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Laparoscopic Ovarian Drilling versus Medical Treatment in Management of Clomiphene Citrate Polycystic Ovarian Syndrome
REVIEW ARTICLE
Laparoscopic Ovarian Drilling versus Medical

Treatment in Management of Clomiphene Citrate

Polycystic Ovarian Syndrome

Vaduneme K Oriji
Lecturer and Consultant, Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt
Nigeria

Abstract
Polycystic ovarian syndrome (PCOS) has remained an enigma since it was first described as a clinical entity by Stein and Leventhal in
1935. The treatment of this condition has evolved through ovarian wedge resection at laparotomy, induction of ovulation with clomiphene
citrate (CC) to laparoscopic ovarian drilling or other chemotherapeutic agents when CC treatment has failed. Evidence shows that
laparoscopic ovarian drilling (LOD) reverses all the abnormalities associated with PCOS especially in those with CC treatment failure. The
same could be said for these chemotherapeutic agents (metformin, gonadotropin-releasing hormone analogues (GnRHa), or follicle
stimulating hormone (FSH) alone or in combination with CC). The seeming comparative advantage of LOD is in its one off therapy,
sustained reversal of the pathology, high ovulation and pregnancy rates, cost safety reduced risk of multiple pregnancy and acceptability
by patients.
Keywords: Laparoscopic drilling, laser, diathermy, polycystic ovarian syndrome, polycystic ovaries hyperandrogenemia, insulin resistance,

AIMS/OBJECTIVES 3. Method of patient selection to involve only those with

The aim of this review is to highlight the efficacy and safety polycystic ovarian syndrome (WHO Type II).
of laparoscopic ovarian drilling in the management of 4. Laparoscopic ovarian drilling done for clomiphene
clomiphene resistant polycystic ovarian syndrome. The resistant polycystic ovaries was compared with any
effectiveness, safety and controversies of laparoscopic further medical treatment with metformin, CC, FSH or
ovarian drilling is compared to the different chemo- GnRHa.
therapeutic agents used in treatments for clomiphene These articles were reviewed for the following
resistant PCOS. considerations.
1. Technique, operative care and time for laparoscopic
MATERIALS AND METHODS ovarian drilling.
2. Operative and postoperative complication/morbidity.
A literature search was conducted with Google search 3. Length of hospital stay and time to normal activity.
engine, Highwire press and PubMed. Laparoscopic ovarian 4. Safety cost and effectiveness.
drilling, polycystic ovarian syndrome, clomiphene citrate, 5. Quality-of-life analysis.
metformin, GnRHa with polycystic ovaries were entered
as search words. DIAGNOSIS OF PCOS/PATIENT SELECTION
Articles were selected for review from all the citations
produced from the search. These were selected based on FOR LOD
predetermined criteria as stated below. The diagnosis of polycystic ovarian syndrome is by clinical
1. Year of publication not exceeding 15 years ago. and ancillary investigations revealing the presence of 1)
2. Randomized controlled trials and systematic reviews Irregular menstrual cycles and anovulation with onset at
were favored and other studies of high power addressing puberty. (Note that 25 percent of women who have PCOS
the criteria for comparison. have regular menstrual cycles), elevated total and free

World Journal of Laparoscopic Surgery, May-August 2010;3(2):99-102 99