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%