Laparoscopic ovarian surgery (LOS) applies diathermy or laser for ovarian drilling aimed at restoring ovulation and achieving pregnancy. The main indication for LOS in patients with PCOS is resistance to clomiphene citrate.
LOS can achieve single ovulation without the risk for ovarian hyperstimulation or multiple pregnancies. Following LOS, regular monitoring of follicular development is not required. This method is an alternative option to gonadotropin administration in anovulatory patients with PCOS who are resistant to clomiphene citrate. LOS is particularly indicated in patients in whom regular monitoring with ultrasound is not feasible. With current technical advances, the intervention is completed in a single session. The risks of LOS are small and include laparoscopy per se, the development of adhesions and the destruction of normal ovarian tissue. The damage to the ovaries should be limited as much as possible. Irrigation with specific solvents might be useful for the reduction of risk for development of adhesions.
The chance of achieving a continuing pregnancy within 6 months is less than with carefully conducted ovulation induction with gonadotrophins but, if adjuvant ovulation induction agents are used in those who do not initially respond, the 12-month pregnancy rates are similar.