Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility

Objective

To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty.

Methods

The present retrospective study included 127 patients with diagnosis of a uterine septum and otherwise unexplained infertility. The reproductive outcomes of 102 patients who underwent hysteroscopic metroplasty (group 1) and 25 patients who rejected the operation (group 2) were compared.

Results

Of the 102 patients who underwent hysteroscopic metroplasty, 44 (43.1%) were able to achieve pregnancy, as compared with 5 (20%) of the 25 patients who did not undergo the operation (P = 0.03). The abortion rate was 11.4% (5/44) in group 1, compared with 60% (3/5) in group 2 (P = 0.02). The live birth rate was 35.3% (36/102) in group 1, as compared with 8% (2/25) in group 2 (P = 0.008).

Conclusions

The results indicate that hysteroscopic metroplasty improves reproductive outcome for patients with a uterine septum and otherwise unexplained infertility.     

Comparison of the efficacy and adverse effects of nifedipine and indomethacin for the treatment of preterm labor

Objective

To compare the effectiveness and adverse effects of nifedipine versus indomethacin in the treatment of preterm labor.

Methods

In a randomized clinical trial, 79 women with labor pain at 26-33 weeks of gestation were treated with either oral nifedipine (n = 40) or rectal indomethacin (n = 39).

Results

Twenty-three (59%) women in the indomethacin group, and 10 (25%) in the nifedipine group did not respond to treatment (P = 0.002). None of the 16 and 30 women remaining in the indomethacin and nifedipine groups, respectively, delivered during the subsequent 48 hours. Of these remaining women, 1 (6.25%) in the indomethacin group and 4 (13.3%) in the nifedipine group delivered between 48 hours and 7 days (P = 0.162). For the women who responded to treatment, the mean gestational age at time of delivery was 238.5 ± 19.4 days and 246.4 ± 15.4 days in the nifedipine and indomethacin groups, respectively (P = 0.182). Seventeen (42.5%) women in the nifedipine group, and 11 (28.2%) in the indomethacin group showed adverse effects (P = 0.184).

Conclusion

Indomethacin was less effective than nifedipine for the fast treatment of preterm labor. For women who responded to treatment within 2 hours, however, the delaying of delivery by indomethacin was similar to that by nifedipine.     

Increase in the incidence of gestational trophoblastic disease in The Netherlands

Objectives

The purpose of this study was to clarify the clinical outcome of patients with stage IA mucinous epithelial ovarian cancer (mEOC) treated with fertility-sparing surgery (FSS).

Methods

After a central pathological review and search of the medical records from multiple institutions, a total of 148 stage I mEOC patients were retrospectively evaluated in the current study. All mEOC patients were divided into three groups: group A (FSS; age, 40≥); groups B and C {radical surgery; age, 40≥ (B); 40< (C)}. Survival analysis was performed among these three groups using Kaplan-Meier methods.

Results

The median follow-up time of all mEOC patients was 71.6 (4.8-448.3) months. Among the 41 patients in group A, 27 patients (65.9%) had IA disease, and 14 (34.1%) had IC disease. Five-year overall survival (OS) and disease-free survival (DFS) rates of patients in the groups were as follows: group A, 97.3% (OS)/90.5% (DFS); group B, 94.4% (OS)/94.4% (DFS); group C; 97.3% (OS)/89.3% (DFS). Collectively, there was no significant difference in OS or DFS among these groups even though they were stratified to each substage (IA/IC) (OS, P = 0.180; DFS, P = 0.445, respectively). Furthermore, in multivariate analyses, the surgical procedure was not an independent prognostic factor for either OS or DFS (OS, HR: 0.340, 95% CI: 0.034-3.775, P = 0.352; DFS, HR: 0.660, 95% CI: 0.142-3.070, P = 0.596).

Conclusions

Patients with stage I mEOC treated with FSS did not necessarily show a poorer prognosis than those receiving radical surgery.     

Malaria and stillbirth in Omdurman Maternity Hospital, Sudan

Objective

The study was conducted in the labor ward of Omdurman Maternity Hospital, Sudan, from November 2007 to February 2008 to investigate the prevalence and risks factors for stillbirth.

