Laparoscopic Ovarian Diathermy [Ovarian Drilling]
Surgery is recommended should the medical treatment fail and for women who have experienced OHSS. This may be ovarian drilling or ovarian wedge resection. It is not clear why women with PCOS ovulate after ovarian drilling or wedge resection. After surgery, ovulation occurs spontaneously in 70-90% of women and the probability of pregnancy after one year is in the region of 40-60%. There is no increased risk of multiple pregnancy or OHSS. If ovulatory cycles fail to restore after the surgery, the doctor may restart ovulation induction. A recent study up to 20 years after laparoscopic drilling has shown persistence of ovulation over many years. Compared with medical treatment, it need only be performed once and intensive monitoring is not required. The main problems associated with surgery include adhesion formation, the risk of destruction of the ovaries leading to ovarian failure. In addition, there are risks associated with surgery and anaesthesia.
Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women with polycystic ovary syndrome (PCOS) who have not responded to weight loss and fertility medication. Electrocautery or laser is used to destroy portions of the ovaries.
Laparoscopy is usually done with general anaesthesia. A small incision is made in the abdomen at the navel. A tube is used to inflate the abdomen with a small amount of carbon dioxide gas so the laparoscope can be inserted without damage to the abdominal internal organs. The surgeon looks through the laparoscope at the internal organs. Surgical instruments may be inserted through the same incision or other small incisions in the pelvic area.
This shows how the drilling is actually performed
If you have a laparoscopy procedure, you can usually go home the same day and resume normal activities within 24 hours.
Your return to normal activities will also depend on how quickly you recover from surgery, which may take a few days or as long as 2 to 4 weeks.
Ovarian drilling is done for women with PCOS who have not responded to weight loss and fertility medication. Partial ovarian destruction has been reported to restore regular ovulation cycles.
Case series studies of women with PCOS have reported that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate. The advantage of laparoscopy is that tubal patency can be checked at the same time in a single procedure, and ovarian drilling of either one or both ovaries appears to restore ovulation in a substantial number of patients. Serum concentrations of LH and testosterone decrease rapidly after ovarian drilling with a sustained mid- and long-term effect. The proportion of women with regular menstrual cycles increases substantially after drilling and is sustained at long-term follow-up. Ovulation and pregnancy rates are substantially increased in the period after the operation and appear to be maintained. Resistance to the effects of ovarian drilling include marked obesity, very elevated levels of androgens, and long duration of infertility. Addition of other ovulating agents such as clomiphene citrate or FSH appears to improve the effectiveness of laparoscopic ovarian drilling
Summary of Ovarian Drilling: