Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome.

Abstract:

BACKGROUND:Problems in inducing ovulation in women with polycystic ovary syndrome (PCOS) and anovulation (failure to ovulate) are well recognised. Surgical ovarian wedge resection was the first established treatment for anovulatory PCOS patients but was largely abandoned because of the risk of post-surgical adhesion formation. It was replaced by medical ovulation induction with clomiphene and gonadotrophins. However patients with PCOS treated with gonadotrophins often have a polyfollicular response and are exposed to the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. Although effective, it is an expensive, stressful and time consuming form of treatment requiring intensive monitoring. A new surgical therapy, laparoscopic ovarian "drilling", may avoid or reduce the need, or facilitate the use, of gonadotrophins for inducing ovulation. The procedure can be done on an outpatient basis with less trauma and fewer postoperative adhesions. It has been claimed in many uncontrolled observational studies that it is followed, at least temporarily, by a high rate of spontaneous postoperative ovulation and conception, or that subsequent medical ovulation induction becomes easier. OBJECTIVES:To determine the effectiveness and safety of laparoscopic ovarian drilling with ovulation induction for subfertile women with clomiphene resistant polycystic ovarian syndrome. SEARCH STRATEGY:The search strategy of the Menstrual Disorders and Subfertility Group was used for the identification of randomised controlled trials (RCTS). A computerised MEDLINE search was used to identify non randomised controlled trials. SELECTION CRITERIA:Trials were eligible for inclusion if treatment consisted of laparoscopic ovarian drilling in order to induce ovulation in subfertile women with PCOS and compared with a concurrent control group. DATA COLLECTION AND ANALYSIS:Fifteen trials were identified; six were included in the review all of which were randomised. All trials were assessed for quality criteria. The main studied outcomes were ovulation and pregnancy rates. Miscarriage rate, multiple pregnancy rate, and incidence of overstimulation and ovarian hyperstimulation syndrome rate were secondary outcomes. MAIN RESULTS:The ongoing pregnancy rate following ovarian drilling compared with gonadotrophins differed according to the length of follow up. Overall, the pooled OR (all studies) was not statistically significant (OR 1.27, 95% CI 0.77, 1.98). Multiple pregnancy rates were reduced in the ovarian drilling arms of the four trials where there was a direct comparison with gonadotrophins (OR 0.16, 95%CI 0.03,0.98). There was no difference in miscarriage rates in the drilling group when compared with gonadotrophin in these trials (OR 0.61, 955% 0.17, 2.16). REVIEWER'S CONCLUSIONS:There is insufficient evidence of a difference in cumulative ongoing pregnancy rates between laparoscopic ovarian drilling after 6-12 months follow up and 3-6 cycles of ovulation induction with gonadotrophins as a primary treatment for subfertile patients with anovulation (failure to ovulate) and polycystic ovarian syndrome (PCOS). Multiple pregnancy rates are considerably reduced in those women who conceive following laparoscopic drilling.

authors

Farquhar C,Vandekerckhove P,Lilford R

doi

10.1002/14651858.CD001122

keywords:

subject

Has Abstract

pub_date

2001-01-01 00:00:00

pages

CD001122

issue

4

issn

1469-493X

pii

CD001122

pub_type

杂志文章,评审
  • Oral steroids for long-term use in cystic fibrosis.

    abstract:BACKGROUND:In cystic fibrosis (CF) airway obstruction and recurrent respiratory infection lead to inflammation, long-term lung damage, respiratory failure and death. Anti-inflammatory agents, e.g. oral corticosteroids are used since inflammation occurs early in disease. OBJECTIVES:To assess the effectiveness of oral c...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000407.pub2

    authors: Cheng K,Ashby D,Smyth RL

    更新日期:2011-10-05 00:00:00

  • Lithium for schizophrenia.

    abstract:BACKGROUND:Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, among them lithium. OBJECTIVES:To review the effects of lithium for the treatment of schizophrenia and schizophrenia-like psychoses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003834

    authors: Leucht S,McGrath J,Kissling W

    更新日期:2003-01-01 00:00:00

  • Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months.