Methods

A case-control study. Cases were women who delivered stillbirths; 2 consecutive women who delivered a live-born singleton neonate at term (37-42 weeks) per case were used as controls. Sociodemographic, clinical (including malaria infections), and obstetric histories were gathered using standard questionnaires. Maternal body mass index and hemoglobin levels were measured. Maternal, placental, and cord blood smears were investigated for malaria parasites.

Results

Among 4760 singleton deliveries, there were 103 stillbirths, yielding a stillbirth rate of 22 per 1000 deliveries. Over half (52.4%) of these stillbirths were macerated stillbirths. Maternal sociodemographic characteristics were not associated with stillbirth, while a history of maternal malaria in the index pregnancy was the main risk factor for stillbirth (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P = 0.04).

Conclusion

Measures to prevent malaria infection should help to prevent stillbirth in this part of Sudan.     

Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina

Objective

To evaluate reproductive outcomes in women with complete uterine septum with double cervix and vagina following resectoscope metroplasty.

Methods

The pregnancy outcomes of 21 women who underwent vaginal and uterine septum resection were compared with those of 15 untreated women with similar clinical characteristics. The Fisher exact test and the Mann-Whitney test were used for statistical analysis.

Results

Cycle fecundity was better (33.4% ± 28.5% vs 12.2% ± 4.7%; P = 0.046), the rate of term delivery significantly increased (P < 0.05), and the rate of spontaneous abortion decreased (P < 0.05) in the treatment group.

Conclusion

Resectoscope metroplasty was found to improve the pregnancy outcomes of women having primary infertility or a history of pregnancy loss associated with a complete uterine septum with double cervix and vagina.     

Pre-eclampsia is associated with elevated CXCL12 levels in placental syncytiotrophoblasts and maternal blood

Objectives

Placental derived vasculogenic/angiogenic substances in maternal blood are dysregulated in pre-eclampsia. We hypothesized that CXCL12, a chemokine with vasculogenic actions, is amongst such molecules.

Study design

CXCL12, CXCL16, CXCR4, and CXCR6 immunolocalization in placental tissue was analyzed in pre-eclampsia (n = 8) in comparison to controls (n = 8). CXCL12, measured by ELISA in blood, in women diagnosed with pre-eclampsia (n = 14) and prior to the development of pre-eclampsia (at 20 weeks’ gestation, n = 20) was compared with CXCL12 concentrations in gestation-matched, healthy control subjects (n = 34).

Results

In placental tissue, syncytiotrophoblast staining for CXCL12 was increased in pre-eclampsia. Maternal serum CXCL12 was increased in pre-eclampsia [2000 (SD 402) vs 1484 (SD 261) pg/ml, P = 0.01] but not in plasma obtained at 20 weeks of gestation prior to the onset of pre-eclampsia [1183 (SD 336) vs 1036 (SD 144) pg/ml, P = 0.09].

Conclusion

Our data suggest that the syncytiotrophoblast contributes to a pre-eclampsia-associated increase in CXCL12 levels in maternal blood. These findings support the hypothesis that an imbalance of angiogenic factors contributes to the pathogenesis of pre-eclampsia.     

Refusal of emergency caesarean delivery in cases of non-reassuring fetal heart rate is an independent risk factor for perinatal mortality

Objective

To assess pregnancy outcome in women who initially refused medically indicated caesarean delivery (CD) in cases of non-reassuring fetal heart rate (FHR) patterns.

Study design

A retrospective cohort study, comparing patients who refused and did not refuse caesarean delivery (CD) due to non-reassuring FHR tracings, was conducted. Deliveries occurred between the years 1988 and 2009 in a tertiary medical center. Multivariate analysis was performed to control for confounders.

Results

Out of 10,944 women who were advised to undergo CD due to non-reassuring FHR patterns, 203 women initially refused CD. Women refusing medical intervention tended to be older (30.6 ± 6.9 vs. 28.29 ± 6.1, P < 0.001) and of higher parity (46.8% vs. 19.9% had more than 5 deliveries; P < 0.001) as compared to the comparison group. Refusal of CD was significantly associated with adverse perinatal outcome. Using a multiple logistic regression model controlling for confounders such as maternal age, refusal of treatment was found as an independent risk factor for perinatal mortality (adjusted OR = 3.3, C.I. 95% 1.8-5.9, P < 0.001). A non-significant trend towards higher rates of adverse perinatal outcome was found when refusal latency time was longer than 20 min (OR = 2, 95% CI 0.36-11.95; P = 0.29).

