolism in polycystic ovary syndrome. Clin Obstet Gynaecol (1985) 12, 633-647. 24) Hamori M, Urbancsek J, Szendei G, Nemet J. The role of ultrasonography in treating polycystic ovary syndrome. Acta Chir Hung (1988) 29, 27-34. 25) Giorlandino C, Gleicher N, Taramanni C, et al. Ovarian development of the female child and adolescent: I. Morphology. Int J Gynaecol Obstet (1989) 29, 57-63. 26) Yen polycystic ovary syndrome. Clin Endocrinol Oxf (1980) 12, 177-207. 27) Utsunomiya T, Sumioki H, Taniguchi I. Hormonal and clinical effects of multifollicular puncture and resection on the ovaries of polycystic ovary syndrome. Horm Res (1990) 33, 35-37. 28) van der Weiden RM, Alberda AT. Laparoscopic ovarian electrocautery in patients with polycystic ovarian disease resistant to clomiphene citrate. Surg Endosc (1987) 1, 267-219. 29) Sumioki H, Utsunmyiya T, Matsuoka K, Korenaba M, Kadota T. The effect of laparoscopic multiple punch resection of the ovary on hypothalamo-pituitary axis in polycystic ovary syndrome. Fertil Steril (1988) 50, 567-572. 30) Valkov IM, Dokumov SI. Effect of ovarian wedge resection for the Stein-Leventhal syndrome on plasma FSH, LH, oestradiol and testosterone levels and on the responses of the pituitary to intravenous LHRH. Br J Obstet Gynaecol (1977) 84, 539-542. 31) Gjonnaess H, Norman N. Endocrine effects of ovarian electrocautery in patients with polycystic ovarian disease. Br J Obstet Gynaecol (1987) 94, 779-783. 32) Aakvaag A, Gjonnaess H. Hormonal response to electrocautery of the ovary in patients with polycystic ovarian disease. Br J Obstet Gynaecol (1985) 92, 1258-1264. 33) Keckstein G, Rossmanith W, Spatzier K, Schneider V, Borchers K, The effect of laparoscopic treatment of polycystic ovarian disease by CO2-laser or Nd: YAG laser. Surg Endosc (1990) 4, 103-7. 34) van der Weiden RM, Alberda AT, de Jong F, Brandenburg H. Endocrine effects of laparoscopic ovarian electrocautery in patients with polycystic ovarian disease, resistant to clomiphene citrate. Eur J Obstet Gynecol Reprod Biol (1989) 32, 157-162. 35) Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev (1984) 5, 25-44.
Evaluation of laparoscopic ovarian multiple punch resections Yukio HIRANO Department of Obstetrics and Gynecology, Okayama University Medical School, Okayama 700, Japan (Director: Prof. K. Sekiba) Laparoscopic multiple punch resections were applied on the surface of the ovaries in 38 infertile patients who did not have spontaneous ovulation, and the effects on the clinical aspects of ovulation and gestation, and endocrinological state were examined. The patients were categorized into three groups to determine the indication of this treatment as follows. Group A (n=9): ovulated under administration of 100mg/day clomiphene. Group B (n=22): ovulated under administration of 200mg/day clomiphene, failed to ovulate under administra tion of 100mg/day. Group C (n=7): failed to ovulate even under administration of 200mg/day. The dose of clomiphene to induce ovulation was reduced in 8 (89%) in group A, 19 (86%) in Group B and 6 (86%) patients in group C. Although no patients became pregnant in group A, 17 (77%) in Group B and 5 (71%) in Group C became pregnant after this treatment. Irre spective of the good clinical outcome, no endocrinological improvements was found in the results of LH-RH test and serum testosterone levels. These findings suggest that this treat ment is effective on the patients with severe anovulation, and that this effect is not based on the endocrinological improvement but on the local mechanical factors.