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The etiology is still unclear although complex genetic conditions are influenced by environmental factors. Frequently associated with insulin resistance, obesity, infertility obstetrical complication and long-term effects (type 2 diabetes and cardiovascular disease).
PCOS is the most common endocrine disorder in women. Despite its negative effect on reproduction, many women with PCOS can conceive spontaneously. The etiology is still unclear although complex genetic conditions are influenced by environmental factors. Frequently associated with insulin resistance, obesity, infertility obstetrical complication and long-term effects (type 2 diabetes and cardiovascular disease).1
PCOS – phenotypes2
The Rotterdam and AE-PCOS Society criteria recognize unique clinical phenotypes:
Laparoscopic ovarian drilling (LOD)3
Thessaloniki, Greece – 2008 consensus on LOD
Ovarian electrocautery should be considered for selected anovulatory patients, especially those with a normal BMI, as an alternative to ovulation induction.
SOFC Clinical practice guidelines
Laparoscopic ovarian drilling may be considered in women with Clomiphene-resistant PCOS, particularly when there are other indications for laparoscopy (I-A) and Surgical risks always need to be considered in these patients (III-A).
How many punctures?
Most surgeons perform four punctures per ovary, each for 4 s at 40 W (rule of 4), delivering 640 J of energy per ovary (the lowest effective dose recommended) (Armar et al 1990).
Rule of Four
Is ovarian reserve diminished after laparoscopic ovarian drilling?
Complications related to drilling
Polycystic ovaries are not specific for all types of PCOS. Hence, LOD is used only as a method of surgical induction of ovulation and should not be offered for non-fertility indications. LOD is the primary choice in CC resistance patients. Apart from a few advantages, potential complications include the formation of adhesions & long-term effects of tissue damage on ovarian function can occur. Hence proper post-surgical follow-up including ART should be counseled in those patients.
Dr. Sayamstuti Pattanaik.,
MBBS, M.S. (OBG),
Consultant Obstetrician and Gynaecologist, Laparoscopic Surgeon and Infertility specialist Shanti Memorial Hospital, Rourkela, Odisha.