Conclusion

Refusal of CD in cases of non-reassuring FHR tracings is an independent risk factor for perinatal mortality.     

A prospective study of the factors associated with the success rate of external cephalic version for breech presentation at term

Objective

To determine the factors associated with the success rate of external cephalic version (ECV) for breech presentation at term.

Methods

A prospective analysis of 500 ECV maneuvers. The variables maternal age, maternal weight, body mass index, previous cesarean delivery, gestational age, parity, amount of amniotic fluid, placental location, and type of breech were studied using logistic regression analysis.

Results

The success rate of ECV was 52.2% (n = 261). The variables significantly associated with success were parity, placental location, amount of amniotic fluid, and type of breech (P < 0.05). A parity of 2 had a 3.74-times higher probability of success than nulliparity (95% CI, 2.37-5.90); a posterior placenta increased the success rate by 2.85 times compared with an anterior placenta (95% CI, 1.87-4.36); and double footling breech presentation had a 2.77-times higher success rate compared with a frank breech presentation (95% CI, 1.16-6.62). The area under the ROC curve showed a predictive ability of 73.6% (95% CI, 69.2%-77.9%) for these 3 variables.

Conclusion

Parity, placental location, amount of amniotic fluid, and type of breech presentation were associated with the success rate of ECV.     

Comparison of Burch colposuspension and transobturator tape when combined with abdominal sacrocolpopexy

Objective

To compare the treatment outcomes of Burch colposuspension and transobturator tape (TOT) when each is combined with abdominal sacrocolpopexy (ASC) to treat stress urinary incontinence (SUI) with pelvic organ prolapse (POP).

Methods

Consecutive cases of Burch colposuspension and TOT combined with ASC were retrospectively reviewed. Patients with SUI and POP beyond stage III—according to the POP-quantification system—were included.

Results

Mean hospital stay was longer in the Burch group (n = 49) than in the TOT group (n = 60) (11.3 vs 7.8 days; P < 0.001), as was operation time (202.7 vs 170.1 minutes; P < 0.001); furthermore, there were higher rates of urinary retention (53.1% vs 11.7%; P < 0.001), de novo urgency (18.4% vs 3.3%; P = 0.01), and recurrent SUI (18.4% vs 1.7%; P = 0.003) in the Burch group. The cure rate was significantly higher in the TOT group than in the Burch group (98.3% vs 69.7%; P < 0.001).

Conclusion

The use of TOT with ASC resulted in higher cure rates and better functional outcomes than did Burch colposuspension with ASC.     

Morphological characteristics of placentas associated with idiopathic intrauterine growth retardation: a clinicopathologic study

Objectives

To investigate histopathologic findings, placental diameters and characteristics of syncytial knots in the placentas from idiopathic intrauterine growth retardation (IUGR) pregnancies, and to compare them with a normal birth weight group.

Study design

Based on strict eligibility criteria, this prospective case-control study included 52 term placentas from idiopathic IUGR pregnancies and 69 term placentas from normal birth weight pregnancies. The study was carried out at the Clinical Hospital Centre, Split, where all placentas were collected and examined. For each placenta, diameters were measured and the following histopathologic findings were recorded: infarction, intervillous thrombosis, abruption, villous branching and maturation, chorioamnionitis, decidual vasculopathy and hemorrhagic endovasculitis for each placenta. In addition we assessed quantitative (number of syncytial knots and number of syncytial nuclei per syncytial knot) and qualitative (density and surface area) characteristics of syncytial knots in each placental sample. Statistical significance was tested using χ²-test, Student's t-test and Mann-Whitney U-test. Statistical significance was set at P ≤ 0.05.

Results

There was no difference in investigated histopathologic findings between idiopathic IUGR placentas and control group placentas. Placental diameters correlated significantly with neonatal birth weight (r = 0.64; P < 0.01); with higher birth weight there is an increase in placental diameters. Syncytial knots from idiopathic IUGR had significantly smaller surface area (Z = 2.637; P = 0.008) and higher density (Z = 3.225; P = 0.001) compared with the control group, while there is no difference in number of syncytial knots per individual villus, total number of syncytial knots in each placenta sample or number of syncytial nuclei per syncytial knot.

