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Ovulation problems

Details the surgical procedures that can be used to treat polycystic ovarian syndrome (PCOS).

Surgery for polycystic ovarian syndrome (PCOS)

This is suitable for women with ovulation problems due to polycystic ovarian syndrome (PCOS) and who did not respond to treatment with clomiphene. Women who have experienced ovarian hyperstimulation syndrome (OHSS) can also be effectively treated with surgery.

Laparoscopic ovarian drilling for polycystic ovarian syndrome

This is a keyhole surgery where a fibre-optic telescope is introduced through the abdomen to see the inside of the  abdomen and then another probe is introduced to drill small areas of each ovary by diathermy (burning) or laser. The procedure is performed under a general anesthetic. Ovulation occurs in about 70-90% of cases. The main advantages of the procedure is that it there is no additional risk of multiple pregnancy or ovarian hyperstimulation syndrome compared to FSH or hMG. The main disadvantage is the development of adhesions from the surgery, which may affect fertility. Other potential complications include the risk of burns to the bowels and blood vessels during the procedure.

Ovarian drilling by laparoscopy.

Ovarian wedge resection for polycystic ovarian syndrome

This surgery is performed  under a general anesthetic. The procedure involves a slice (wedge) being taken from each ovary, through a cut in the abdomen and the sliced area then being stitched back together. The operation was done much more frequently in the days before effective drug treatment had been discovered.

The procedure can be effective but as with the laparoscopic drilling it may result in the development of adhesions around the ovaries and tubes (about 10-20% of women will develop adhesions after the surgery).

After the surgery, some discomfort may be felt but this is relieved by painkillers. Normal activities can be resumed in 2-5 days. The use of laparoscopic techniques has advantages over classic resection, as it is cost saving and has a lower risk of adhesions. 

It is not clear why women with PCOS ovulate after ovarian drilling or wedge resection. If ovulatory cycles fail to be restored after the surgery, your doctor may restart you on ovulation induction again.

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