Ovarian Drilling for Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting young women (with over 5% of women of childbearing age being affected). Women with at least two of the following three criteria are regarded as having PCOS:

(i) Oligo-ovulation (Infrequent or irregular ovulation) or anovulation (absence of ovulation).
(ii) High concentrations of androgen in the bloodstream and/or clinical signs of androgen surplus.
(iii) Ovarian cysts (abnormal pockets of fluid) shown by ultrasonography (more than 12 follicles measuring 2–9 mm on at least one ovary).

The syndrome may be associated with numerous morbidities, including infertility, obstetrical complications, type 2 diabetes mellitus, cardiovascular disease, abnormal hair growth and mood and eating disorders. The specific cause of PCOS is unknown, however it is thought that a combination of genetic, developmental and environmental factors contribute.

In instances in which PCOS is associated with an overweight or obese BMI, exercise, improved diet and weight loss are well established to be the best means to treat PCOS. Each of the specific symptoms associated with PCOS require specific consideration with regard to treatment; for instance antidiabetic agents may be used to treat associated diabetes mellitus, statins may be taken in order to reduce the risk of cardiovascular morbidity, androgen blockers may be used to treat abnormal hair growth etc. Your GP and an endocrinologist should be able to advise you on these matters. With regard to infertility, however, gynaecological intervention may be required, as will now be discussed.

The first-line method of treatment of infertility is clomiphene citrate, a selective modulator of the oestradiol receptor. Studies have shown that clomiphene citrate leads to a cumulative ovulation rate over 6 months of almost 80% and almost 40% of women receiving this treatment become pregnant. However, prolonging clomiphene citrate treatment for more than 6 months does not improve results, and hence further treatment is required if patients fail to respond to clomiphene citrate.

Metformin, an antidiabetic agent has also been shown to increase ovulation rates in patients with PCOS and may be administered in clomiphene citrate-resistant patients. The use of gonadotropins, hormones which stimulate ovulation may also be utilized in clomiphene citrate resistant patients, however gonadotropins use has also been shown to be associated with multiple pregnancies (ie. twins/triplets etc.) which increases the chance of miscarriage and complications during pregnancy.

For patients failing to achieve fertility despite clomiphene citrate and metformin use, ovarian drilling may be indicated. Ovarian drilling is a surgical procedure in which holes are physically cauterized (burned) into the ovaries. This is thought to stimulate ovulation and normalize hormone secretion from the ovaries. Mr. Trehan performs usually performs around four punctures per ovary as this is sufficient to stimulate ovulation whilst there are concerns that too many punctures (eg. more than 10 punctures) may cause ovarian failure.

Studies have demonstrated that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate in the year following surgery.

The images below show before and after images of one of Mr. Trehan’s patients who underwent ovarian drilling:

  • Ovarian Drilling 1
  • Ovarian Drilling 2
  • Ovarian Drilling 3

Mr. Trehan performs all benign gynaecological procedures, including ovarian drilling for PCOS via laparoscopic (keyhole) surgery as it is associated with less post-operative pain and complications, a quicker recovery and a far superior cosmetic appearance when compared to laparotomy (open surgery). Mr. Trehan’s patients can be confident that their operation will be completed by keyhole means as Mr. Trehan’s conversion to laparotomy rate is amongst the lowest in the medical literature, as are his major complication rates, reoperation rates and readmission rates. Further, over 90% of Mr Trehan’s patients are able to leave the hospital after just an overnight stay in hospital.