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Laparoscopic ovarian drilling (ovarian diathermy) for PCOS
Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women with polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries.
This surgery is not commonly used. But it can be an option for women who are still not ovulating after losing weight and trying fertility medicines.
Ovarian drilling is usually done through a small incision (laparoscopy), with general anesthesia. The surgeon makes a small cut (incision) in the abdomen at the belly button. The surgeon then places a tube to inflate the abdomen with a small amount of carbon dioxide gas so that he or she can insert the viewing instrument (laparoscope) without damage to the internal organs. The surgeon looks through the laparoscope at the internal organs. Surgical instruments may be inserted through the same incision or other small incisions in the pelvic area.
Because the incisions are so small, laparoscopy is often called "Band-Aid surgery."
What To Expect After Surgery
If you have a laparoscopy procedure, you will likely go home the same day and can do your normal activities within 24 hours. Your return to normal activities will depend on how quickly you recover from surgery, which may take a few days or as long as 2 to 4 weeks.
Why It Is Done
Ovarian drilling is sometimes used for women with PCOS who are still not ovulating after trying weight loss and fertility medicine. Destroying part of the ovaries has been reported to restore regular ovulation cycles. 1
How Well It Works
Studies of women with PCOS have shown that ovarian drilling results in an 80% ovulation rate and a 50% pregnancy rate. 1
Younger women and those with a body mass index in the normal range are most likely to benefit from laparoscopic ovarian drilling. 2
Risks
Risks of laparoscopy include:
- Infection of the incision.
- Bleeding from the incision.
- Internal bleeding.
- Accidental injury to internal organs or major blood vessels, from the laparoscope or surgical instruments.
- Pain after the procedure, from inflating the abdomen with gas.
- Problems caused by anesthesia.
- Adhesions or scarring inside the body.
What To Think About
No randomized controlled trials have been used to study this treatment for starting ovulation: 1
- Ovulation and pregnancy rates are based on reports of about 1,000 women.
- Live birth rates, which are the true measure of treatment success, are not available and are probably less than 50%.
Complete the surgery information form (PDF)
(What is a PDF document?)
to help you prepare for this surgery.
Citations
American College of Obstetricians and Gynecologists (2002, reaffirmed 2006). Management of infertility caused by ovulatory dysfunction. ACOG Practice Bulletin No. 34. Obstetrics and Gynecology, 99(2): 347–358.
Stegmann BJ, et al. (2003). Characteristics predictive of response to ovarian diathermy in women with polycystic ovarian syndrome. American Journal of Obstetrics and Gynecology, 188(5): 1171–1173.
| Author | Bets Davis, MFA |
| Author | Kathe Gallagher, MSW |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
| Specialist Medical Reviewer | Samuel S. Thatcher, MD, PhD - Obstetrics and Gynecology, Reproductive Endocrinology |
| Last Updated | January 23, 2008 |
WebMD Medical Reference from Healthwise
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
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Please see Full Prescribing Information for Vivelle-Dot.
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