Ovarian drilling is a surgical procedure performed to address certain fertility challenges. It involves creating small openings in the surface of the ovaries. This minimally invasive technique aims to improve ovarian function and promote regular ovulation.
Why Ovarian Drilling is Performed
Ovarian drilling is considered for women experiencing fertility issues due to specific medical conditions, most notably Polycystic Ovary Syndrome (PCOS). PCOS is a hormonal disorder that can lead to anovulation, meaning the ovaries do not regularly release an egg. The ovaries in women with PCOS often have a thick outer layer, which contributes to increased production of androgens, also known as male hormones.
When first-line treatments, such as oral medications like clomiphene citrate, have not been successful in inducing ovulation, ovarian drilling may be recommended. Clomiphene citrate resistance is defined as the failure to ovulate after at least three cycles with a dose of 150 mg. The procedure works by reducing androgen-producing tissue within the ovaries, restoring a more balanced hormonal environment. This hormonal shift encourages the ovaries to release eggs more consistently.
How the Procedure is Conducted
Ovarian drilling is performed using a minimally invasive surgical technique called laparoscopy. The patient is given general anesthesia. A surgeon makes a small incision, near the belly button, through which a thin, lighted tube called a laparoscope is inserted.
Carbon dioxide gas is then introduced into the abdomen to inflate it, creating space for the surgeon to view the pelvic organs and prevent injury. Additional small incisions may be made in the lower abdomen to insert other surgical instruments. The surgeon then uses either electrocautery or a laser to create several small holes in the ovarian surface. This targets and reduces the androgen-producing cells within the ovarian stroma, which can lead to a decrease in testosterone and luteinizing hormone (LH) levels, while potentially increasing follicle-stimulating hormone (FSH).
Recovery and Potential Considerations
After ovarian drilling, most individuals return home on the same day, as it is a day-case operation. Recovery time varies, with most people resume normal physical activities within a few days to two weeks. During this period, mild pain or discomfort in the lower abdomen is common.
While generally safe, any surgical procedure carries considerations. Risks include bleeding, infection at incision sites, or, in rare instances, internal bleeding. There is also a slight risk of injury to nearby organs like the bowel or bladder, or to major blood vessels, though such occurrences are uncommon. Adhesions (scar tissue) can form following surgery, potentially affecting future fertility. In very rare cases, if too much ovarian tissue is affected, there is a risk of premature ovarian failure, leading to an earlier onset of menopause.
Expected Outcomes
The aim of ovarian drilling is to restore regular ovulation and enhance fertility for women with conditions like PCOS. Many women experience more consistent menstrual cycles after the procedure. Studies indicate ovulation rates after ovarian drilling range from 74% to 83% within three to six months.
Pregnancy success rates vary, with studies reporting outcomes between 44% and 66%. Some research shows 50% of women achieve pregnancy within the first year following surgery. Factors influencing success include patient age (younger women often have better outcomes) and duration of infertility. While the procedure can improve ovulation, it does not provide a permanent cure for PCOS, and some symptoms may persist or return.