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Ovarian drilling

Mr Amit Shah, Mr Anil Gudi, & Prof Roy Homburg

Laparoscopic ovarian drilling (LOD) is a procedure used for the treatment of infertile women who have polycystic ovary syndrome (PCOS).

When the first cases of PCOS were first described in 1935 by Stein and Levanthal, the treatment they suggested was to remove a wedge-shaped section of each ovary. They thought at that time that this would release eggs that were “trapped” in these ovaries. Although we know today that this explanation was not correct, the operation helped and ovulation was frequently seen and pregnancies ensued. The problem was that while solving the problem of no ovulation the operation frequently caused a mechanical problem (adhesions) which did not allow the egg to meet the sperm. For this reason the operation was dropped but in the meantime it was realized that the reason for its relative success was the reduction in the mass of the polycystic ovary. The modern method to achieve this, through a laparoscope, is to reduce the amount of follicles and tissue in the polycystic ovaries by “drilling” them with diathermy or laser. The holes, 4-10 in number in each ovary, are small and superficial but enough to produce ovulation and pregnancy in more than half of these women within 12 months. Those most suited to this one-off operation are of normal weight and having high levels of luteinising hormone (LH).

If ovulation has not resumed within 3 months of the operation, first clomifene and then FSH may be used and excellent results may be expected even if there was no response to these methods to induce ovulation before the operation. In the right hands, complications are minimal and the chance of interfering adhesions small. Although LOD produces an improvement in the abnormal hormone levels of PCOS, this operation should be employed for curing infertility only for those who have not responded to other treatment and are suitable candidates and not for the treatment of other symptoms of PCOS.

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