Impact of Laparoscopic Ovarian Drilling on Serum Anti-Mullerian Hormone levels in Patients with Anovulatory Polycystic Ovarian Syndrome

Background:
Anti Mullerian Hormone (AMH) is a marker of the activity of recruitable ovarian follicles. It is useful in the prediction of ovarian reserve. Women with Polycystic Ovarian Syndrome (PCOS) have elevated circulating and intra follicular AMH levels. Laparoscopic Ovarian Drilling (LOD) in PCOS patients will destroy ovarian androgen producing tissue and reduce their peripheral conversion to estrogens. Identifying factors that determine the response of PCOS patients to LOD will help in selecting the patients who will benefit from this treatment. AMH is one such marker that can predict the response to LOD.
Objectives:
To evaluate the effect of LOD on serum AMH levels among PCOS responders and non-responders and the usefulness of AMH as a tool in predicting the response to LOD and to see if there is loss of ovarian function after LOD.

Materials and Methods:
This is a prospective cohort study including 30 clomiphene resistant women with anovulatory PCOS undergoing LOD. Statistical analysis was done to evaluate the effect of LOD on serum levels of AMH on those women.

Results:
A significant fall in the levels of AMH was observed after LOD in both responders and non-responders (P<0.001). Women with AMH >8.3 ng/ml showed a significantly lower ovulation rate (33.3%). LOD was not associated with a risk of diminished ovarian reserve.
Conclusion:
LOD is an effective first line treatment for PCOS women with clomiphene resistance. LOD does not have any negative effect on ovarian reserve. AMH is a useful marker in predicting the outcome of LOD.