Conclusions

The investigated histopathologic findings in idiopathic IUGR placentas are incidental, with no higher frequency than in placentas from uncomplicated pregnancies, and should not be considered as possible causative factors for idiopathic IUGR. The demonstrated qualitative changes of syncytial knots in placentas associated with IUGR could represent a compensatory mechanism.     

Assessment of bone mineral density should be considered earlier in perimenopausal women with vasomotor symptoms

Objective

To investigate the relationship between vasomotor symptoms (hot flashes) and osteopenia or osteoporosis in perimenopausal women.

Method

In this cross-sectional study 79 perimenopausal women aged between 45 and 55 years and seen at the Gynecology or Menopause Outpatient Clinic of Marmara University School of Medicine were allotted to one of 2 groups according to the presence or absence of hot flashes. The groups were then compared for bone mineral density (BMD) of the lumbar vertebrae, as measured by dual energy X-ray absorptiometry.

Results

The mean BMD measurement for vertebrae L2 to L4 was 0.32 ± 0.19 for the group with no hot flashes and  − 0.53 ± 0.21 for the group with hot flashes (P = 0.007). In the former, 6.1% of the women and in the latter, 32.6% of the women had a BMD value less than a 1.5 standard deviation from the mean (P = 0.005).

Conclusion

Women with vasomotor symptoms are more prone to have osteopenia or osteoporosis.     

Short- and long-term outcome of infants born after maternal (pre)-eclampsia, HELLP syndrome and thrombophilia: a retrospective, cohort study

Objectives

To investigate the short- and long-term outcome of children born from mothers with pre-eclampsia, eclampsia and/or HELLP syndrome, and to determine the differences between children born from mothers with and without underlying thrombophilic disorder.

Study design

Four hundred and nine infants (from 370 women) born between February 1991 and January 2006 were eligible for evaluation and were classified into group A (n = 162) and group B (n = 247). Thirty-four infants were not admitted to the hospital. Between-group differences were tested with regard to neonatal mortality, morbidity and follow-up measurements for neuromotor and mental development at 9 months and 2 years of age, using two-tailed Student's t-tests, Fisher's exact tests and logistic regression models.

Results

Of the 409 infants, 44 infants (10.8%; n = 20 group A/n = 24 group B) died. The mean gestational age in both groups was 31.9 (SD: 3.5) weeks. Of the 375 admitted infants 152 (40.5%) were related to a thrombophilic mother and 223 (59.5%) were not. Six children were lost to follow-up. At 9 months and 2 years of age development was assessed in 326 surviving children. At 9 months of age, 193 (59.2%; n = 66 group A/n = 127 group B) children showed a normal (52% group A versus 63.8% group B, P = 0.046), 24 (7.4%; n = 9 group A/n = 15 group B) a suspect and 14 (4.3%; n = 6 group A, n = 8 group B) an abnormal development during follow-up assessment. Ninety-five children (29.1%; n = 46 group A/n = 49 group B) did not have a follow-up assessment. At 2 years of age, 112 children (34.4%; n = 43 group A/n = 69 group B) had a normal, 21 (6.4%; n = 11 group A/n = 10 group B) a suspect and 17 (5.2%; n = 5 group A/n = 12 group B) an abnormal development. 176 children (54%; n = 70 group A/n = 106 group B) did not have a follow-up assessment.

Conclusion

Short-term outcome was not different between infants from mothers with or without thrombophilic disorders. At 9 months of age, the probability of having a normal development was significantly lower in children born from a mother with an underlying thrombophilic disorder than in those without. At 2 years of age, no differences in development were observed.     

Efficacy of mifepristone in reducing intermenstrual vaginal bleeding in users of the levonorgestrel intrauterine system

Objective

To evaluate the efficacy of mifepristone to reduce intermenstrual bleeding in levonorgestrel intrauterine system (LNG-IUS) users.

