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Ovarian Drilling

Ovarian drilling is a surgical procedure that is used to help patients with

Polycystic Ovarian Syndrome (PCO) achieve pregnancy.

Several years ago I published a review of the medical literature on this subject as well as an instructional review for other physicians who wished to learn the technique. Some reproductive endocrinologists have expressed mixed feelings about this technique. Some believe that any benefit from ovarian drilling can be obtained non-surgically using glucophage. We continue to find it a useful technique for several types of patients. These include younger patients who fail to respond to some version of clomiphene citrate therapy and who do not wish or can't afford IVF. They are not candidates for gonadotropin therapy with IUI because they have too great a risk of multiple gestations. We also like to use ovarian drilling in those patients who cannot tolerate glucophage. I feel that ovarian drilling works by establishing small areas of fibrosis in the ovary. Oocytes (eggs) that happen to be located near these areas of fibrosis can develop follicles in a more normal environment endocrinologically that existed prior to the ovarian dilling. Such oocytes are more likely to be better quality eggs when they ovulate. One of the major concerns with ovarian drilling is adhesion formation after the procedure. I have not seen significant adhesion formation on any second look laparoscopies that I have done in patients who had ovarian drilling. I continue to believe that this is due to my use of large volumes of fluid in the abdomen. I have done two second look laparoscopies in patients who had ovarian drilling done by other doctors with presumably other techniques in which the pelvic organs had severe adhesion formation. For all medical procedures, it is desirable to be treated by someone who has much experience as possible with that procedure.