Ovarian drilling is better reserved for failure of medical induction of ovulation or patients who couldn't afford for the expensive medical infertility drugs. This is due to high risk of ovarian adhesions and decreasing the ovarian reserve due to trauma by diathermy on both ovaries.

Hi Ahmed,

thank for the reply. so what i understand is that there are chances of decreased ovarian reserve in pcod females.. is this true for all the cases??

Yes , surely after drilling the reserve will decrease.

In more than 20 years with a special interest in polycystic ovary syndrome, I have never seen a patient who had ovarian drilling who did not developed postoperative ovarian adhesions. These may be minimal to severe. Many of these patients have decreased ovarian reserve.

I therefore developed a minimal access method (very low mini-laparotomy with eversion suturing of the peritoneum to increase access) of microsurgical wedge resection, followed by microsurgical inversion suturing of the ovarian capsule with PDS 6/0.

The incidence/prevalence of ovarian adhesions is very low after this method and the polycystic ovary syndrome is usually reversed. I am continuing with long-term follow-up.

Regards,

Johan (JT) Nel.

Additionally there is no scientific evidence as to how many holes should be drilled. Some say/write 2, some 4, some 6, etc. This is some indication as to how unscientific this metrhod is ! Science is not ideas without proof.

I apologise for the spelling mistakes - I am pressurised for time, as I suspect most of my colleagues are. Nevertheless, spelling mistakes should not obscure the truth ! If I was a female, I would NEVER allow ovarian drilling to be done on myself !

I agree with Ahmed.

Thanks for being able to comment.

Regards,

johan : thanks for the info.. unfortunately, i went through this procedure at the age of 18 as i was not reacting to the medical procedure over two yrs. basically i was naive and unaware of the consequences later in life. i stopped my medication two yrs back and revived my menses naturally through yoga and eating well.

also, i would like to know that if the cysts reappear again and again even after long-term medication??

im pregnant with my first child and my gynaec said i have issues with my insulin and has prescribed metformin to avoid gestational diabetes. i really sympathize with females suffering with pcod.. its seems like never ending process..

regards,

Apoorva

The main risk of the ovarian drilling is the possibility of decreasing the ovarian reserve due to thermal damage. An adjustment of the thermal dose applied during ovarian drilling according to ovarian volume (see El-Sayyed et al, 2017) or considering an ovarian wedge resection instead of ovarian drilling (see Duleba et al., 2003) could help to minimize this risk. A recent meta-analysis of Abu Hashim et al. suggested furthermore that "clinicians could be advised to offer the fixed-dose unilateral laparoscopic ovarian drilling (ULOD) to their infertile patients with clomiphene-resistant PCOS" (Arch Gynecol Obstet 2018). In my opinion, a reasonable patient selection and a cautious use of thermal energy are the most important precautions related to therapy success.