Outcome of laparoscopic ovarian drilling (LOD) for women with polycystic ovary syndrome (PCOS): A retrospective case note review

Objective: To evaluate the effectivity of laparoscopic ovarian drilling procedures at the East Sussex Healthcare Trust, UK, over the past decade on sub-fertile women with polycystic ovary syndrome, regardless of clomiphene resistance. Design: Retrospective case note review of LOD procedures Methods: Study 1: Evaluating a systematic literature review investigating ovulation and pregnancy rates following LOD. Study 2: An audit of 58 women with LOD treated for ovulation induction at the ESHT fertility clinic between 2005-2014. Main outcome measures: Ovulation, pregnancy, live birth, miscarriage rates; tubal patency; associated pathologies; previous treatments compared with Cochrane Review 2012. Results: Study 1: From the literature review, 71% achieved ovulation, whereas the pregnancy, live birth and miscarriage rates were 25-51%, 24-44% and 4-9% respectively. Study 2: Of the 58 patients studied, ovulation rate was 69%, pregnancy rate was 39.4% and live birth rate was 30.3%. The miscarriage rate was 15.4%. Pregnancy outcome after LOD, irrespective of further treatment, showed 34 pregnancies. Including 17 spontaneous pregnancies and 17 pregnancies after further treatment. Of the 34 pregnancies, 85.3% were live birth, 11.7% miscarriages and 1 ectopic pregnancy. Conclusion: No significant difference in ovulation rates post-LOD in ESHT, which is comparable to published studies. The low pregnancy and live birth rates indicate that additional factors affect the success of LOD. Co-existing pathology is associated with lower pregnancy rate post-LOD. Novel theories are postulated to explain underlying pathologies, thus PCOS treatment may change and open a fascinating area of research.