Intraoperative Morphology-based Laparoscopic Ovarian Drilling in Women with Polycystic Ovary Syndrome: Technique and Reproductive Outcomes
Abstract
Introduction: Polycystic Ovary Syndrome (PCOS) is a common cause of anovulatory infertility. Although Laparoscopic Ovarian Drilling (LOD) is an established second-line treatment, conventional techniques typically employ a fixed number of punctures irrespective of ovarian morphology and ovarian reserve. This study describes an intraoperative morphology based LOD technique tailored to ovarian characteristics and evaluates its reproductive outcomes and perioperative safety. Aim: To evaluate the technique of LOD employed in the study, among women with PCOS and determine the reproductive outcomes after LOD. Materials and Methods: This was a retrospective study conducted at Indigo Women’s Center, Chennai, Tamil Nadu, India from September 2025 to February 2026. Data was obtained from past clinical records, extended from June 2022 to May 2024 (a total duration of two years). The number of ovarian punctures was individualised according to ovarian morphology and ovarian reserve parameters. Operative characteristics, perioperative safety, and reproductive outcomes were analysed using descriptive statistics. Results: A total of 152 women underwent LOD. The median number of punctures performed per ovary was 10 (IQR: 7-13), with a mean operative time of 20±10 minutes. No intraoperative or postoperative complications were recorded. During six months of follow-up, 60 women (39.5%) achieved pregnancy, of whom 56 (36.84%) had live births, three (1.97%) experienced miscarriage, and one (0.66%) had an ectopic pregnancy. Women who did not conceive within the first three months subsequently received Ovulation Induction (OI) with letrozole as part of routine clinical management. Conclusion: LOD, employing an individualised technique, in this study of 152 women with PCOS, using a monopolar electrode was associated with favourable reproductive outcomes and an excellent perioperative safety profile in women with PCOS. The procedure was completed within a relatively short operative time, including diagnostic hysteroscopy and chromopertubation, supporting its feasibility as a safe surgical option for OI.