Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome

Abstract

Laparoscopic ovarian drilling (LOD) is an alternative to ovulation induction with gonadotropins for polycystic ovarian syndrome (PCOS) patients unresponsive to clomiphene. It is quick and easy to perform, although the number of punctures and energy doses has not been standardized. The mechanism of LOD is unclear, but it is likely mediated by a reduction in intraovarian androgen production. Serum luteinizing hormone and testosterone levels are rapidly normalized, and these changes are sustained over long-term follow-up. Studies have shown that ovulation and pregnancy rates are comparable between ovulation induction with gonadotropins and LOD, but LOD avoids the risks of multiple pregnancy and ovarian hyperstimulation syndrome. LOD is also more cost effective and better tolerated than gonadotropin therapy. Concerns regarding clinically significant adhesion formation and premature ovarian failure are not supported by the available data. Transvaginal hydrolaparoscopy and ultrasound guidance are less invasive techniques for performing ovarian drilling and may encourage LOD earlier in the course of treatment for PCOS.

Comparison of clinical outcomes in clomiphene citrate resistant infertile polycystic ovarian syndrome women after treatment with laparoscopic ovarian drilling (LOD) versus gonadotropins

“…8 Postoperative serum concentrations of androstenedione and testosterone decreases at least for a time, and inhibin concentrations also decline. 9 Both changes are likely contributed to an associated increase in FSH levels and thus ovulation. On the other hand, the mechanism of action of gonadotropins is to induce ovulation, maintain and provoke optimum follicle growth via the controlled administration of FSH and LH.…”

Restricting the induction of NGF in ovarian stroma engenders selective follicular activation through the mTOR signaling pathway

“…Polycystic ovarian syndrome is thought to occur in 5–10% of reproductively aged women, and surgical treatment with wedge resection or ovarian 'drilling' is the typical choice for anovulation, as opposed to clomiphene or human menopausal gonadotropins. 9 In women undergoing procedures for bilateral endometriomas, there is a low but definite risk of post-surgical POI, and menopause can then occur earlier than normal. 10 Comparable studies have reported an immediate decline in antral follicle counts and serum AMH levels after cystectomy, but a partial restoration is normally observed several months later.…”

Polycystic ovary syndrome current status and future perspective

“…Today, this procedure is successful in creating a pregnancy in 84% of patients with PCOS-related infertility (125). LOD helps improve insulin resistance (126) and ovarian androgen production, as well as increase the SHBG levels (127). These improvements have been seen to last in long-term follow-ups in 54% of women 8-12 years after the procedure (128, 129).…”