Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome

Molecular Mechanisms of Laparoscopic Ovarian Drilling and Its Therapeutic Effects in Polycystic Ovary Syndrome

“…The medical therapies reported to be useful for PCOS women include oral contraceptive pills, anti-obesity pharmacological agents, anti-androgen pharmacological agents, and ovulation induction agents [10]. Besides well-known medications, some nutrients and anti-oxidative agents have been investigated to manage women with PCOS [5,[39][40][41][42]. These alternative agents are also reported to have a positive effect on augmentation of the drug-therapeutic response [5,[39][40][41][42].…”

“…Besides well-known medications, some nutrients and anti-oxidative agents have been investigated to manage women with PCOS [5,[39][40][41][42]. These alternative agents are also reported to have a positive effect on augmentation of the drug-therapeutic response [5,[39][40][41][42]. Inositol supplements are one of the best examples [5,29,[40][41][42].…”

“…The current assisted reproductive technique (ART) involving oocyte retrieval and subsequent in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) has been widely used for the therapy of a certain population of PCOS women with infertility [10,[43][44][45]. However, besides gastrointestinal side effects from the drugs, medical treatment may have other adverse events, such as cycle cancellation [39]. Ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies due to over responses to the ART procedure also occur more frequently in PCOS women compared to women without PCOS, leading to safety concerns for the use of ART in PCOS women.…”

“…The incidence of OHSS during ART in PCOS women after using a surgical method for the treatment of PCOS ranges from two to 21 per 1000 patients and is statistically significant lower than the incidence among those without antecedent surgical treatment (23 per 1000 patients), with an odds ratio (OR) of 0.25 (95% confidence interval [CI] 0.07-0.91) [39]. The risk of multiple pregnancies following surgical treatment of the ovary ranged from 0.9% to 3.4%, if we assume the risk of a multiple pregnancy following medical ovulation induction alone to be 5.0% [39]. Therefore, surgical treatment can be considered an alternative treatment for PCOS patients to minimize the risk of the aforementioned medication-related adverse events frequently noted for PCOS women.…”

“…Surgical approaches can be performed either via ovarian ablative therapy or via an ovarian drilling procedure. The latter option is further separated into laparoscopic ovarian drilling (LOD) and ultrasound-guided ovarian drilling (UGOD) [10,15,21,[25][26][27][28]38,39].…”