Comparing laparoscopic ovarian drilling and medication to induce ovulation in women with polycystic ovarian syndrome

This study investigated laparoscopic ovarian drilling (LOD) compared to medical ovulation induction (MOI) in women with polycystic ovarian syndrome (PCOS). 

They found that LOD was associated with decreased live birth rates (LBR) when compared with MOI.

Polycystic ovarian syndrome (PCOS) is a common condition. It is caused by cysts on the ovaries. These cysts can cause a number of symptoms. Patients with PCOS may also have reduced fertility. Many women with PCOS do not ovulate. Ovulation is necessary to release an egg for fertilization in the womb. Ovulation induction (OI) is one treatment for infertility in PCOS. Medical OI (MOI) is achieved using medication. Surgery can also be used for OI. This is called laparoscopic ovarian drilling (LOD).

LOD is a minimally invasive procedure. It involves breaking down the outer layer of the ovary. In PCOS this outer layer produces extra testosterone (TTT). TTT can suppress ovulation. LOD is used in women with PCOS that do not respond to MOI. It is unclear if LOD is more effective at OI in women resistant to MOI.

This study reviewed 38 clinical trials. This included 3326 women with PCOS. These women were resistant to MOI with clomiphene citrate (CC). Some women underwent MOI and LOD. Others underwent LOD only. The authors compared pregnancy across all trials. The main pregnancy outcome was the live birth rate (LBR). Miscarriage rate (MCR) and multiple pregnancies (MPs) were other pregnancy outcomes evaluated.

LOD was associated with a 29% reduction in LBR across all studies. There was no difference between LOD and LOD + MOI in 4 randomized controlled trials (RCTs). LOD may reduce the chance of MPs by 66%. There was no strong evidence to suggest LOD was different from LOD + MOI in other pregnancy outcomes. These included MCR or ovarian hyperstimulation (OHSS). 

The authors concluded that LOD with or without MOI may decrease LBR in women with PCOS.

The quality of these trials was low to moderate in quality. This means that the findings may not be accurate. Larger controlled studies are needed.