Evaluation of laparoscopic management and clinical outcome in women with premature ovarian failure

Objective: To analyse the results of laparoscopic ovarian biopsy and the laparoscopically observed morphological features of the ovary in premature ovarian failure (POF), in relation to clinical outcome, and to construct an appropriate guideline for clinical management utilizing laparoscopy. Design: A retrospective study of patient records. Setting: Fujita Health University Hospital. Subjects: 19 women with POF, treated between 1991 and 2000. Main outcome measures: The ovaries from 12 patients who underwent laparoscopy were classified, according to morphological features, as sclerotic, atrophic or hypoplastic. The detection rate for a primordial follicle was assessed for each ovarian type, and the correlation between morphological features and patient clinical outcome was investigated. Results: Induction of ovulation was successful in eight of 19 patients (42.1%). Among the 12 patients who underwent laparoscopy, ovulation induction was successful in four, but not in the remaining eight. The rate of detection of a primordial follicle was 50.0% for the four women with successful ovulation induction and 14.2% in the eight other women. With regard to ovarian type, primordial follicles were detected only in sclerotic ovaries. It was shown that cyclic therapy with estrogen and progesterone (CTEP) had appreciably favourable effects, and then the combined therapy with CTEP-primed gonadotrophin-releasing hormone (GnRH) agonist and human menopausal gonadotrophin-human chorionic gonadotrophin (hMG-hCG) was a reasonable therapeutic method. Conclusions: There was a clear relation between the rate of detection of primordial follicles and the morphological features of the ovaries. Therefore, laparoscopy should be done an early stage to determine the type of ovary. Furthermore, in establishing whether or not there is a primordial follicle in the ovary, laparoscopy seems to have an important role in the planning of treatment.