We looked at whether women who have clomiphene-resistant polycystic ovarian syndrome (PCOS) would benefit from applying ultrasound-guided transvaginal ovarian needle drilling (UTND) to induce ovulation.
Clomiphene citrate is one of the first-line treatments used to induce ovulation (release of an egg from the ovary) in women with PCOS (a hormonal disorder common in women of child-bearing age). However, 15% to 40% of women with PCOS do not ovulate after clomiphene administration (known as clomiphene resistance). Ultrasound-guided transvaginal ovarian needle drilling (puncturing an ovary under the guidance of images created by an ultrasound probe inserted into the vagina) is used in women with clomiphene-resistant PCOS to assist releasing a dominant follicle (ovulation). Also, gonadotropins (injectable hormonal medicines) may be offered as a treatment option to induce ovulation in women with clomiphene-resistant PCOS.
It has been suggested that compared to laparoscopic (where small incisions are made in the pelvis and a tiny camera is used to view the ovaries) ovarian drilling, UTND may decrease the risk of surgical complications. Nevertheless, most of the studies of UTND have limitations in study quality. We did not identify any studies for inclusion. The safety and effectiveness of UTND are still uncertain.
We searched for studies published up to December 2020.
No studies could be included for analysis. We placed three previously included studies in the awaiting classification category due to uncertainties regarding study methods.
We were unable to assess the benefit or harm of applying UTND for women with clomiphene-resistant PCOS, as no studies could be included in the current review.
Quality of the evidence
No studies could be included for quality evaluation.
Since we did not identify any studies for inclusion, we were unable to assess the benefit or harm of applying UTND for women with clomiphene-resistant PCOS.
Ovulatory disturbance is a key diagnostic feature of polycystic ovarian syndrome (PCOS), leading to infertility and correspondingly heavy disease burden. Many therapeutic strategies have been used to induce ovulation for women with PCOS who are infertile. Ultrasound-guided transvaginal ovarian needle drilling (UTND) is a novel surgical method used to induce ovulation for women with clomiphene-resistant PCOS at the outpatient clinic.
To evaluate the efficacy and safety of UTND for subfertile women with clomiphene-resistant PCOS.
We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, and other databases to December 2020. We checked conference abstracts, reference lists, and clinical trials registries. We also contacted experts and specialists in the field for any additional trials .
We planned to include randomised controlled trials comparing UTND to laparoscopic ovarian drilling, and UTND combined with gonadotropins to gonadotropins, in women of reproductive age with clomiphene-resistant PCOS and infertility.
Two review authors independently screened the trials identified by the search for inclusion, assessed methodological quality and risk of bias, and extracted data. The primary outcomes were live birth rate and incidence of surgical complications (bleeding and infection). Secondary outcomes included pregnancy rate, ovulation rate, and ovarian hyperstimulation syndrome. We planned to calculate odds ratios with 95% confidence intervals for dichotomous data. We would assess overall quality of the evidence by applying the GRADE criteria.
We did not identify any trials for inclusion in the review. We were unable to assess the benefit or harm of applying UTND for women with clomiphene-resistant PCOS, as no studies could be included in the current review. We moved the previously included trials to studies awaiting classification due to concerns regarding methodology.