Metformin versus laparoscopic ovarian drilling in clomiphene- and insulin-resistant women with polycystic ovary syndrome |
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Authors: | Hossam O. Hamed Asmaa F. Hasan Marwa A. Ahmed |
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Affiliation: | a Women's Health University Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt b Department of Physiology, Faculty of Medicine, Assiut University, Assiut, Egypt |
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Abstract: | ObjectiveTo 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.MethodsA 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.ResultsGroups 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.ConclusionAlthough metformin results in a better attenuation of insulin resistance, laparoscopic ovarian drilling is associated with higher rates of ovulation and pregnancy. |
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Keywords: | Clomiphene resistance Insulin resistance Laparoscopic ovarian drilling Metformin Polycystic ovary syndrome |
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