Laparoscopic Ovarian Drilling Improve Endometrial Receptivity by Increasing Production of Endometrial Metabolites

Abstract

Objective: Laparoscopic ovarian drilling normalizes ovulation by reducing cortical thickening, lowering androgen production, and regulating luteinizing hormone pulse frequency. On the other hand, the effect of laparoscopic ovarian drilling on the endometrium is unknown. This study was planned to investigate the changes in the functional markers of choline, creatine, lactate, and lipid metabolites of the endometrium before and after laparoscopic ovarian drilling in women with polycystic ovary syndrome.

Methods: Twenty women diagnosed with clomiphene-resistant polycystic ovary syndrome who did not ovulate successfully despite the administration of clomiphene citrate or aromatase inhibitor were included in the study. Patients were offered Assisted Reproductive Technology (ART) or laparoscopic ovarian drilling options. Patients who accepted laparoscopic ovarian drilling formed the study group. Endometrial MR spectroscopy was applied to the participants in the mid-luteal phase before laparoscopic ovarian drilling. Choline, creatine, lactate, and lipid metabolites of all patients were measured and denominated parts per million. The second MR spectroscopy was performed 2 months after the first MR spectroscopy, and the changes in endometrial metabolites after laparoscopic ovarian drilling were recorded. Twenty patients who did not have clinical and laboratory findings of polycystic ovary syndrome and were matched for age and body mass index were accepted as the control group. The patients in this group were selected from fertile women with at least 2 children. MR spectroscopy was performed in the mid-luteal phase in fertile women. The obtained results were compared within and between groups and the possible effects of laparoscopic ovarian drilling on metabolite synthesis were tried to be determined.

Results: During MR spectroscopy examination main endometrial metabolites choline, creatine, lactate, and lipid were detected in the polycystic ovary syndrome group. The most prominent metabolite peak before and after laparoscopic ovarian drilling was recorded as choline and creatine. There was a significant increase in choline and creatine peaks after laparoscopic ovarian drilling compared to the values before laparoscopic ovarian drilling. There was no significant increase in lactate and lipid signals before and after laparoscopic ovarian drilling. The choline and creatine metabolite levels of the women with polycystic ovary syndrome before laparoscopic ovarian drilling were significantly lower than those of the fertile women. The choline and creatine metabolite levels of the women with polycystic ovary syndrome after m laparoscopic ovarian drilling were similar to those of the fertile women. There was no significant difference between lactate and lipid signals before and after laparoscopic ovarian drilling.

Conclusion: Laparoscopic ovarian drilling improves polycystic ovary syndrome-related subfertility by increasing endometrial choline and creatine metabolite levels to those of fertile women.