Ovarian Drilling in PCOS Is it Really Useful?

Is it really useful for Ovarian Drilling in PCOS

Ovarian drilling is a laparoscopic surgical procedure that uses laser or electrocautery to destroy the androgen-producing tissue in the ovaries and thereby improve ovulation in the treatment of PCOS. This procedure is not a common treatment of choice but it is useful as an option in women who do not ovulate after losing weight and trying fertility medicines. Destroying part of the ovaries by drilling is expected to restore regular ovulation cycles and improve chances of getting pregnant. Ovarian drilling can be useful when it is tried as the last resort in women who have not responded to other treatments for PCOS in Chennai such as lifestyle modifications, medications or hormonal therapy for ovulation induction. 

Ovarian drilling – A minimally invasive laparoscopic surgery in PCOS

Ovarian drilling has evolved into a safe and effective surgical treatment for anovulatory, infertile women with PCOS, unresponsive to non-surgical methods of ovulation induction. This minimally invasive surgery is termed laparoscopic ovarian drilling (LOD) as the procedure uses a thin, lighted telescope called, laparoscope. The common techniques of LOD is the use of monopolar electrocautery (diathermy) or laser. Almost three decades after the first report of LOD using a unipolar electrode, it was proposed as a less invasive alternative than bilateral ovarian wedge resection to surgically trigger ovulation induction. The laparoscope is inserted through a small surgical incision made by the surgeon near the belly button while the patient is under anaesthesia. A tiny camera is used for the surgeon to see the ovaries and other internal organs through the laparoscope. Through the same incision or other tiny incisions made in the pelvic region, the surgeon inserts tools that reach the ovaries to make very small holes in them. The number of punctures needed is chosen depending on the ovarian size. The aim is to destroy the tissues in the ovary that are producing excess testosterone.

How does ovarian drilling work in PCOS?

Women with PCOS usually have ovaries with a thick outer layer and make more testosterone. High testosterone levels can lead to irregular menstrual periods. Women who do not have regular menstrual periods means that they don’t ovulate (release an egg) every month, making it difficult to get pregnant. PCOS is responsible for more than 80% of cases of infertility due to anovulation The main goal of the procedure, ovarian drilling is induction of mono-ovulatory cycles. Ovarian drilling works to make it easier to get pregnant by helping the ovaries to release an egg each month and start regular monthly cycles. This is made possible by breaking through the thick outer surface and removing tissues by the drilling procedure, thus lowering the amount of testosterone made by the ovaries. The most plausible mechanisms of action in reducing testosterone levels is the destruction of ovarian follicles and a part of the ovarian stroma, inducing a reduction of serum androgens and inhibin levels, which results in an increase of FSH that restores the ovulation function. LOD may allow a high delivery of gonadotrophins and post-surgical local growth factors by increasing ovarian blood flow. Improvement of insulin sensitivity after LOD has also been reported in few case studies. Normal ovulation may be expected in the next 3–6 months. Several factors such as BMI, insulin resistance and concentrations of testosterone could influence the efficacy of ovarian drilling. Patients with elevated LH concentrations and a history of infertility less than 3 years seem to have a higher likelihood of success after ovarian drilling. Restoration of regular ovulation, menstruation as well as reduction in androgen and LH levels after the procedure of ovarian drilling can persist long-term to achieve fertility in Polycystic ovarian syndrome treatment in Chennai.

Indications for Ovarian drilling in PCOS

  • The main indication for ovarian drilling is to be used as second-line therapy for anovulatory infertile PCOS cases, specifically as an alternative to gonadotropins. Gynaecologists restrict ovarian drilling as a second-line treatment in PCOS, only for those with resistance to medications to induce ovulation.  
  • Ovarian drilling and ovarian wedge resection are surgical options to reduce the amount of androgen producing tissues in the ovaries of women with PCOS. However, ovarian drilling is preferred to wedge resection because cutting into the ovary can cause adhesions and result in postoperative complications. 
  • Ovarian drilling is preferred as an option only in highly selected cases, particularly in those with hypersecretion of luteinizing hormone (LH), normal body mass index, women requiring laparoscopic assessment of the pelvis or who need distant, intensive monitoring during gonadotropin therapy.
  • During gonadotrophin administration for ovulation induction in PCOS, there is a high risk of ovarian hyper-stimulation and multiple pregnancies. LOD lowers the risk of multiple pregnancies and thus surgery with LOD may become an indication as an alternative treatment before gonadotrophins that helps to obtain normal ovulatory cycles.

Advantages of Ovarian drilling in PCOS

  • Shorter time to pregnancy and less need to use ovulation induction drugs. 
  • Better comfort and possibility to be performed ambulatory.
  • cost-effectiveness in terms of comparison of laparoscopy cost for PCOS in Chennai to assisted reproductive techniques.
  • One-time treatment as compared to fertility medicines that have to be taken every month. 
  • Reduced risk of having twins or triplets with ovarian drilling unlike fertility medicines. 
  • Respond better to fertility medicines. 

Disadvantages of ovarian drilling in PCOS

  • Results of LOD are not better than those of first-line treatments in PCOS.
  • Benefits of ovarian drilling are not permanent
  • Ovulation and menstrual cycles may become irregular over time.
  • As with all surgical procedures, ovarian drilling involves risks of bleeding, anaesthesia and infection.
  • LOD can cause injury to the bowel, bladder, and blood vessels.
  • Adhesions or scarring may develop between the ovaries and the fallopian tubes.
  • Damage to ovary can cause risks to fertility and early menopause.

Ovarian drilling in PCOS may be useful if considered as a second-line option, particularly in indications for laparoscopy or high risk of multiple pregnancies or a contra-indication of multiple pregnancies in a selected population for Polycystic ovarian syndrome treatment in Chennai

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