Treatment Options for Polycystic Ovary Syndrome

The Role of Surgery and Assisted Reproductive Techniques in Polycystic Ovary Syndrome

A variety of techniques are available to improve the likelihood of ovulation and pregnancy in women with polycystic ovary syndrome (PCOS). These techniques include:

• In vitro fertilization
• Ovarian wedge resection
• Laparoscopic ovarian diathermy
• Transvaginal ovarian drilling

In-vitro Fertilization

In-vitro Fertilization (IVF) is a well-established and proven technique that is increasingly being used to help women with PCOS enhance their fertility. The patient is first treated with hormones to enhance follicular development. The eggs are then harvested, combined with sperm, and, after fertilization has occurred, the embryo is reimplanted into the uterus.

This procedure offers many advantages, including:

• Giving the doctor the ability to estimate the optimal time for harvesting the eggs for IVF
• Ovarian stimulation therapy can be more aggressive because follicular development is monitored very closely which reduces the risk of ovarian hyperstimulation syndrome (OHSS) while optimizing the likelihood of successful IVF.

There is limited data regarding use of metformin during in vitro fertilization in relation to egg quality.

Ovarian Wedge Resection

Ovarian wedge resection (OWR) is a surgical procedure that was developed back in the 1930s. In this procedure, a section of the ovary is removed resulting in a reduction of lutenizing hormone (LH) and androgen production. Studies have shown that OWR leads to regular menses in approximately 75% of women who undergo the procedure. The most severe side effect is the risk of formation of pelvic adhesions that occurs in approximately 30% of women.

Due to the recent availability of laparoscopic ovarian diathermy , which is less invasive and equally effective, OWR has become a less popular surgical treatment option for infertility.

Laparoscopic Ovarian Diathermy

In laparoscopic ovarian diathermy (LOD), also called laparoscopic ovarian drilling, the ovaries are punctured four to ten times either by laser or electrocautery needle. This causes a dramatic lowering of androgens by destroying some of the androgen producing cells in the ovary. Following LOD, menses frequently resume spontaneously. Many women who failed to respond to metformin or clomiphene citrate before this procedure, have a heightened response when the medication is reintroduced following LOD.

When LOD was compared with gonadotropin therapy, studies indicated that the rates for ovulation and pregnancy were similar. Even though LOD is a surgical procedure that is performed under general anesthesia, many women prefer this one-time surgical procedure rather than undergoing repeated injections and continuous monitoring which is necessary with the use of ovulatory-inducing drugs.

Laparoscopic ovarian diathermy is usually reserved for women who have attempted other interventions to increase fertility but were not able to become pregnant. Approximately 80% of women undergoing the LOD procedure experience ovulation and, of those cases where ovulation has been restored, about 50% become pregnant.

Transvaginal Ovarian Drilling

Transvaginal ovarian drilling (TVOD) is similar in principle to LOD but is done transvaginally (through the vagina), and is therefore less invasive and less expensive than LOD. It is often used for women who have failed IVF therapy.

A study published in 2001 in the journal Fertility and Sterility reported that TVOD was effective in improving IVF results in difficult to treat patients with PCOS and was less invasive and less costly than LOD.