Ovarian drilling

Ovarian drilling is a surgical technique of puncturing the membranes surrounding the ovary with a laser beam or a surgical needle using minimally invasive laparoscopic procedures. It differs from ovarian wedge resection, because resection involves the cutting of tissue. Ovarian drilling and ovarian wedge resection are performed to reduce the amount of androgen producing tissue in women with polycystic ovarian syndrome. Ovarian drilling is often preferred to wedge resection because cutting in to the ovary can cause adhesions which may complicate postoperative outcomes. Ovarian drilling was first developed after 1980.

Ovarian drilling has lower rates of ovarian hyperstimulation syndrome and of multi-fetal gestation.

Procedures

When the clinician determines that ovarian drilling is appropriate and the woman decides to undergo this treatment, consent is obtained. The risks are communicated to the woman.

Common instrumentation consists of the use of a bipolar electrical surgical electrodes or a CO2, argon, or ND-YAG laser. This instrumentation has the ability to produce the intended results with a very focal approach. The punctures to the ovary done by the surgeon are usually 4-10mm deep and 2-4mm wide. The number of punctures is related to subsequent ability to conceive—it has been found that five to ten punctures are more likely to produce the intended conception.

Risks

Though preferable to creating incisions on the ovary, ovarian drilling does have some risks. These are: pelvic adhesion formation, long-term ovarian function, developing hyperstimulation syndrome, adhesion formation, infertility and multiple births.