Impact of Ultrasound-Guided Transvaginal Ovarian Needle Drilling Versus Laparoscopic Ovarian Drilling on Ovarian Reserve and Pregnancy Rate in Polycystic Ovary Syndrome: A Randomized Clinical Trial.

STUDY OBJECTIVE: To compare the impact of ultrasound-guided transvaginal ovarian needle drilling (TND) versus laparoscopic ovarian drilling (LOD) on ovarian reserve and pregnancy rate in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).

DESIGN: A randomized clinical trial (Canadian Task Force classification I).

SETTING: A university hospital.

PATIENTS: Of 644 patients who presented at an infertility clinic, 246 with CC-resistant PCOS were randomized for treatment.

INTERVENTIONS: Patients were randomly allocated to ultrasound-guided TND (n = 124) and LOD (n = 122).

MEASUREMENTS AND MAIN RESULTS: Ovarian reserve parameters (serum antimüllerian hormone [AMH] and antral follicle count [AFC]) and pregnancy rate at 3 and 6 months were evaluated. At 3 months, patients in the LOD group experienced a significantly lower AMH (p < .001) and a higher ovulation rate (p < .05) with comparable AFC and pregnancy rate to patients in the TND group (p > .05) and a significant decrease in AMH and AFC within each individual group when compared with baseline (p < .001). At 6 months, patients in the LOD group experienced a significantly lower AMH (p < .001), lower AFC (p < .001), higher ovulation rate (p < .001) and higher pregnancy rate (p < .001) when compared with patients in the TND group. This effect started to diminish between the fourth and sixth month with an increase of AMH and AFC compared with baseline values (p < .05).

CONCLUSIONS: Although TND is simple, safe, and less invasive than LOD, its effect on ovarian reserve appears to be transient and diminishes at 6 months. Multicenter studies are warranted to confirm efficacy as a second-line treatment in patients with CC-resistant PCOS.