Ovarian drilling, formally known as laparoscopic ovarian drilling (LOD), is a minimally invasive surgical procedure used to treat specific forms of infertility. The technique involves a surgeon making small punctures in the surface of the ovaries. Performed under general anesthesia, this surgery is an option for women who have difficulty ovulating and conceiving. The procedure is designed to restore the body’s natural hormonal balance, increasing the chance of spontaneous ovulation.
Purpose of the Procedure
This surgical option is primarily offered to women with Polycystic Ovary Syndrome (PCOS) who have not responded to first-line oral fertility medications, such as Clomiphene Citrate or Letrozole. PCOS is a common endocrine disorder that often leads to anovulation, or the absence of regular ovulation, a major cause of female infertility. Ovaries in women with PCOS frequently exhibit a thick outer layer and produce an excess of androgens.
These high levels of androgens interfere with the normal signaling required for the ovary to release a mature egg each month. When oral medications fail, ovarian drilling provides a targeted, one-time treatment alternative. This procedure aims to reduce the tissue responsible for excessive androgen production, correcting the hormonal environment within the ovary.
The Surgical Process
Ovarian drilling is performed using laparoscopy, often called keyhole surgery. After the patient is under general anesthesia, the surgeon makes a small incision, typically near the belly button, to insert a laparoscope. This thin tube is equipped with a camera and light, allowing the surgeon to view the pelvic organs on a monitor.
Additional small incisions may be made to introduce specialized surgical instruments. The surgeon then uses either electrocautery (heat energy) or a laser to create a small number of punctures in the surface of each ovary. Each puncture is typically 4 to 10 millimeters deep, and the number of perforations is kept low to minimize damage to the ovarian tissue.
The mechanism involves the thermal destruction of tissue, specifically the outer layer and a portion of the stroma, which contains many androgen-producing cells. Destroying these cells causes a rapid drop in the serum levels of androgens and Luteinizing Hormone (LH). This hormonal shift increases the secretion of Follicle-Stimulating Hormone (FSH), allowing remaining follicles to mature and restoring spontaneous ovulation.
Preparing for and Recovering from the Procedure
Preparation
Preparation follows standard protocol for a laparoscopic procedure, typically requiring fasting before surgery. Patients undergo necessary pre-operative tests and must avoid unprotected intercourse in the cycle leading up to the procedure if there is any chance of pregnancy. Ovarian drilling is generally performed as a day-case procedure, allowing most patients to return home the same day.
Recovery
Immediately after surgery, patients may experience side effects associated with general anesthesia, such as a sore throat or temporary nausea. Mild abdominal pain and discomfort are common and managed with prescribed medication. Bloating can also occur due to the gas used to inflate the abdomen during laparoscopy.
Recovery time is relatively short due to the minimally invasive nature of the surgery. Most individuals can resume light activities within 24 hours. A full return to work and strenuous physical activity typically takes a few days up to two to four weeks. Patients should monitor incisions for signs of infection and contact their doctor if they experience severe pain or a fever.
Expected Outcomes and Potential Risks
The primary outcome of ovarian drilling is the restoration of regular, spontaneous ovulation. Studies suggest that approximately 8 out of 10 women who undergo the procedure will begin to ovulate again. This often leads to an increase in natural conception, with pregnancy rates of around 50% reported within the first year after surgery for women previously resistant to oral medication.
A key advantage is the lower risk of multiple pregnancies compared to ovulation induction using injectable fertility drugs. The restoration of ovulation is a one-time event, unlike fertility medications that require monthly cycles. However, the beneficial effects are not always permanent, and ovulation issues may recur over time.
The procedure carries potential risks associated with any surgery and general anesthesia, including bleeding, infection, and injury to internal organs like the bowel or bladder. A specific risk is the potential for the formation of scar tissue, known as adhesions, which could develop around the ovaries or fallopian tubes and complicate future conception. In rare instances, if too much ovarian tissue is damaged, there is a risk of reducing the ovarian reserve, potentially leading to earlier menopause.