Laparoscopic ovarian drilling (ovarian diathermy) for PCOS

Surgery Overview

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Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women with polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries.

This surgery is not commonly used. But it can be an option for women who are still not ovulating after losing weight and trying fertility medicines.

Ovarian drilling is usually done through a small incision (laparoscopy), with general anesthesia. The surgeon makes a small cut (incision) in the abdomen at the belly button. The surgeon then places a tube to inflate the abdomen with a small amount of carbon dioxide gas so that he or she can insert the viewing instrument (laparoscope) without damage to the 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.

Because the incisions are so small, laparoscopy is often called "Band-Aid surgery."

What To Expect After Surgery

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If you have a laparoscopy procedure, you will likely go home the same day and can do your normal activities within 24 hours. Your return to normal activities will depend on how quickly you recover from surgery, which may take a few days or as long as 2 to 4 weeks.

Why It Is Done

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Ovarian drilling is sometimes used for women with PCOS who are still not ovulating after trying weight loss and fertility medicine. Destroying part of the ovaries has been reported to restore regular ovulation cycles.¹

How Well It Works

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Studies of women with PCOS have shown that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate.¹

Younger women and those with a body mass index in the normal range are most likely to benefit from laparoscopic ovarian drilling.²

Risks

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Risks of laparoscopy include:

• Infection of the incision.
• Bleeding from the incision.
• Internal bleeding.
• Accidental injury to internal organs or major blood vessels, from the laparoscope or surgical instruments.
• Pain after the procedure, from inflating the abdomen with gas.
• Problems caused by anesthesia.
• Adhesions or scarring inside the body.

What To Think About

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No randomized controlled trials have been used to study this treatment for starting ovulation:¹

• Ovulation and pregnancy rates are based on reports of about 1,000 women.
• Live birth rates, which are the true measure of treatment success, are not available and are probably less than 50%.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2): 347–358.

2. Stegmann BJ, et al. (2003). Characteristics predictive of response to ovarian diathermy in women with polycystic ovarian syndrome. American Journal of Obstetrics and Gynecology, 188(5): 1171–1173.

Credits

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Author	Bets Davis, MFA
Author	Kathe Gallagher, MSW
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Samuel S. Thatcher, MD, PhD - Obstetrics and Gynecology, Reproductive Endocrinology
Last Updated	January 23, 2008