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Abstract
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulatory cycles and oligomenorrhea or amenorrhea and occurs in approximately 3-5% of the female population. PCOS may be the leading cause of infertility. Although PCOS is a complex and heterogeneous disorder that presents a challenge for clinical investigators, the optimal therapeutic approach has not yet been full standardized. There are diverse clinical and biochemical findings in PCOS. Also, the syndrome appears to vary in different racial groups (Hoyt and Schmidt, 2004).
Clomiphene citrate (CC) is considered the first-line treatment for infertile women with PCOS. However, 20% of patients have been shown to be resistant to CC. Ovulation induction with gonadotropins is well established in patients resistant to CC, but extensive monitoring is necessary because of the high sensitivity of PCOS to exogenous gonadotropins, the risk of multiple follicle development leading to termination of the cycle, possible ovarian hyperstimulation syndrome, and multiple pregnancies in up to 20% of patients with a greater than 20% miscarriage rate (Hayashi et al., 2005).
Due to the rapidly expanding field of operative laparoscopy, there has been renewed interest in surgical treatment. LOD has gained much credibility and replaced wedge resection with laparotomy as a surgical therapy since it was first described for the treatment of infertile women with PCOS.
Laparoscopic ovarian drilling (LOD) is used as a second- or third line treatment after ovulation induction, depending on the preferences of the doctor or the institution.