Surgical versus medical treatment for PCOS: long term effects on fertility

This trial compared the long-term reproductive effects of two treatment strategies in women diagnosed with polycystic ovary syndrome (PCOS): laparoscopic ovarian drilling versus gonadotropin analogs.

If conservative treatments (such as weight loss) fail, women with PCOS may be treated with fertility drugs to induce ovulation, or with surgical ovarian drilling.

Ovulation induction medications, such as clomiphene citrate (Clomid), are fertility drugs used to stimulate the production and release of eggs from the ovaries (ovulation). These drugs also control the timing of ovulation, allowing for timed intercourse or insemination. Gonadotropin analogs (such as Pergonal or GonalF) are a class of injectable ovulation induction drugs commonly used during infertility treatments (especially if treatment with clomiphene citrate has failed).

Laparoscopic ovarian drilling is a surgical treatment that may trigger ovulation in women with PCOS. Small holes are drilled in the ovaries, aiding in the release of eggs for fertilization. 

The present study compared the long-term effects of these strategies on reproduction by interviewing women 8 to 12 years following treatments.

Between 1998 and 2001, 168 women with PCOS were randomly assigned to receive either a gonadotropin analog or surgical therapy. These women were interviewed in 2009 and asked about their menstrual cycle regularity, successful and aborted pregnancies, and menopause.

In this study group, laparoscopic surgery was as effective as gonadotropin analogs in terms of live births. 86% of patients receiving surgery reported at least one live birth compared to 81% of patients treated with gonadotropin analogs. Surgery was found to reduce the need for additional ovulation induction treatments in subsequent pregnancy attempts by 31% compared to gonadotropin treatment. The chance of a second live birth was also increased by 40% with surgical ovarian drilling. In addition, the chances of regular menstrual cycles following treatment was increased by 50% among women undergoing surgery compared to those receiving gonadotropin analogs.

This study concluded that laparoscopic ovarian drilling provides better long-term reproductive outcomes than gonadotropin analogs among women with PCOS not responsive to clomiphene citrate treatment.

This trial disregarded the short-term risks and benefits of both treatments. Ovarian drilling has inherent surgical risks (such as bleeding and injury to nearby organs). In addition, surgery may cause adhesions (internal scarring) which may also lead to infertility. Older and obese women are also less likely to benefit from surgical treatment; the present study did not account for a variety of patient characteristics.

Consult with your physician regarding the risks and benefits of gonadotropin analogs and laparoscopic ovarian drilling in the treatment of PCOS induced infertility.