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Pregnancy outcome in women with polycystic ovary syndrome comparing the effects of laparoscopic ovarian drilling and clomiphene citrate stimulation in women pre-treated with metformin: a retrospective study

DOI: 10.1186/1477-7827-8-45

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Setting: Academic research institution. We retrospectively analyzed the courses of 40 spontaneous pregnancies after LOD for CC-resistance, 40 pregnancies after CC stimulation, and 40 pregnancies after metformin treatment alone. Patients in the LOD and the CC groups had been pre-treated with Metformin. Primary outcome parameters were: the rate of multiple pregnancies; the rate of early pregnancy losses/miscarriages; the development of gestational diabetes, pregnancy-induced hypertension, and preeclampsia/HELLP-syndrome; premature delivery; and birth weight.The rate of twin pregnancies did not differ between the CC group (12.5%), the LOD group (7.5%), and the metformin only group (2.5%, p = 0.239). Seventeen women suffered an early miscarriage. There were no differences with regard to the rates of gestational diabetes, pregnancy-induced hypertension, preeclampsia, and preterm delivery. By analyzing all pregnancy complications together, the overall pregnancy complication rate was highest in the CC group (70.0%, 28/40), followed by the LOD group (45.0%, 18/40), and the metformin only group (47.5%, 19/40; p = 0.047).CC, but not LOD, increases the complication rate in pregnant patients who received metformin.Despite the fact that polycystic ovary syndrome (PCOS) remains one of the most common female endocrinopathies, with an incidence of 5-10% in women of reproductive age, the etiology, pathogenesis, and even treatment of infertile women who suffer from PCOS are still the subject of much controversy [1,2]. Clomiphene citrate (CC) is presumed to be the first-line therapy, since it is known to result in higher ovulation, conception, pregnancy, and live-birth rates when compared with metformin; the combination of both drugs did not result in a significant benefit [3,4].As second- and third-line therapies, gonadotropin stimulation and laparoscopic ovarian drilling (LOD) are recommended for CC-resistant anovulatory PCOS patients. To date, five randomized controlled trials have


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