    abstract:BACKGROUND:Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily zinc supplements have been reported to prevent acute lower respiratory tract infection (LRTI) and reduce child mortality. This is an update o...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005978.pub3

    authors: Lassi ZS,Moin A,Bhutta ZA

    更新日期:2016-12-04 00:00:00

  • Sapropterin dihydrochloride for phenylketonuria.

    abstract:BACKGROUND:Phenylketonuria results from a deficiency of the enzyme phenylalanine hydroxylase. Dietary restriction of phenylalanine keeps blood phenylalanine concentration low. Most natural foods are excluded from diet and supplements are used to supply other nutrients. Recent publications report a decrease in blood phe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008005.pub4

    authors: Somaraju UR,Merrin M

    更新日期:2015-03-27 00:00:00

  • Interventions for helping to turn term breech babies to head first presentation when using external cephalic version.

    abstract:BACKGROUND:Breech presentation is associated with increased complications. Turning a breech baby to head first presentation using external cephalic version (ECV) attempts to reduce the chances of breech presentation at birth, and reduce the adverse effects of breech vaginal birth or caesarean section. Tocolytic drugs a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000184.pub3

    authors: Cluver C,Hofmeyr GJ,Gyte GM,Sinclair M

    更新日期:2012-01-18 00:00:00

  • Hormonal therapy in advanced or recurrent endometrial cancer.

    abstract:BACKGROUND:Endometrial cancer is a cancer of the lining of the womb and worldwide is the seventh most common cancer in women. Treatment with hormones is thought to be beneficial in patients with endometrial cancer. OBJECTIVES:To assess the indications, effectiveness and safety of hormone therapy for advanced or recurr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007926.pub2

    authors: Kokka F,Brockbank E,Oram D,Gallagher C,Bryant A

    更新日期:2010-12-08 00:00:00

  • Bisphosphonates and other bone agents for breast cancer.

    abstract:BACKGROUND:Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab, inhibit key pathways in the vicious cycle of bone metastases. OBJECTIVES:To assess the effect of bisphosphonates...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003474.pub3

    authors: Wong MH,Stockler MR,Pavlakis N

    更新日期:2012-02-15 00:00:00

  • Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix.

    abstract:BACKGROUND:For early squamous cell carcinoma of the uterine cervix, the outcome is similar after either primary surgery or primary radiotherapy. There are reports that this is not the case for early adenocarcinoma (AC) of the uterine cervix: some studies have reported that the outcome is better after primary surgery. T...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006248.pub2

    authors: Baalbergen A,Veenstra Y,Stalpers LL,Ansink AC

    更新日期:2010-01-20 00:00:00

  • Audio recordings of consultations with doctors for parents of critically sick babies.

    abstract:BACKGROUND:Family centred care is an important part of neonatal intensive care. Ensuring effective communication in the neonatal intensive care unit (NICU) is a challenge but is crucial to the implementation of family centred care. Providing parents in NICU with audiotape recordings of their conversations with neonatol...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004502.pub2

    authors: Koh TH,Budge D,Butow P,Renison B,Woodgate P

    更新日期:2005-01-25 00:00:00

  • Email for the provision of information on disease prevention and health promotion.

    abstract:BACKGROUND:Email is a popular and commonly used method of communication, but its use in health care is not routine. Its application in health care has included the provision of information on disease prevention and health promotion, but the effects of using email in this way are not known. This review assesses the use ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007982.pub2

    authors: Sawmynaden P,Atherton H,Majeed A,Car J

    更新日期:2012-11-14 00:00:00

  • Screening programmes for the early detection and prevention of oral cancer.

    abstract:BACKGROUND:Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with or...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004150.pub3

    authors: Brocklehurst P,Kujan O,Glenny AM,Oliver R,Sloan P,Ogden G,Shepherd S

    更新日期:2010-11-10 00:00:00

  • Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation.

    abstract:BACKGROUND:Chronic pulmonary infection is one of the hallmarks of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 17 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009529.pub2

    authors: Horsley A,Jones AM

    更新日期:2012-10-17 00:00:00

  • Physical activity programs for promoting bone mineralization and growth in preterm infants.

