Endocrinology & Metabolic Syndrome
Open Access
ISSN: 2161-1017
ISSN: 2161-1017
Jeffrey M Goldberg
Cleveland Clinic, USA
Posters & Accepted Abstracts: Endocrinol Metab Syndr
Laparoscopic ovarian drilling (LOD) has evolved from bilateral ovarian wedge resection by laparotomy, which was the only clinical treatment for polycystic ovary syndrome (PCOS) during the 3 decades prior to the introduction of clomiphene citrate and parenteral gonadotropins in the 1960s. Like ovarian wedge resection, LOD increases fertility by restoring ovulatory function but has the advantages of being a minimally invasive outpatient procedure with less ovarian destruction or clinically significant postoperative adhesions. It is very quick and easy to perform with common laparoscopic instruments. Unfortunately, the procedure has not been standardized as far as the number of punctures, the energy dose, duration and source or whether one or both ovaries should be treated. LOD has been shown to reverse many of the hormonal and ultrasonographic abnormalities associated with PCOS. It is indicated as an alternative to parenteral gonadotropin therapy for infertility due to anovulation which is unresponsive to oral agents such as clomiphene, letrozole and/or metformin. Pregnancy rates are similar to ovulation induction with gonadotropins but without the risk of multiple pregnancy and ovarian hyperstimulation syndrome. It is preferred by patients since multiple daily injections and frequent office visits for follicle monitoring are avoided. It has also been shown to be more cost effective. Despite these clear benefits, it is very infrequently performed in the US. More research is needed to determine the optimal surgical technique as well as long-term non-reproductive outcomes such has reduction in hirsutism, metabolic syndrome and endometrial cancer.
Email: GOLDBEJ@ccf.org