Women who have polycystic ovary syndrome have irregular or absent menstrual periods along with elevated serum testosterone and androstenedione, (out-of-whack hormone levels, in short) leading to abnormal bleeding, infertility, obesity, excess hair grown, hair loss and acne. PCOS can affect approximately 6-10% of women, and may have a genetic component. PCOS can also be responsible for infertility, as well as irregular periods, beginning as early as puberty. While there is no specific “cure” for PCOS, it can be controlled in several different ways–controlling your PCOS is important whether or not you are planning on having children as the measures used to control PCOS also lower your risks of infertility, miscarriage, diabetes, heart disease and uterine cancer.
Initial Treatment for PCOS
While it may sound like a lifestyle choice, the first line of medical treatment for PCOS includes eating a healthy diet, not smoking, and getting regular exercise. So, if you are overweight, losing even a small amount may help balance your hormones and start your menstrual cycles and ovulation going again. Because women who smoke have higher levels of androgens, consider quitting, and make every effort to do so. If you are hoping to get pregnant, and the weight loss did not improve your fertility, your doctor may suggest an insulin-lowering medicine in conjunction with further weight loss. If you are not planning a pregnancy at the time, you may be a good candidate for hormone therapy which can correct menstrual cycle problems, and keep your endometrial lining from building up for too long a time.
Ovarian Drilling for PCOS
Laparoscopic ovarian drilling can trigger ovulation in those with PCOS, however it is a surgical treatment, and is presently considered more of a “last try” to be used in women who are still not ovulating after losing weight and taking fertility medications. A small incision is made at the belly button by the surgeon while you are out, under general anesthesia. A tube will then be placed in the incision to inflate the abdomen with a small amount of carbon dioxide gas to enable the surge to insert the laparoscope with no damage to your internal organs. Once the laparoscope is in place, the surgeon can look around your insides at your internal organs.
Ovarian Drilling Procedure
Once the surgeon is able to see your ovaries, he will do the ovarian drilling—the goal is to destroy the testosterone producing tissue of the ovary.
There are generally small follicles which are visible on the surface of the ovary; this is where the electrical or laser energy will be directed, as this is presumed to be the spots where hormone production is at its maximum.
Your surgeon will make anywhere from 4-20 holes in each ovary, which are approximately 3 millimeters wide and 3 millimeters deep. While surgeons generally choose to perform the ovarian drilling on both ovaries, there have been reports of successful treatment of only one ovary.
Your surgeon will attempt to keep the areas of ovarian drilling as far away from your fallopian tubes as possible to limit the chances of tubal scarring.
Some surgeons will wrap your ovaries with a specific dissolvable material to inhibit scar formation, but despite best efforts, adhesions around the tubes and ovaries do occur after ovarian drilling.
Success Rates for Ovarian Drilling
It has been noticed that success rates for this procedure tend to be better in patients who were at or near their ideal body rate as opposed to the patients who remained obese at the time of the surgery.
Success rates for future ovulation range from 53% to 92%, with a slightly higher success rate when using electrical energy, which tends to destroy more tissue.
More specifically, approximately 80% of patients who underwent ovarian drilling resumed ovulation, while nearly 50% were able to become pregnant.
Patients who are not ovulating after an ovarian drilling procedure have been shown, in many cases, to be more responsive to clomiphene citrate, even if they were previously impervious to the drug.
After Ovarian Drilling
After you have had laparoscopic ovarian drilling, you will likely go home the same day, and can resume your regular activities within 24 hours.
Your risks from this procedure include infections from the incision, bleeding from the incision, pain after the procedure, problems caused by anesthesia, adhesions or scarring inside the body or internal bleeding, although serious complications are rare.
If you have explored many other options for PCOS, with little or no success, ovarian drilling may be a treatment for you, giving you a possible 50% increased chance of being able to get pregnant.
