Impact of Laparoscopic Ovarian Drilling on Anti-Müllerian Hormone, Ovulatory Function, and Folliculogenesis in Clomiphene-Resistant Polycystic Ovary Syndrome Patients

Abstract

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder affecting women of reproductive age, leading to anovulation and infertility. Laparoscopic ovarian drilling (LOD) is considered a promising therapeutic option for clomiphene-resistant PCOS patients. Objective: To assess the impact of laparoscopic ovarian drilling on Anti-Müllerian hormone (AMH) levels, ovulatory function, and folliculogenesis in clomiphene-resistant PCOS patients. Methods: This prospective study was conducted at the Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, United States. A total of 164 clomiphene-resistant PCOS patients, aged 18-35, were recruited from January 2020 to June 2021. The patients underwent laparoscopic ovarian drilling, and data on AMH levels, ovulation rate, and folliculogenesis were measured pre- and post-procedure. Standard statistical methods, including paired t-tests, were used for data analysis. Statistical significance was set at a p-value of <0.05. Results: Following LOD, a significant reduction in AMH levels was observed (pre-operative AMH = 7.85 ± 3.21 ng/mL, post-operative AMH = 5.67 ± 2.45 ng/mL, p = 0.02). Ovulation rate increased from 22.5% to 58.3%, with a p-value of <0.001. Follicular development improved, with 48% of patients showing dominant follicle formation compared to 12% preoperatively (p = 0.004). The standard deviation for ovulation rates was 7.9%, and the percentage change in AMH levels showed a 28% decrease. Conclusion: Laparoscopic ovarian drilling significantly improves ovulatory function and folliculogenesis while reducing AMH levels in clomiphene-resistant PCOS patients. The procedure offers a promising option for enhancing fertility outcomes.