Whole-Ovary Laparoscopic Incisions Improve Hormonal Response and Fertility in Patients with Extremely Poor Ovarian Response

Chia Lin Chang; Tzu Hsuan Chin; Ya Chiung Hsu; Aaron J Hsueh

doi:10.1016/j.jmig.2022.04.011

Whole-Ovary Laparoscopic Incisions Improve Hormonal Response and Fertility in Patients with Extremely Poor Ovarian Response

J Minim Invasive Gynecol. 2022 Jul;29(7):905-914. doi: 10.1016/j.jmig.2022.04.011. Epub 2022 Apr 27.

Authors

Chia Lin Chang¹, Tzu Hsuan Chin², Ya Chiung Hsu², Aaron J Hsueh³

Affiliations

¹ Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center (Drs Chang, Chin, Hsu), Chang Gung University, Taoyuan, Taiwan. Electronic address: amego@cgmh.org.tw.
² Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center (Drs Chang, Chin, Hsu), Chang Gung University, Taoyuan, Taiwan.
³ Department of Obstetrics and Gynecology, School of Medicine (Dr Hsueh), Stanford University, Stanford, California.

PMID: 35489579
DOI: 10.1016/j.jmig.2022.04.011

Abstract

Study objective: Recent findings have shown mechanical fragmentation of ovarian cortex and ovarian drilling could promote follicle growth in patients with premature ovarian insufficiency and polycystic ovarian syndrome, respectively. A common element shared by these treatments is the mechanical disturbance of ovarian extracellular matrix tissues. We thus hypothesized a simplified whole-ovary laparoscopic incision (WOLI) procedure may provide the intrinsic stimuli needed to activate resting follicles in patients with an extremely poor ovarian response (EPOR) who had negligible chance of becoming pregnant with their own oocytes via modern in vitro fertilization practice.

Design: Retrospective pilot study.

Setting: The study was conducted in a research medical center in Taiwan.

Patients: Women who had multiple canceled ovarian stimulation cycles due to the lack of follicle growth were recruited. A total of 6 patients with EPOR received the WOLI procedure, which covers the whole surface of ovaries, in 2015 to 2017.

Interventions: After receiving an outpatient WOLI procedure, ovarian response and follicle growth were monitored for 90 days with or without gonadotropin stimulation. Embryo quality and clinical outcomes were analyzed.

Measurements and main results: After the WOLI treatment, 5 of 6 patients had significant increases in serum estradiol level and improved follicle growth (p = .001). Multiple oocytes were retrieved from each of these patients, and it led to thawed embryo transfer (ET) cycles in 4 patients (p = .010). On average, the duration from the WOLI procedure to the first ovum pickup was 24 days (11 to 58 days). After ET, 2 patients became pregnant and delivered healthy babies. Two other patients received ET, and 1 led to a chemical pregnancy. One patient had cryopreserved embryos with pending transfer.

Conclusion: The standardizable WOLI procedure restored hormonal responses in a majority of patients with EPOR. Further validation of this novel and yet simple laparoscopic procedure, which requires only 1 laparoscopic surgery, may provide a practical option to reactivate the aging ovarian environment in patients with EPOR and premature ovarian insufficiency.

Keywords: Laparoscopic incision; Mechanobiology; Ovarian fragmentation; Ovulation; Poor ovarian response.

MeSH terms

Female
Fertility
Fertilization in Vitro / methods
Humans
Laparoscopy*
Ovulation Induction / methods
Pilot Projects
Pregnancy
Pregnancy Rate
Primary Ovarian Insufficiency* / surgery
Retrospective Studies