Method

In this prospective, open-label, comparative study, 36 women using the LNG-IUS for menorrhagia received 100 mg of mifepristone every 30 days for 3 months (group 1). Fifty age-matched LNG-IUS users who did not receive any drugs were used as the comparison group (group 2). Menstrual bleeding days, pictorial blood loss assessment chart (PBAC) score, and intermenstrual bleeding/spotting days were compared between the 2 groups at 3 months (during treatment) and at 6 months (3 months post treatment).

Results

Baseline characteristics were comparable between the groups. At 3 months, median duration and episodes of intermenstrual bleeding/spotting were significantly lower in group 1 compared with group 2 (6 vs 12.5 days, P = 0.01; 2.5 vs 3, P = 0.05, respectively). More women were satisfied with the LNG-IUS in the mifepristone group compared with the control group (75% vs 44%; P = 0.004). At 6 months, the median duration of intermenstrual bleeding/spotting was significantly lower in group 1 compared with group 2 (6 vs 15 days; P = 0.008).

Conclusion

Mifepristone was effective in reducing the number of episodes and duration of intermenstrual bleeding/spotting in LNG-IUS users.     

Randomized comparison of near-infrared fluorescence lymphatic tracers for sentinel lymph node mapping of cervical cancer

Objective

Near-infrared fluorescence imaging using indocyanine green (ICG) has recently been introduced as a novel technique for sentinel lymph node (SLN) mapping in early-stage cervical cancer. Although preclinical research has shown that ICG adsorbed to human serum albumin (ICG:HSA) improves its performance, the need for HSA has not yet been confirmed in cervical cancer patients. The current randomized study aims to determine whether ICG:HSA offers advantages over using ICG alone.

Methods

Eighteen consecutive early-stage cervical cancer patients scheduled to undergo pelvic lymphadenectomy were included. Prior to surgery, 1.6 mL of 500 μM ICG:HSA or 500 μM ICG alone was injected transvaginally in 4 quadrants around the tumor. The Mini-FLARE imaging system was used for intraoperative NIR fluorescence detection and quantitation.

Results

SLNs were identified intraoperatively in 78% of the patients. Patient and tumor characteristics were equally distributed over both treatment groups. No significant difference in signal-to-background ratio (9.3 vs. 10.1, P = .72) or average number of detected SLNs (2.9 vs 2.7, P = .84) was found between the ICG:HSA group and the ICG alone group, respectively.

Conclusions

In conclusion, this double-blind, randomized trial showed no advantage of ICG:HSA over ICG alone for the SLN procedure in early-stage cervical cancer. Further optimization is required to improve the intraoperative detection rate.     

Plasma and placental nitric oxide levels in women with and without pre-eclampsia living at different altitudes

Objective

To investigate the nitric oxide (NO) levels in the plasma and the placentas of pregnant women with pre-eclampsia and women without pre-eclampsia, and to determine the effect of high or low altitude of residence.

Methods

NO was determined by chemoluminescence and group comparisons were performed.

Results

Women with pre-eclampsia (n = 63) had higher plasma NO levels (38.6 ± 17.44 vs 30.6 ± 12.44 µmol/L, P = 0.004) and higher placental NO levels (38.5 ± 17.0 vs 24.3 ± 7.16 ng/mg protein, P < 0.05) compared with women without pre-eclampsia. A similar trend was found when comparisons were made according to altitude of residence. NO levels were significantly higher in the plasma of pre-eclamptic women living at sea level (41.11 ±18.78 vs 28.96 ± 9.57 µmol/L, P = 0.003), and in the placentas of women living at high altitude (39.51 ± 16.98 vs 21.91 ± 6.64 ng/mg protein, P < 0.0001).

Conclusion

Women with pre-eclampsia had higher plasma and placental NO levels and the differences were associated with altitude of residence.     

Insulin resistance, dyslipidemia, and metabolic syndrome in women with polycystic ovary syndrome

Objective

To investigate the association of insulin resistance with dyslipidemia and metabolic syndrome (MBS) in women with polycystic ovary syndrome (PCOS).

Methods

Fasting glucose (G), insulin (I), and lipid levels were measured in 50 infertile women with PCOS. A fasting G/I ratio of 4.5 or less (n = 29) defined insulin resistance (IR).