    abstract:BACKGROUND:Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth. OBJECTIVES:The primary objective was to assess whether...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005387.pub3

    authors: Schulzke SM,Kaempfen S,Trachsel D,Patole SK

    更新日期:2014-04-22 00:00:00

  • Short-acting insulin analogues versus regular human insulin for adult, non-pregnant persons with type 2 diabetes mellitus.

    abstract:BACKGROUND:The use of short-acting insulin analogues (insulin lispro, insulin aspart, insulin glulisine) for adult, non-pregnant people with type 2 diabetes is still controversial, as reflected in many scientific debates. OBJECTIVES:To assess the effects of short-acting insulin analogues compared to regular human insu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD013228

    authors: Fullerton B,Siebenhofer A,Jeitler K,Horvath K,Semlitsch T,Berghold A,Gerlach FM

    更新日期:2018-12-17 00:00:00

  • Deflation of gastric band balloon in pregnancy for improving outcomes.

    abstract:BACKGROUND:In line with the rise in the prevalence of obesity, an increasing number of women of childbearing age are undergoing laparoscopic adjustable gastric banding (LAGB), resulting in an increasing number of pregnancies with a band in place. Currently, there is no consensus on optimal band management in pregnancy....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD010048.pub2

    authors: Jefferys AE,Siassakos D,Draycott T,Akande VA,Fox R

    更新日期:2013-04-30 00:00:00

  • Anti-IL-12/23p40 antibodies for induction of remission in Crohn's disease.

    abstract:BACKGROUND:Ustekinumab (CNTO 1275) and briakinumab (ABT-874) are monoclonal antibodies that target the standard p40 subunit of the cytokines interleukin-12 and interleukin-23 (IL-12/23p40), which are involved in the pathogenesis of Crohn's disease. OBJECTIVES:The objectives of this review were to assess the efficacy a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007572.pub3

    authors: MacDonald JK,Nguyen TM,Khanna R,Timmer A

    更新日期:2016-11-25 00:00:00

  • Oestrogens alone or with amniotomy for cervical ripening or induction of labour.

    abstract:BACKGROUND:Studies in sheep showed that there is a pre-labour rise in oestrogen and a decrease in progesterone, both of these changes stimulate prostaglandin production and may help initiate labour. Though oestrogen has been suggested as an effective cervical ripening or induction agent, research in humans have failed ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003393

    authors: Thomas J,Kelly AJ,Kavanagh J

    更新日期:2001-01-01 00:00:00

  • Parenteral anticoagulation in patients with cancer who have no therapeutic or prophylactic indication for anticoagulation.

    abstract:BACKGROUND:Anticoagulation may improve survival in patients with cancer through an antitumor effect in addition to the perceived antithrombotic effect. OBJECTIVES:To evaluate the efficacy and safety of parenteral anticoagulants in patients with cancer with no therapeutic or prophylactic indication for anticoagulation....

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006652.pub2

    authors: Akl EA,Gunukula S,Barba M,Yosuico VE,van Doormaal FF,Kuipers S,Middeldorp S,Dickinson HO,Bryant A,Schünemann H

    更新日期:2011-01-19 00:00:00

  • Exercises for mechanical neck disorders.

    abstract:BACKGROUND:Neck disorders are common, disabling and costly. The effectiveness of exercise as a physiotherapy intervention remains unclear. OBJECTIVES:To improve pain, disability, function, patient satisfaction, quality of life and global perceived effect in adults with neck pain. SEARCH METHODS:Computerized searches ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004250.pub4

    authors: Kay TM,Gross A,Goldsmith CH,Rutherford S,Voth S,Hoving JL,Brønfort G,Santaguida PL

    更新日期:2012-08-15 00:00:00

  • Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under.

    abstract:BACKGROUND:Lower respiratory tract infections (LRTIs) in young children account for 1.4 million deaths annually worldwide. Antibiotics could be beneficial in preventing LRTIs in high-risk children, and may also help prevent school absenteeism and work days missed by children and/or carers. While it is well documented t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD011530.pub2

    authors: Onakpoya IJ,Hayward G,Heneghan CJ

    更新日期:2015-09-26 00:00:00

  • Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery.

    abstract:BACKGROUND:Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. OBJECTIVES:To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. SEARCH METHODS:We...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007105.pub2

    authors: Andreae MH,Andreae DA

    更新日期:2012-10-17 00:00:00

  • General health checks in adults for reducing morbidity and mortality from disease.

