Ovarian drilling

Ovarian drilling
Specialtygynaecology

Ovarian drilling, also known as multiperforation or laparoscopic ovarian diathermy, is a surgical technique of puncturing the membranes surrounding the ovary with a laser beam or a surgical needle using minimally invasive laparoscopic procedures.[1] It differs from ovarian wedge resection, which involves the cutting of tissue. Minimally invasive ovarian drilling procedures have replaced wedge resections.[2] Ovarian drilling is favored over wedge resection because cutting into the ovary might result in adhesions, potentially complicating postoperative outcomes.[3] Ovarian drilling and ovarian wedge resection are treatment options to reduce the amount of androgen producing tissue in women with polycystic ovarian syndrome (PCOS).[4] PCOS is the primary cause of anovulation, which results in female infertility.[5] The induction of mono-ovulatory cycles can restore fertility.[6]

The oral drug clomiphene citrate (CC) is the first-line treatment for PCOS-related infertility, yet one-fifth of women are resistant to the drug and fail to ovulate.[7] Patients are considered resistant if the treatment fails for six months at the appropriate dosage.[1] Women who are resistant to the medication clomiphene citrate are commonly treated with medications that induce ovulation such as gonadotrophins.[8] Medications that induce ovulation such as CC can also be associated with multiple pregnancies and problems with the women's cycle and this therapy is very expensive due to the route of administration (daily by injection) and the requirement for regular ultrasounds, laparoscopic ovarian drilling is sometimes considered by medical professionals for treating anovulation.[8] Known side effects and risks include the need for anesthesia, the risk of infection, and a risk of adhesions forming.[8] There may sometimes be a smaller risk of the person losing ovarian function.[8]

Ovarian drilling is a surgical alternative to CC treatment or recommended for women with WHO Group II ovulation disorders.[6] Other non-surgical medical options in the treatment of PCOS include the oestrogen receptor modulator tamoxifen, aromatase inhibitors, insulin sensitising drugs, and hormonal ovarian stimulation.[9] The effectiveness of the surgical procedure is similar to CC or gonadotropin treatment for induced ovulation for PCOS patients, but results in fewer multiple pregnancies per ongoing pregnancy regardless if the technique is unilaterally or bilaterally performed.[10]

If patients do not become pregnant six months after ovulation has been reestablished from ovarian drilling treatment, drug treatments may be reintroduced or in vitro fertilisation (IVF) may be considered.[1]

  1. ^ a b c Cite error: The named reference :9 was invoked but never defined (see the help page).
  2. ^ Cite error: The named reference :2 was invoked but never defined (see the help page).
  3. ^ Portuondo, J. A.; Melchor, J. C.; Neyro, J. L.; Alegre, A. (1984-07-01). "Periovarian adhesions following ovarian wedge resection or laparoscopic biopsy". Endoscopy. 16 (4): 143–145. doi:10.1055/s-2007-1018560. ISSN 0013-726X. PMID 6236073. S2CID 11796110.
  4. ^ Ndefo, Uche Anadu; Eaton, Angie; Green, Monica Robinson (2013-06-01). "Polycystic ovary syndrome: a review of treatment options with a focus on pharmacological approaches". Pharmacy and Therapeutics. 38 (6): 336–355. ISSN 1052-1372. PMC 3737989. PMID 23946629.
  5. ^ Hueb, Cristina Kallás; Dias Júnior, João Antônio; Abrão, Maurício Simões; Filho, Elias Kallás (2015-11-01). "Drilling: medical indications and surgical technique". Revista da Associação Médica Brasileira. 61 (6): 530–535. doi:10.1590/1806-9282.61.06.530. ISSN 1806-9282. PMID 26841163.
  6. ^ a b Lebbi, Issam; Ben Temime, Riadh; Fadhlaoui, Anis; Feki, Anis (2015-01-01). "Ovarian Drilling in PCOS: Is it Really Useful?". Frontiers in Surgery. 2: 30. doi:10.3389/fsurg.2015.00030. PMC 4505069. PMID 26236709.
  7. ^ Moazami Goudarzi, Zahra; Fallahzadeh, Hossein; Aflatoonian, Abbas; Mirzaei, Masoud (2014-08-01). "Laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome: A systematic review and meta-analysis". Iranian Journal of Reproductive Medicine. 12 (8): 531–538. ISSN 1680-6433. PMC 4233311. PMID 25408702.
  8. ^ a b c d Bordewijk, Esmée M.; Ng, Ka Ying Bonnie; Rakic, Lidija; Mol, Ben Willem J.; Brown, Julie; Crawford, Tineke J.; van Wely, Madelon (2020-02-11). "Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome". The Cochrane Database of Systematic Reviews. 2 (2): CD001122. doi:10.1002/14651858.CD001122.pub5. ISSN 1469-493X. PMC 7013239. PMID 32048270.
  9. ^ Wang, Rui; Kim, Bobae V.; Wely, Madelon van; Johnson, Neil P.; Costello, Michael F.; Zhang, Hanwang; Ng, Ernest Hung Yu; Legro, Richard S.; Bhattacharya, Siladitya (2017-01-31). "Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis". BMJ. 356: j138. doi:10.1136/bmj.j138. ISSN 0959-8138. PMC 5421445. PMID 28143834.
  10. ^ Bosteels, J.; Weyers, S.; Mathieu, C.; Mol, B. W.; D'Hooghe, T. (2010-01-01). "The effectiveness of reproductive surgery in the treatment of female infertility: facts, views and vision". Facts, Views & Vision in ObGyn. 2 (4): 232–252. ISSN 2032-0418. PMC 4086009. PMID 25009712.