Polycystic ovary syndrome: surgical management of an endocrine disorder
Polycystic ovary syndrome [PCOS] is the commonest cause of anovulatory infertility. Treatment could be medical or surgical. Clomiphene citrate has been the first line treatment and if unsuccessful, can be followed by direct gonadotrophin stimulation. The main setback of gonadotrophins is the otherwise prevalent complications of ovarian hyperstimulation syndrome and multiple pregnancies. Laparoscopic ovarian surgery [LOS] is proving equally as successful as gonadotrophins for the induction of ovulation, particularly in clomiphene-resistant patients with high Luteinizing Hormone concentrations. The main advantage of ovarian drilling is the very high prevalence of mono-follicular ovulation and therefore a significant reduction in multiple pregnancy rates compared with gonadotrophin therapy. Further possible advantages of LOS are a reported reduction in miscarriage rates, the fact that it is an often successful “one-off ” procedure which may avoid the use of expensive medical therapy and the exclusion of ovarian hyperstimulation syndrome. If ovulation is delayed following LOS, ovarian stimulation with clomiphene or gonadotrophins can more likely result in successful ovulation than before the surgery. Further studies are needed to identify the appropriate ‘dose’ and degree of ovarian tissue damage that will result in ovulation and conceptions with minimal adhesions and risk of ovarian failure.
Keywords: Laparoscopic ovarian surgery, PCOS, ovulation, multiple pregnancy, hyperandrogenism.