Transvaginal Hydrolaparoscopic Ovarian Drilling for Infertile Women with Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a syndrome of ovarian dysfunction showing cardinal features of hyperandrogenism and polycystic ovarian morphology. It is one of the most common reproductive endocrine disorders in young adult women, showing clinical signs of menstrual disorder, anovulation, hirsutism, acne, and obesity. Frequently, this group of patients present with infertility due to chronic oligoovulation or anovulation. In cases that do not respond to medical induction of ovulation, ovarian surgery such as ovarian wedge resection via laparotomy or ovarian drilling by trans-abdominal laparoscopy has been utilized. Laparoscopic ovarian drilling (LOD) by the trans-abdominal approach has been widely used to induce ovulation in PCOS women after failure of treatment with clomiphene citrate. So far, many authors have reported high rates of ovulation (∼ 80%) and pregnancy (∼ 60%) following LOD. Recently, a transvaginal method for laparoscopy, named transvaginal hydrolaparoscopy (THL), was developed near the end of the 20th century. Since then, THL has been performed for diagnostic purposes in infertile women. More recently, THL has been performed for operative laparoscopy, especially for ovarian drilling in women with PCOS. This novel technique, transvaginal hydrolaparoscopic ovarian drilling (THLOD) using a laser or bipolar electrosurgery, appears to be an effective minimally invasive procedure to induce ovulation in women with PCOS. Larger studies to assess the safety and long-term efficacy of THLOD are needed. This review article describes the minimally invasive operation for infertile women with PCOS by THLOD.
Keywords: Polycystic ovary syndrome, anovulation, transvaginal hydrolaparoscopic ovarian drilling, ovarian wedge resection, laparoscopic ovarian drilling
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