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Ovarian Drilling

The original treatment for PCOS, proposed by Stein and Levanthal in 1935, was bilateral wedge resection of the ovaries which surgically removes a large amount of ovarian tissue. This met with remarkable success regarding resumption of ovulation but was abandoned due to the high probability of inducing pelvic adhesions and the advent of medical means of inducing ovulation.

Today the same effect of decreasing the amount of active ovarian tissue can be achieved by ‘drilling’ holes in the ovaries – laparoscopic ovarian drilling (LOD) by diathermy or laser and this method now presents a further treatment option for women with anovulatory infertility associated with PCOS. No less than 4 and no more than 10 punctures to a depth of 2-4mm on each ovary should be made according to the size of the ovary. The main advantages of ovarian drilling are a very high prevalence of a single ovulation in each cycle and therefore a significant reduction in multiple pregnancy rates compared with gonadotrophin therapy, a reported reduction in miscarriage rates and the fact that it is an often successful “one-off” procedure which may avoid the use of expensive medical therapy and the exclusion of ovarian hyperstimulation syndrome.

If ovulation is not forthcoming within 2-3 months following LOD, then ovulation induction can often be more successfully employed than preceding the operation with clomifene or FSH if clomifene fails to induce ovulation. Follow-up after LOD showed that 49% conceived spontaneously within a year and a further 38% within 1 to 9 years following the operation. Women with anovulatory PCOS who are of normal weight and have high LH concentrations seem to have the most favourable prognosis. LOD should not be employed merely for the treatment of other symptoms of PCOS.

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