Laparoscopic Ovarian Drilling vs. Recombinant FSH for Treatment of Infertility in Women Diagnosed with Clomiphene Citrate Resistant PCOS: Safety and Cost-Effectiveness

Taha, Wael Soliman; Abdelmoaty, Muhamed Ahmed; Abdelaziz, Ahmed Atef

doi:10.21608/aimj.2025.446421

Laparoscopic Ovarian Drilling vs. Recombinant FSH for Treatment of Infertility in Women Diagnosed with Clomiphene Citrate Resistant PCOS: Safety and Cost-Effectiveness

Document Type : Original Article

Authors

Obstetrics and Gynecology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446421

Abstract

Background: Clomiphene Citrate (CC) is a first-line treatment for anovulatory infertility in women with Polycystic Ovary Syndrome (PCOS). However, approximately 20-30% of women are resistant to CC, necessitating alternative treatments. Laparoscopic Ovarian Drilling (LOD) and Recombinant Follicle-Stimulating Hormone (rFSH) therapy are two primary alternatives for such cases. While both treatments are effective, their safety and cost-effectiveness remain topics of debate.
Aim of the Work: This study aims to compare the efficacy, safety, and cost-effectiveness of LOD and rFSH in women diagnosed with CC-resistant PCOS.
Patients and Methods: A total of sixty women with CC-resistant PCOS were enrolled in this randomized controlled trial. Participants were divided into two groups: one group underwent LOD, and the other received rFSH therapy. The primary outcomes were ovulation and pregnancy rates, while secondary outcomes included the safety and cost-effectiveness of the treatments.
Results: Sixty patients were included, with 30 in the LOD group and 30 in the rFSH group. The rFSH group showed higher effectiveness in achieving regular menstrual cycles (87% vs. 60%, p< 0.01), successful ovulation (90% vs. 67%, p < 0.01), and pregnancy (70% vs. 50%, p < 0.05) with a shorter time to pregnancy (5.2 vs. 7.5 months, p < 0.05). However, LOD was more cost-effective, with a lower cost per participant (20,000 vs. 35,000 EGP, p < 0.05). Safety profiles were similar, though rFSH had a higher incidence of ovarian hyperstimulation syndrome (10% vs. 0%).
Conclusion: Recombinant FSH (rFSH) is more effective in achieving pregnancy and inducing ovulation in women with Clomiphene Citrate-resistant PCOS, but it is more expensive and carries a higher risk of ovarian hyperstimulation syndrome. Laparoscopic Ovarian Drilling (LOD) is a more cost-effective and safer alternative, making it a strong option for treating infertility in these patients.

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