Will ovarian drilling help me get pregnant?
Dear Dr Mitchell,
I was diagnosed with Polycystic ovary syndrome (PCOS) just before I turned 18. I am now 25 years old. My periods started at 11 years old. They were regular until I reached age 16. I am 5ft 3in, and weigh 150 lb. I have been trying to conceive for seven years with the same partner. My partner’s sperm count is normal. I have tried seven cycles of Clomid which were unsuccessful. I’ve also tried Metformin by itself and with the Clomid but this did not work and the side effects were brutal. We even tried one cycle of IVF, which did not work. I’m frustrated that nothing seems to be working and I’m now considering ovarian drilling to see if that would give me a better chance at becoming pregnant. Please advise.
Ovarian drilling is a surgical procedure used to treat PCOS. It is similar to ovarian wedge resection. Women with PCOS tend to have a thick outer surface that can prevent ovulation. Ovarian drilling breaks through the outer layer of the ovary and stimulates fertility. It also helps to reduce testosterone production and increases the frequency of ovulation. It is usually done via laparoscopy or open laparotomy.
Laparoscopy involves the use of small incisions with the introduction of an instrument called a laparoscope through the umbilicus. Laparotomy is done using a slightly larger incision just above the pubic bone. Both procedures are done under general anaesthesia.
Laparoscopy is usually done as an outpatient procedure and requires minimal recovery time with discharge on the same day.
In ovarian wedge resection, a wedge portion of the ovaries is removed. In ovarian drilling, ovarian tissue is destroyed by making very small holes in the ovary and reducing the production of male hormones. This effectively helps in improved management of the symptoms due to PCOS.
There is, however, the risk of ovarian scarring, and non-surgical methods of treating PCOS, such as weight loss and drug therapy using Clomid and Metformin, should be used before surgery is done.
Ovarian drilling may also be complicated with bleeding and pain, formation of adhesions or scar tissue on the pelvic organs, and excessive destruction of the ovarian tissue causing egg supplies to decrease significantly at a young age resulting in the onset of early menopause. Scar tissue may form between the ovaries and Fallopian tubes making conception difficult.
Ovarian drilling has a pregnancy success rate from 30 to 85 per cent and tends to be higher in women who have normal weight for their height. The risk of ovarian damage and other complications are minimal compared to the benefits of the procedure. Letrozole (Femara) may be a better option than Clomid to improve pregnancy rates in women with polycystic ovaries.
Clomid is usually the drug of choice to stimulate ovulation, but it has a higher rate of multiple pregnancy and increased exposure to oestrogen. Letrozole does not raise oestrogen to the same extent as Clomid and has a lower risk of cardiac problems. It is a definite option in women who do not respond to Clomid.
Consult your doctor who will advise you further.
Best regards.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
