Polycystic Ovary Syndrome: Surgical Therapy

Wedge excision of both ovaries (surgical removal of a wedge from both ovaries) (obsolete): for a long time, wedge excision of the ovaries, described by Stein and Leventhal, was considered the gold standard for treating anovulation in PCO syndrome. The postoperative pregnancy rate was approximately 60%. In the 1960s and 1970s, this surgical procedure was abandoned because of:

  • The postoperative late effects: tubal adhesions (adhesions in the area of the fallopian tubes) with subsequent subfertility (limited fertility).
  • Better results due to ovulation triggering (ovulation triggering) by pharmaceuticals (eg, clomiphene, gonadotropins).

Laparoscopic Ovarian Drilling (LOD): the possibility of minimally invasive pelviscopic surgical procedures (laparoscopy) gave rise to an alternative to gonadotropin therapy in women who were resistant to clomiphene the so-called Laparoscopic Ovarian Drilling (LOD). It is a pelviscopic surface treatment of the ovary (ovary). Depending on the size, 4-6 few millimeters deep coagulations or stiches with a diameter of 3-5 mm are placed on both ovaries by:

  • Electrocoagulation
  • CO2 laser
  • Argon laser
  • Yag laser

The result is a drop in androgen and LH. Testosterone decreases in the long term by about 50%. Up to 90% spontaneous ovulation (ovulation) occurs, even in clomiphene-resistant patients, with an effect up to five years. Ovarian adhesions (adhesions around the ovaries) have been described up to 20%