Results

The mean levels of total cholesterol (P < 0.001), low-density lipoprotein (P = 0.02), and triglycerides (P < 0.001) were significantly higher and the mean levels of high-density lipoprotein were significantly lower (P < 0.001) in the IR group. The prevalence of MBS (P = 0.02) and obesity (P = 0.04), hypertension (P = 0.02), fasting hyperglycemia (P = 0.03), low high-density lipoprotein levels (P = 0.02), and hypertriglyceridemia (P = 0.02) were also significantly higher in the IR group.

Conclusion

Insulin resistance is associated with dyslipidemia and MBS in women with PCOS. Lifestyle modification and insulin-sensitizing agents should be part of the management plan.     

Specific exercises to treat pregnancy-related low back pain in a South African population

Objective

To investigate the effect of an exercise program, including specific stabilizing exercises, on pain intensity and functional ability in women with pregnancy-related low back pain.

Methods

Fifty women between 16 and 24 weeks of pregnancy were recruited at Tygerberg and Paarl Hospitals, Western Cape, South Africa. Twenty-six women were randomized to a 10-week exercise program and 24 were randomized as controls.

Results

Overall, the most frequent type of back pain experienced was lumbar pain (36 [72.0%]). Pain intensity (P = 0.76) and functional ability (P = 0.29) were comparable between the groups on study entry. In the study group, there was a significant improvement in pain intensity (P < 0.01) and an improvement in functional ability (P = 0.06) at the end of the study. In the control group, there were no significant changes in pain intensity (P = 0.89) or functional ability (P = 0.70) at the end of the study.

Conclusion

A specific exercise program decreased back pain intensity and increased functional ability during pregnancy in South African women with lumbar and pelvic girdle pain.     

Adequacy of visual inspection with acetic acid in women of advancing age

Objective

The present study assessed the adequacy and predictive performance of visual inspection with acetic acid (VIA) in women over the age of 50 years and compared the specificity and sensitivity of VIA with that of the conventional cytology.

Methods

In total, 588 Salvadoran women ages 50-79 underwent VIA, Pap smear, and cervical biopsy. VIA was considered adequate if the squamocolumnar junction was completely visible. A positive biopsy was defined as cervical intraepithelial neoplasia (CIN) 2 or worse.

Results

Age was negatively correlated with VIA adequacy (P = 0.04). Nevertheless, the majority of women—even in the older age groups—had adequate examinations. The adequacy of VIA was positively correlated with gravida (P = 0.01) and was higher in women who had been treated by cryotherapy (P = 0.02). The rate of positive biopsies was unexpectedly low (n = 6 [1%]) making it difficult to assess the predictive performance of VIA. In this small sample, the sensitivities of VIA (17%) and Pap (33%) were low; the high number of false negatives could not be fully explained by inadequacy of the examinations.

Conclusions

Adequacy of VIA declined with age. However, the squamocolumnar junction was visible to the naked eye in the majority of women, indicating that they are good candidates for VIA.     

Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome

Objective

To compare the hormonal-metabolic profiles and reproductive outcomes in clomiphene-resistant patients with polycystic ovary syndrome and insulin resistance between women receiving metformin and those undergoing laparoscopic ovarian drilling.

Methods

A total of 110 eligible participants were randomly allocated to diagnostic laparoscopy plus metformin therapy (group 1, n = 55) or laparoscopic ovarian drilling (group 2, n = 55). The t test was used for mean comparisons of hormonal-metabolic parameters and OGTT values before and after treatment. The χ² test was used for comparisons of ovulation, pregnancy, and abortion rates.

Results

Groups 1 and 2 showed a significant decline in testosterone, insulin-like growth factor-1 (P < 0.001 vs P < 0.001), and luteinizing hormone (P < 0.05 vs P < 0.001), while the glucose to insulin ratio was significantly increased (P < 0.001 vs P < 0.05) compared with baseline. Group 2 patients had more regular cycles and higher rates of ovulation and pregnancy compared with group 1: 76.4% [42/55] vs 58.2% [32/55], P < 0.04; 50.8% [131/258] vs 33.5% [94/281], P < 0.001; and 38.2% [21/55] vs 20.0% [11/55], P < 0.03, respectively. The difference in the early abortion rate between the groups was not statistically significant.

Conclusion

Although metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy.