Impact of laparoscopic ovarian drilling on the pregnancy rate in clomiphene-resistant polycystic ovarian syndrome patients undergoing in vitro fertilization: randomized controlled trial

Abstract

Abstract Background The main objective of this randomized controlled trial was to study the impact of LOD on the pregnancy rate after ICSI-ET in PCOS. Results The study was conducted in Egypt in the period 2015–2017 and included 212 clomiphene-resistant PCOS patients, with at least 1-year infertility. The study group was the drilling group who underwent LOD and then ICSI-ET, while the control group did not undergo LOD but directly proceeded to ICSI-ET. The primary outcome was the clinical pregnancy rate per ET cycle. The baseline characteristics and hormonal profiles were comparable (p > 0.05) between the two groups. Ovarian stimulation days were (p < 0.001) higher in the drilling group. Endometrial thickness, estradiol at triggering day, and the number of oocytes retrieved were (p < 0.001) lower in the drilling group. The numbers of embryos transferred were not different (p > 0.05). The clinical pregnancy rate per ET cycle was higher in the drilling group (51%) than in the control group (37%) (p = 0.046). Multiple pregnancies were not significantly (p = 0.265) different between groups. The rate of OHSS was (p = 0.046) higher in the control group. Coasting was (p < 0.001) higher in the control group (18%) compared to the drilling group (2%). Conclusion Laparoscopic ovarian drilling for PCOS patients before ICSI-ET improves the clinical pregnancy rate with a reduction of OHSS. Trial registration Clinical Trial Registration: Pan African Clinical Trials Registry (PACTR), PACTR201604001567272, 5 April 2016.