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Understanding Ovarian drilling to treat PCOS

Understanding ovarian drilling to treat PCOS. In this video, Mark P. Trolice, M.D., a board-certified reproductive endocrinology and infertility specialist and founder of Fertility CARE: The IVF Center, discusses how ovarian drilling is used to treat polycystic ovarian syndrome (PCOS). “Today we're going to talk about ovarian drilling,” says Dr. Trolice. “When I use the term ovarian drilling, the eyes of patients usually bug out, they can't believe the word ‘drilling.’ But it's a very tried and true procedure that’s been around for many years. I spoke at the World Congress on Polycystic Ovarian Syndrome, and the origins of ovarian drilling came from the very early days of managing polycystic ovarian syndrome and diagnosing it.” “Patients back then who had large ovaries would have a wedge of the ovary surgically removed, and it was called ovarian wedge resection. As a result, patients started ovulating regularly. Therefore, in diagnosing and treating PCOS, doctors noticed that reducing the ovarian volume improved ovulation function. The downside is that the procedure also resulted in significant loss of ovarian volume and eggs, and accelerated ovarian aging. It also caused severe scarring from the pelvic adhesions.” “Fast forward to the 1970s when laparoscopy started being used. Removing some parts of the ovary capsule for tissue sampling (biopsy) was shown to induce ovulation. So the consensus that has evolved is using needle tip cautery to treat PCOS. Some doctors have used lasers, some have used the harmonic scalpel, but it seems that needle tip cautery provides the greatest consistency.” “The ovary is like a golf ball,” says Dr. Trolice. “Using a needle tip cautery, we drill tiny holes in the ovary circumferentially - not too many or else it could reduce blood flow to the ovary which can result in severe ovarian aging. Rarely, rarely, it's been reported in the medical literature for ovarian failure, but I've never seen that.” “The minimum number of punctures on one ovary is five, but we typically will look at both ovaries and do around 10 to 15 punctures based on the size of the ovary. If the ovary is not as large, we'll do less. Afterward, we see about two-thirds of patients start ovulating regularly, and about 50% of them are able to have a baby.” “Therefore, if the sperm analysis is normal and the fallopian tubes are open, ovarian drilling is a terrific option for patients. They can also opt for in vitro fertilization (IVF). Insurance usually covers ovarian drilling, so it's not as expensive as IVF. We usually perform ovarian drilling as the second line of treatment. The first line would be using fertility medication, typically oral medication like letrozole, clomiphene if body weight is low, but letrozole certainly if one’s BMI index is above 30.” “If you're not successful with the oral medication, then you can opt for injectable medications. Injectable medication provides a similar outcome to ovarian drilling, but injectables have a higher risk of multiple births.” “Patients who are thinner seem to have a better prognosis. So I would say a body mass index of 30 or less is ideal. Typically with polycystic ovarian syndrome, we see elevated LH levels (a pituitary hormone). Increased LH levels are what increases the male hormones in the ovary. Therefore, lower LH levels seem to have a better prognosis.” “Overall, ovarian drilling is a great option for patients,” concludes Dr. Trolice. “It is surgery. The average time of recovery is somewhere between six to eight weeks before getting your period back, but it could take longer. We've also seen women get their periods back as soon as two weeks after the procedure, and then two weeks after that - a pregnancy.” “If we don’t see any ovulatory activity or pregnancy three to six months after ovarian drilling, we can try other medications or in vitro fertilization. We've had patients had several children from just the one surgery (ovarian drilling) because they keep on ovulating. And studies have shown if ovarian drilling is successful, ovulation can continue for up to 20 years.” For more visit https://www.myfertilitycare.com/ To learn more about Dr. Trolice visit http://www.myfertilitycare.com/mark-t... To learn more about Fertility CARE fertility services visit https://www.myfertilitycare.com/our-s... To learn more about IVF visit https://www.myfertilitycare.com/ivf/ To learn more about egg freezing visit https://www.myfertilitycare.com/egg-f... To learn more about intracytoplasmic sperm injection (ICSI) visit https://www.myfertilitycare.com/intra... To learn more about IUI visit https://www.myfertilitycare.com/infer...