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Laparoscopic Ovarian Drilling: A Second-Line Option for PCOS-Related Infertility

Dr. M. V. Jyothsna, Consultant Obstetrician & Gynaecologist, Yashoda Hospitals, Hyderabad

 Polycystic Ovary Syndrome is a common endocrine condition that can interfere with ovulation, making it difficult for many women to conceive. While first-line management typically includes lifestyle modification, weight management, and ovulation-inducing therapies, some women do not respond adequately to these measures. In such cases, laparoscopic ovarian drilling (LOD) may be considered as a second-line treatment option.

Laparoscopic ovarian drilling is a minimally invasive surgical procedure performed under general anaesthesia using a keyhole technique. Small incisions are made in the abdomen, through which a camera and specialised instruments are inserted. The surgeon then creates tiny punctures on the surface of the ovaries using controlled heat or laser energy. This process targets and reduces a small portion of ovarian tissue responsible for producing excess androgens.

Elevated androgen levels are a hallmark of PCOS and play a key role in disrupting normal follicle development and ovulation. By lowering androgen production, LOD helps restore hormonal balance within the ovaries, allowing follicles to mature and ovulation to occur more regularly. This can improve the chances of natural conception in selected patients.

LOD is particularly beneficial for women who are resistant to standard ovulation-inducing treatments. It may also reduce the need for injectable fertility therapies, which are associated with risks such as ovarian hyperstimulation syndrome and multiple pregnancies. In some cases, ovarian drilling may improve the ovaries’ responsiveness to future fertility treatments.

However, it is important to note that LOD is not a cure for PCOS. The condition is chronic and may still require long-term management for symptoms such as irregular periods, insulin resistance, acne, and weight gain. Additionally, not all women undergoing the procedure will achieve pregnancy, and the benefits may diminish over time.

As with any surgical intervention, LOD carries certain risks, including bleeding, infection, and damage to surrounding structures. There is also a small risk of pelvic adhesions and reduced ovarian reserve if excessive tissue is affected. Therefore, the procedure should be performed by experienced specialists with careful patient selection.

Recovery from LOD is generally quick, with most women discharged within 24 hours and returning to routine activities within a few days. Overall, it remains a valuable option for women with PCOS-related infertility who do not respond to conventional treatments, provided the risks and benefits are thoroughly evaluated.