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The doctors who first described PCOS removed part of the ovaries (wedge resection), for microscopic examination. They observed that the menstrual cycle and fertility were often restored following these operations. More recently, it has been shown that drilling tiny holes in the ovaries (ovarian drilling) at the time of laparoscopy (laparoscopy), may improve their chemistry although it is too early to know how long this improvement will be sustained. Whilst ovarian drilling may have a part to play in PCOS patients with infertility, this treatment is not proven to have a definite place in treatment for hirsutism.
Ovarian drilling may result in spontaneous ovulation. Unlike ovulation stimulation, there is no increased risk of multiple pregnancy or ovarian hyperstimulation (enlargement of the ovaries with the possibility of other problems such as excess fluid in the abdominal cavity). We do not know why ovarian drilling works. For those patients who respond to ovarian drilling there appears to be a reduction in LH levels which suggests that the drilling must in some way alter the hormone feedback to the hypothalamus and pituitary possibly by the release of a factor not yet identified. Interestingly, in one study where four patients had drilling of just one ovary, there was evidence of ovulation from the other ovary in the first cycle after treatment in three of the patients.
One study has shown that the insulin response to sugar is not altered following ovarian drilling. Related Medical Abstracts - Click on the paper title:-
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