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Semin Reprod Med 2011; 29(2): 138-146
DOI: 10.1055/s-0031-1272476
© Thieme Medical Publishers

Laparoscopic Ovarian Drilling for Clomiphene-Resistant Polycystic Ovary Syndrome

Rebecca L. Flyckt1 , Jeffrey M. Goldberg1
  • 1Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
Further Information

Publication History

Publication Date:
24 March 2011 (online)

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ABSTRACT

Laparoscopic ovarian drilling (LOD) is an alternative to ovulation induction with gonadotropins for polycystic ovarian syndrome (PCOS) patients unresponsive to clomiphene. It is quick and easy to perform, although the number of punctures and energy doses has not been standardized. The mechanism of LOD is unclear, but it is likely mediated by a reduction in intraovarian androgen production. Serum luteinizing hormone and testosterone levels are rapidly normalized, and these changes are sustained over long-term follow-up. Studies have shown that ovulation and pregnancy rates are comparable between ovulation induction with gonadotropins and LOD, but LOD avoids the risks of multiple pregnancy and ovarian hyperstimulation syndrome. LOD is also more cost effective and better tolerated than gonadotropin therapy. Concerns regarding clinically significant adhesion formation and premature ovarian failure are not supported by the available data. Transvaginal hydrolaparoscopy and ultrasound guidance are less invasive techniques for performing ovarian drilling and may encourage LOD earlier in the course of treatment for PCOS.

KEYWORDS

Laparoscopic ovarian drilling - ovarian electrocoagulation - ovarian diathermy - polycystic ovarian syndrome - anovulation

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Jeffrey M GoldbergM.D. 

Head, Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology

Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195

Email: goldbej@ccf.org