الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Polycystic ovary syndrome (PCOS) is a frustrating experience for women, often complex for managing clinicians and is a scientific challenge for researchers. (Diamanti-Kandarakis et al., 1999).
The exact pathophysiology of PCOS is complex and remains largely unclear. Although a detailed discussion is beyond the scope of this review, the underlying hormonal imbalance created by a combination of increased androgens and/or insulin underpin PCOS (Figure 1) (Legro and Strauss, 2002).
Laparoscopic ovarian drilling (LOD) is currently accepted as a successful second line treatment for ovulation induction in CC-resistant PCOS being as effective as gonadotrophin treatment and is not associated with an increased risk of multiple pregnancy or OHSS (Farquhar et al., 2002; Bayram et al., 2004; Farquhar et al., 2007 and Flyckt et al., 2011).
The exact mechanism is yet to be elucidated. The most plausible one is the destruction of ovarian follicles and stroma resulting in a decrease in androgen and inhibin levels and a secondary rise in follicle-stimulating hormone (FSH) levels (Felemban et al., 2000; Kato et al., 2007; Flyckt et al., 2011 and Abu Hashim et al., 2013).
The aims of this study was to evaluate the results of laparoscopic treatment in women with polycystic ovary syndrome; and to compare their response as regard ovulation, hormone profiles change and clinical outcome before and after drilling.
A total of 174 papers were obtained using the mentioned keywords in the research of all internet-based databases. Of these, 67 were excluded due to non relevance to our topic, and 107 papers were included in our study.
The total number of cases in all of the studies was 6491 cases. After removal of repeated cases; the true total number of cases was found to be 5746 cases.
Regarding the publication years, 2005 showed the largest number of publications (11 papers), while 2008 showed the lowest number (2 papers only).
The mean age was recorded in 28 papers, and the mean age of each of them was 28.88 years.
The mean duration of infertility was recorded in 8 papers, and the mean age of each of them was 49.45 months, a little more than 4 years.
Ovulation, as a sign of response to LOD, is recorded in 62 papers, and the total number of cases who achieved ovulation was 2763 out of 4062 cases, who accounts for 68% of the total number of treated cases in these studies.
Pregnancy, as a sign of response to LOD, is recorded in 70 papers, and the total number of patients got pregnant after LOD was 2303 out of 4903 cases, and the total percentage of pregnancy after LOD is nearly 47%.
Abortion, as a complication of pregnancy after LOD was recorded in 14 papers, and the total number of abortions was 79 cases, out of a total of 413 pregnancy, accounting of 19.13% of pregnancy.
The technique used for all LOD studies was the standard electro-cautery technique. However, in 15 studies, other techniques used either alone or as a comparison to the standard technique.
Analysis of 7 studies revealed some favourable prognostic factors, which when present, predict better response after LOD. They included higher preoperative sex hormones, shorter period of infertility and younger age.
Analysis of 11 studies revealed some unfavourable prognostic factors, which when present, predict worse response after LOD. They included older age low basal hormonal level obesity and/or impaired lipid profile and/or impared insulin metabolism, high duration of infertility more than 3 years, early menarch and hypoglycemia.
Analysis of 13 studies revealed the following hormonal and chemical changes after LOD: reduction of sex hormones (LH, FSH, LH/FSH ratio and/or testosterone) which is in fact, restiration of these sex hormones to the normal or near normal levels, normalization of initially high VEGF, improvement of insulin resistance and reduction of serum inhibin B.
Conclusion
LOD should be recommended as a successful and economical second-line treatment for ovulation induction in women with CC-resistant PCOS.