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surgical treatment of PCO

If clomiphene does not produce ovulation in women that have polycystic ovarian disease (PCO), surgical treatment of PCO can be considered as an alternative to injections of gonadotropins.

Previously, surgical treatment was first developed on the basis of a simple hypothesis; given that the ovary produces too much of the hormone androgen, less of the hormone will be produced if part of the ovarian tissue is removed.

In the surgical treatment of PCO therefore a small piece, or wedge, is removed from the ovary, a procedure that is called a wedge excision. Despite the fact that this procedure was sometimes successful in producing ovulation, it is now rarely used. In some cases, little ovarian tissue remained and, consequently, women were unable to react to subsequent treatment with gonadotropin (injections to stimulate ovulation).

A laparoscopic electrocoagulation of the ovaries (LEO) is now used more frequently. Small holes are burned in the surface of the ovaries, as a result of which the hormonal activities in the ovaries changes. In the first months, particularly, there is a chance of ovulation and therefore a regular cycle. The advantages and disadvantages are not yet fully understood and therefore LEO is not provided in all centres. This method can be used as an alternative to injections of gonadotropins, if clomiphene is not successful.

how it works
risks
results

how it works

This procedure can be carried out by laparoscopy and consists of burning small holes in the outer layer or capsule of the ovary using a cauterising needle or laser. Both seem to have the same effect as the previous wedge incision, but crucially much more of ovarian tissue is preserved. Making holes in the capsule appears to be enough to be effective.

An increase in the level of follicle stimulating hormone (FSH) observed after the operation and the appearance of a dominant follicle show that the surgery has been successful.

Ovulation is permanently restored in some women, while others ovulate for a short time and then return to their previous condition of anovulation. Some women do not react at all.

risks

In the wedge incision, it is possible that adhesions, a type of scar tissue that can form on the ovaries, will be formed after the operation. These adhesions can cause subsequent fertility problems.
Just as with surgery, there is a risk of complications (therefore in practice a drug based therapy using clomiphene is considered in the first instance).

results

The LEO method is still not widely used because of the invasive nature of the operation and because little is yet known about the long-term effects of the surgery. However, the percentage of successful ovulation seems to be comparable to that of treatment with gonadotropins.

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