Laparoscopic ovarian drilling for infertility treatment

You are trying to get pregnant but you have not been able to release eggs after losing weight and using clomiphene or letrozole, with or without metformin. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in people with polycystic ovary syndrome (PCOS).

PCOS is a condition where hormones are out of balance and make it difficult to get pregnant. You may not have a typical monthly cycle as the hormone imbalance can affect your periods and ovulation. Your ovaries may have many tiny follicles (underdeveloped sacs in which eggs develop) and your androgen (hormone) levels may be increased.

Ovarian drilling is a surgical procedure done by laparoscopic (keyhole) surgery on your abdomen (tummy). It is done under general anaesthetic. 

Laparoscopic ovarian drilling (LOD) involves a laparoscopy (keyhole surgery) under a general anaesthetic (while you are asleep) and is usually done as a day case.

After your first consultation you will be assessed either by telephone or in the pre-assessment clinic. We will check if you are fit for the laparoscopy.

If you are taking the contraceptive pill, there is no need to stop as the surgery is only a day case procedure.

Please avoid unprotected sex during the month of your laparoscopy. If there is any chance of you being pregnant your operation will be cancelled.

If you think that you may be on your period on your surgery date, please contact your consultant’s secretary as we might be able to give you hormone tablets. You will need to take these a week before your expected period. This will postpone your period until after the surgery.

The anaesthetist and a gynaecologist will talk to you before your keyhole procedure takes place to answer any questions you may have.

After you have been given an anaesthetic and you are asleep the surgery will begin.

A small instrument will be inserted into your uterus, through your vagina, to help gently move it. This is to allow for better visualisation and access to the pelvic structures, as well as administration of the dye if this is planned.

A small cut will then be made below your belly button for the laparoscope to be inserted into your abdominal cavity. Additional small cuts may be needed for use of other instruments to perform the procedure.

4 to 6 holes are drilled in each ovary using an electric current. The aim is to destroy the tissue that’s producing androgens (hormones).

Dissolvable stitches will be used to close the wound.

The surgery will take about 30 minutes.

This treatment is often successful in inducing ovulation and regular periods.

The findings will be explained to you before you go home.

The alternatives to ovarian drilling are stimulation of your ovaries using fertility hormones injections Follicle Stimulating Hormone (FSH) or Intrauterine Insemination (IUI). Your doctor can discuss these alternatives with you.

• Around 8 in 10 people who have ovarian drilling start ovulating again.
• Nearly 5 in 10 people are able to become pregnant within a year. 
• You are less likely to have twins or triplets compared to other fertility treatments (which are as high as 1 in 10 people). 

Many laparoscopic surgeries are completed without problems but the recognised risks are:

• all surgical procedures have a risk of bleeding and infection. Very rarely, there is a risk of death, however your healthcare team would not suggest this surgery to you if they did not feel that you were fit for surgery.
• laparoscopic surgeries can cause injury to your bowel, bladder, and blood vessels. 
• risks to fertility. The procedure may affect your egg reserve. If there is too much damage to the ovary during the ovarian drilling procedure, you may get early ovarian failure and enter menopause at a younger age than expected. 
• after the procedure, adhesions (scarring) can form between your ovaries and your fallopian tubes, making it hard to get pregnant. 

The National Institute of Clinical Excellence (NICE) recommends ovarian drilling and its advice can be viewed on its website. 

Ovarian drilling is a day case operation which means that most people can go home the same day. In extremely rare cases it may be necessary to make a bigger incision than planned; a laparotomy. Should this happen, you will need to stay in hospital overnight. 

You may have a sore throat or nausea from the anaesthetic. You will be given pain relief.

You can take a bath or shower the day after the procedure.

Sexual activity can be resumed as soon as you are comfortable to do so.

The stitches will dissolve but can be removed by your GP’s practice nurse if they irritate you.

Everyone recovers at a different rate. Most people are back to normal physical activity including gentle exercise after 5 days and feel able to return to work in 1 to 2 weeks.

The charity group Verity runs a support network. Information is available on their website. . 

You can also speak to your Gynaecologist or your General Practitioner if you have any questions.

Infertility Nurse

01709 427641

Infertility Secretary

01709 424191