“Laparoscopic ovarian drilling”

Ovulation Induction with Laparoscopic ovarian drilling (LOD) is a surgical procedure to treat oligomenorrhea and anovulatory amenorrhea which is a very major cause of infertility due to PCOS. This is an alternative therapy for the conventional hormonal therapy and Clomiphene citrate (CC) resistant PCOS patients. This is a simple in-office type keyhole surgery which is less invasive and less cumbersome. LOD is most successful in patients who are CC-resistant and had been not ovulating since at least 1 year. Infertility treatments with laser and electrode based diathermy were first tried in 1984. Since its inception in 1984 LOD has evolved to be a safe and effective treatment alternative for CC-resistant and infertile PCOS women. This method basically drives on the factor that it sensitizes the ovarian tissue to the spike in FSH and a decrease in LH after the injury to the Ovaries and few follicles in the process. LOD further increases the folliculogenesis and blood supply to the ovaries and result in the higher availability of FSH to the developing ovarian follicles. And there is a reported decrease in FAH and Testosterone and other androgens in optimal ovarian drilling with significant outcomes.

Who should go for Ovarian Drilling Procedures:

Women with a long history of PCOS and familial history can go for LOD based on the Doctors advice. Failure with selective estrogen receptor modulators and Clomiphene Citrate for three cycles if still cant result in pregnancy but had 6-9 menstrual cycles can be treated with Laparoscopic ovarian drilling. On overall 4-10 punctures have given significant dose pregnancy outcomes which were dose-dependent and were sufficient to elicit a response for the ovary for ovulation and further conceiving.

Advantages:
  • Laparoscopic ovarian drilling is as effective as the hormonal induction of ovulation and does not have the problem of multiple pregnancies as in the case of hyperstimulation and OHSS.
  • This procedure also works for CC-resistant women.
  • This method is primarily a least invasive procedure as Laparoscopic procedures are called Ban-Aid Surgery.
  • Result in quick recovery and early resumption of work.
Disadvantages:
  • There are minor disadvantages associated with these procedures as they may cause iatrogenic infections and adhesions in some cases.
  • The decrease in Ovarian reserves (DOR) may be a cause of concern as it may cause early Menopause.
Sucesss Rate:

The Overall success rate of the Laparoscopic Ovarian drilling is quite promising and has almost similar effects as compared to Hormonal and Clomiphene citrate treated patients most often. But LOD is more effective over CC-resistant patients and also patients with insulin resistance. Ovarian drilling procedures offer overall a higher success rate of about 80% increased ovulation and 65% increase in pregnancy and live birth outcomes.