Effect of laparoscopic ovarian drilling on serum vascular endothelial growth factor and ovarian stromal blood flow in patients with polycystic ovarian syndrome

Background
Women with polycystic ovary syndrome have significant difference in their ovarian stromal blood flow indices when compared with women with normal ovaries.
Aim
To determine the serum level of vascular endothelial growth factor (VEGF) and ovarian stromal blood flow changes in anovulatory women with polycystic ovarian syndrome before and after laparoscopic ovarian drilling (LOD).
Patients and methods
This is a prospective, controlled study conducted at the Department of Obstetrics and Gynecology at Al Zahraa University Hospital. Thirty-eight women with polycystic ovarian syndrome (PCOS) according to Rotterdam Criteria, 2003, aged 25–40 years, BMI between 20 and 30 kg/m, having normal hysterosalpingography (HSG), resistant to clomifene citrate treatment, and partners having normal semen analysis according to WHO criteria were included. Thirty-eight women with polycystic ovarian syndrome resistant to clomifene citrate treatment and 18 healthy fertile women served as the control group. Ovarian Doppler and serum levels of VEGF, luteinizing hormone (LH), follicular stimulating hormone (FSH), and total testosterone were measured in the early follicular phase of PCOS (before LOD) and control cases, then PCOS women undergo LOD, then ovarian Doppler and serum levels of VEGF, LH, FSH, and total testosterone were measured in the early follicular phase within 3 months after LOD
Results
After LOD, serum level of VEGF concentrations in women with PCOS significantly decrease in its level after LOD; LH decreased significantly from 11.1±1.4 mIU/ml before LOD to 5.8±0.8 mIU/ml after LOD. FSH increased significantly from 4.5±0.6 mIU/ml before LOD to 7±0.1 mIU/ml after LOD and total testosterone decreased significantly from 0.9±0.2 ng/ml before LOD to 0.5±0.1 ng/ml after LOD. Ovarian stromal blood flow velocity declined significantly after LOD in women with PCOS. There is significant increase in the resistance index, pulsatility index after LOD when compared with its value before LOD levels.
Conclusion
LOD reduced serum levels of VEGF, in addition to ovarian blood flow indices, in women with PCOS. LOD is a good second choice to induce ovulation in patients with PCOS who are clomifene citrate resistant, as it improves ovulation in infertile anovulatory PCOS women.