From the Guidelines
Laparoscopic drilling is not recommended as a first-line treatment for Polycystic Ovary Syndrome (PCOS). The first-line treatments for PCOS typically include lifestyle modifications (diet and exercise) and medications such as metformin or combined oral contraceptive pills, as recommended by the international evidence-based guideline for the assessment and management of PCOS 1. For women specifically seeking fertility treatment, clomiphene citrate is usually the initial approach. Laparoscopic drilling is considered a second-line or third-line treatment option, primarily reserved for women with PCOS who have not responded to medication-based fertility treatments. This surgical procedure involves making small punctures in the ovaries to reduce androgen production and restore ovulation. While effective for some patients, LOD is more invasive, carries surgical risks including potential adhesion formation, and may have limited long-term benefits. Additionally, there's concern about possibly reducing ovarian reserve. The procedure should only be considered after failure of less invasive approaches and following thorough discussion with a reproductive endocrinologist about the benefits, risks, and alternative treatment options. The American College of Obstetricians and Gynecologists (ACOG) also indicates that the benefit and role of surgery, including laparoscopic ovarian drilling, are undetermined in women who have PCOS 1.
Some key points to consider when managing PCOS include:
- Lifestyle modification, including diet and exercise, is a fundamental aspect of PCOS management 1
- Medications such as metformin and combined oral contraceptive pills are commonly used as first-line treatments for PCOS
- Clomiphene citrate is often used as a first-line fertility treatment for women with PCOS
- Laparoscopic drilling should only be considered after failure of less invasive approaches and with careful consideration of the potential risks and benefits.
It is essential to prioritize lifestyle modifications and less invasive treatments before considering surgical options like laparoscopic drilling, given the potential risks and limited long-term benefits associated with the procedure 1.
From the Research
Laparoscopic Drilling in PCOS Management
- Laparoscopic drilling is a surgical alternative to medical treatment for women with anovulatory polycystic ovary syndrome (PCOS) who are resistant to clomiphene citrate 2.
- The procedure may decrease live birth rates slightly compared to medical ovulation induction alone, but it probably reduces multiple pregnancy rates 2.
- Moderate-quality evidence suggests that laparoscopic ovarian drilling (LOD) reduces the number of multiple pregnancies, with an estimated risk reduction from 5.0% to between 0.9% and 3.4% 2.
Effectiveness and Safety of Laparoscopic Drilling
- Low-quality evidence suggests that there may be little or no difference between LOD and medical ovulation induction alone in terms of clinical pregnancy rates 2.
- LOD may result in less ovarian hyperstimulation syndrome (OHSS) compared to medical ovulation induction alone 2, 3.
- The quality of evidence is insufficient to justify a conclusion on live birth, clinical pregnancy, or miscarriage rates for unilateral LOD versus bilateral LOD 2.
Considerations for Laparoscopic Drilling
- LOD is not recommended as a first-line treatment for PCOS, but rather as an alternative for women who are resistant to clomiphene citrate or other medical ovulation induction agents 4, 5, 6.
- The procedure should be considered on a case-by-case basis, taking into account the individual patient's medical history, fertility goals, and potential risks and benefits 4, 5, 6.
- Laparoscopic drilling may be a safe and effective procedure for the treatment of clomiphene citrate-resistant infertility in patients with PCOS, with significant improvement in cycle regularity and cumulative pregnancy rates 3.