    abstract:BACKGROUND:General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also,...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD009009.pub3

    authors: Krogsbøll LT,Jørgensen KJ,Gøtzsche PC

    更新日期:2019-01-31 00:00:00

  • Interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women.

    abstract:BACKGROUND:Surgery is a common treatment modality for stress urinary incontinence (SUI), usually offered to women for whom conservative treatments have failed. Midurethral tapes have superseded colposuspension because cure rates are comparable and recovery time is reduced. However, some women will not be cured after mi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD009407.pub3

    authors: Bakali E,Johnson E,Buckley BS,Hilton P,Walker B,Tincello DG

    更新日期:2019-09-04 00:00:00

  • Interventions for paracetamol (acetaminophen) overdoses.

    abstract:BACKGROUND:Self-poisoning with paracetamol (acetaminophen) is a common cause of hepatotoxicity in the Western World. Interventions for paracetamol poisoning encompass inhibition of absorption, removal from the vascular system, antidotes, and liver transplantation. OBJECTIVES:The objective was to assess the beneficial ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003328

    authors: Brok J,Buckley N,Gluud C

    更新日期:2002-01-01 00:00:00

  • Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections.

    abstract:BACKGROUND:Acute respiratory infections (ARIs) comprise a large and heterogeneous group of infections including bacterial, viral and other aetiologies. In recent years, procalcitonin - the prohormone of calcitonin - has emerged as a promising marker for the diagnosis of bacterial infections and for improving decisions ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007498.pub2

    authors: Schuetz P,Müller B,Christ-Crain M,Stolz D,Tamm M,Bouadma L,Luyt CE,Wolff M,Chastre J,Tubach F,Kristoffersen KB,Burkhardt O,Welte T,Schroeder S,Nobre V,Wei L,Bhatnagar N,Bucher HC,Briel M

    更新日期:2012-09-12 00:00:00

  • Post-operative radiotherapy for ductal carcinoma in situ of the breast.

    abstract:BACKGROUND:The addition of radiotherapy (RT) following breast conserving surgery (BCS) was first shown to reduce the risk of ipsilateral recurrence in the treatment of invasive breast cancer. Ductal carcinoma in situ (DCIS) is a pre-invasive lesion. Recurrence of ipsilateral disease following BCS can be either DCIS or ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD000563.pub5

    authors: Goodwin A,Parker S,Ghersi D,Wilcken N

    更新日期:2009-07-08 00:00:00

  • Aspirin with or without an antiemetic for acute migraine headaches in adults.

    abstract:BACKGROUND:This is an updated version of the original Cochrane review published in Issue 4, 2010 (Kirthi 2010). Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers choose not to, or are unable to, seek professional help and rely on over-the-counter anal...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008041.pub3

    authors: Kirthi V,Derry S,Moore RA

    更新日期:2013-04-30 00:00:00

  • Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents.

    abstract:BACKGROUND:Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently us...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003032

    authors: Posner EB,Mohamed K,Marson AG

    更新日期:2003-01-01 00:00:00

  • Methotrexate for induction of remission in refractory Crohn's disease.

    abstract:BACKGROUND:Although corticosteroids are effective for induction of remission of Crohn's disease, many patients relapse when steroids are withdrawn or become steroid dependent. Furthermore, corticosteroids exhibit significant adverse effects. The success of methotrexate as a treatment for rheumatoid arthritis led to its...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003459.pub4

    authors: McDonald JW,Wang Y,Tsoulis DJ,MacDonald JK,Feagan BG

    更新日期:2014-08-06 00:00:00

  • Antibiotic lock for the prevention of catheter-related infection in neonates.

    abstract:BACKGROUND:Use of a central venous catheter (CVC) in neonates is associated with an increase in nosocomial infection. Numerous strategies exist to prevent catheter-related bloodstream infection (CRBSI); however, CRBSI continues to be a major problem. Antibiotic locking catheters is a new and promising treatment that po...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010336.pub2

    authors: Taylor JE,Tan K,Lai NM,McDonald SJ

    更新日期:2015-06-04 00:00:00