Pregnancy complications and metabolic disease in women with clomiphene citrate-resistant anovulation randomized to receive laparoscopic electrocautery of the ovaries or ovulation induction with gonadotropins: a 10-year follow-up.

Abstract

OBJECTIVE:

To assess long-term effects of laparoscopic electrocautery of the ovaries compared with ovulation induction with gonadotropins in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) on the incidence of pregnancy complications like gestational diabetes, hypertensive disorders, and metabolic or cardiovascular disease.

DESIGN:

Long-term follow-up study.

SETTING:

Twenty-eight hospitals within the Netherlands.

PATIENT(S):

One hundred sixty-eight CC-resistant women who had participated in a randomized controlled trial between 1998 and 2001 comparing electrocautery and gonadotropins.

INTERVENTION(S):

Postal questionnaire, search in medical files.

MAIN OUTCOME MEASURE(S):

Pregnancy complications, metabolic or cardiovascular disease.

RESULT(S):

Eighty-two percent of follow-up data were obtained. Thirteen of 68 women (19%) allocated to electrocautery, and 14 of 63 women (22%) allocated to gonadotropins had evidence for pregnancy complications (relative risk 0.86; 95% confidence interval 0.43-1.7). At follow-up, 12 of 69 (17%) women allocated to electrocautery, and 13 of 69 (19%) women allocated to gonadotropins had evidence for metabolic or cardiovascular disease (relative risk 0.90; 95% confidence interval 0.39-2.1). The risk of these was modified by body mass index (BMI), but not by female age or treatment allocation. This study is based on questionnaires and data from medical files. In the absence of routine screening, under-reporting in our follow-up study is likely.

CONCLUSION(S):

Electrocautery in women with CC-resistant PCOS does not affect pregnancy complications or metabolic or cardiovascular disease later in life compared with ovulation induction with gonadotropins.

• Authors: Marleen J Nahuis, Eefje J Oude Lohuis, Neriman Bayram, Peter G A Hompes, G Jurjen E Oosterhuis, Fulco van der Veen, Ben Willem J Mol, Madelon van Wely
• Journal: Fertility and sterility (Fertil Steril) Vol. 101 Issue 1 Pg. 270-4 (Jan 2014) ISSN: 1556-5653 [Electronic] United States
• PMID: 24268702 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Fertility Agents, Female
• Gonadotropins
• Clomiphene

Topics

• Adult
• Anovulation (diagnosis, drug therapy, epidemiology)
• Clomiphene (pharmacology, therapeutic use)
• Drug Resistance (drug effects, physiology)
• Electrocoagulation (methods)
• Female
• Fertility Agents, Female (pharmacology, therapeutic use)
• Follow-Up Studies
• Gonadotropins (pharmacology)
• Humans
• Laparoscopy (methods)
• Metabolic Diseases (diagnosis, drug therapy, epidemiology)
• Ovary (drug effects, surgery)
• Ovulation Induction (methods)
• Pregnancy
• Pregnancy Complications (diagnosis, drug therapy, epidemiology)
• Young Adult