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This minimally invasive surgery is used to treat ovulation problems linked to PCOS. Doctors generally recommend this procedure only in carefully selected cases, especially for individuals who do not respond well to ovulation induction drugs.
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is a common hormonal disorder and affects 6 to 13 per cent of individuals of reproductive age according to the World Health Organisation (WHO). It disrupts the balance of hormones in your body, often leading to higher levels of testosterone and irregular ovulation. To be diagnosed with PCOS, you need to have at least two of these three signs:- Ovulation dysfunction or abnormal menstrual intervals.
- Excess hair growth in a male pattern or high testosterone levels.
- Polycystic ovaries are visible on an ultrasound.
Who is a Candidate for Laparoscopic Ovarian Drilling?
Ovarian drilling isn’t the first treatment for PCOS. It’s usually considered a second-line option. You might be a candidate if:- You’ve tried weight loss and fertility medicines, but still don’t ovulate.
- You have a resistance to medications for ovulation induction. Many individuals don’t ovulate despite increasing doses.
- You have high luteinising hormone (LH) levels. It is a hormone secreted by the pituitary gland. In people assigned female at birth, LH helps regulate the menstrual cycle and triggers ovulation. If you have PCOS, LH levels are often elevated, which may disrupt ovulation, increase testosterone, and cause irregular periods or infertility. Ovarian drilling aims to reduce LH levels, which can restore hormonal balance and ovulation. However, high LH levels are not a strict requirement for being considered a first-line candidate for the procedure.
- You’re at high risk of ovarian hyperstimulation or multiple pregnancies with gonadotropin treatment (hormone therapy that stimulates the ovaries to produce eggs).
- A normal body mass index (BMI) is a favourable factor for this procedure. Individuals with a normal BMI often have better outcomes with ovarian drilling compared to those with obesity. Excess weight can complicate hormonal imbalances and reduce treatment success.
How is Laparoscopic Ovarian Drilling Performed?
Ovarian drilling is a well-established procedure done under general anaesthesia. Take a look at an overview of this procedure:- Your abdomen is inflated with a small amount of carbon dioxide through a tiny tube. This creates space for the surgeon to work safely.
- A small incision is made near your belly button to insert the laparoscope, a thin tool with a camera to view your pelvic organs.
- Additional tiny incisions may be made in your pelvic area for surgical tools.
- The surgeon uses electrocautery or a laser to make multiple small holes in your ovaries. The number of punctures depends on your ovarian size.
- The aim is to destroy parts of the ovarian stroma (the connective tissue within the ovary) and follicles that produce excess testosterone.
How Ovarian Drilling Helps Restore Ovulation
If you have PCOS, your ovaries often have a thick outer surface and produce more androgens (male hormones) than usual. This prevents regular ovulation and makes it harder for you to get pregnant. Ovarian drilling targets this issue by:- Breaking through the thick outer layer of the ovaries.
- Destroying some of the androgen-producing tissue (theca cells) to lower testosterone levels.
- Reducing levels of androgens and inhibin, which can boost follicle-stimulating hormone (FSH) to restore ovulation. Inhibin blocks FSH, a hormone that helps eggs grow and mature. When inhibin drops, FSH levels can rise, which helps the ovaries start releasing eggs again.
- Increase ovarian blood flow.
Benefits of Laparoscopic Ovarian Drilling
Ovarian drilling offers several advantages for individuals with PCOS who haven’t responded to other treatments. These are the key benefits:- Restores regular ovulation and menstrual cycles, making it easier to get pregnant.
- Shortens the time to pregnancy compared to some other methods.
- Reduces the need for monthly ovulation induction drugs.
- Lowers the risk of twins or triplets compared to fertility medicines.
- May improve response to fertility drugs if needed later.
- Helps protect your uterine lining from cancer by regulating periods.
- Decreases testosterone, improving acne and unwanted hair growth.
- Prevents anaemia from continued irregular bleeding.
- It is cost-effective compared to assisted reproductive techniques like in vitro fertilisation (IVF).
- It can be done as an outpatient procedure.
Risks of Laparoscopic Ovarian Drilling
Like any surgery, ovarian drilling carries risks. You should be aware of these before deciding:- Infection at the incision site.
- Bleeding from the incision or internally.
- Accidental injury to your bowel, bladder, blood vessels, or ureter from the laparoscope or tools.
- Pain after surgery due to inflating the belly with air.
- A possible reaction to anaesthesia.
- Adhesions or scarring between your ovaries and fallopian tubes could affect fertility.
- Too much damage to the ovaries, potentially leading to fewer eggs and early menopause (when periods stop).
Cost of Laparoscopic Ovarian Drilling in India
The cost of laparoscopic ovarian drilling in India typically ranges from Rs 28,000 to Rs 100,000, with an average cost of around Rs 70,000. The price varies based on factors like the hospital, city, consultation fees, diagnostic tests, room type, and the surgeon’s expertise.Does Ovarian Drilling Guarantee Pregnancy?
Ovarian drilling can improve your chances of getting pregnant, especially if your menstrual cycles become more regular after the procedure. Many individuals get pregnant within a year of the surgery. Your odds are better if there are no other issues, like blocked fallopian tubes that make conception difficult. According to a study published in the Academic Oxford University Press, ovarian drilling may improve ovulation and pregnancy rates for up to 9 years in many individuals with PCOS. However, this may not hold true for everyone, as individual responses to the procedure can vary. Keep in mind that ovulation and periods may not stay regular long-term even after this procedure. If your cycles remain irregular, fertility medicines might work better after surgery than before.Laparoscopic ovarian drilling can be a useful option if you have PCOS and continue to have trouble ovulating after trying weight loss or fertility medications. However, the results aren’t permanent, and there are risks like scarring or injury to nearby organs. If you’re exploring this for PCOS treatment, discuss it with your healthcare professional to see if it fits your needs.FAQs on Laparoscopic Ovarian Drilling (LOD) for Polycystic Ovary Syndrome (PCOS)
- How long does recovery take after laparoscopic ovarian drilling?Most people recover within 24 hours to a few days. In some cases, full recovery may take 2 to 4 weeks.
- How soon can I get pregnant after laparoscopic ovarian drilling?Many individuals start ovulating within 3 to 6 months and conceive within a year after the procedure.
- Is laparoscopic ovarian drilling safe for all individuals with PCOS?It’s usually recommended for those with normal BMI and those who haven’t responded to fertility medicines. It’s not the first-line treatment.