Laparoscopic Ovarian Drilling for PCOS

Medically reviewed by Dr Manan Boob, MS ObGyn (Gold Medalist), DNB — Consultant Gynaecologist & Laparoscopic Surgeon

What it is

Laparoscopic ovarian drilling (LOD) is a short keyhole operation for women with polycystic ovary syndrome (PCOS) whose ovaries are not releasing an egg each month. Through small cuts in the abdomen, a few tiny punctures are made on the surface of each ovary using a fine needle that carries heat energy.

Why would that help? In PCOS the ovary has a thick outer shell and a lot of tissue that makes male-type hormones, which keeps eggs from maturing and being released. Drilling reduces that hormone-producing tissue. In many women the hormonal balance shifts afterwards, periods become more regular and ovulation starts again — at least for a stretch of time.

It is not a cure for PCOS, and it does not make the “cysts” on the scan disappear. It treats one problem: failure to ovulate. Our blog on the signs of PCOS explains how the condition is recognised in the first place.

Who needs it

This is a narrow operation for a particular woman, and a lot of my consultation time goes into deciding whether she is that woman. Drilling is worth discussing when:

• You have PCOS, you are not ovulating, and you want to conceive, and ovulation tablets (letrozole or clomiphene) at proper doses and for enough cycles have not worked.
• Injectable ovulation treatment would be risky or impractical — for example, your ovaries over-respond easily and the risk of ovarian hyperstimulation or multiple pregnancy is high, or you cannot manage the frequent scans that injectable cycles demand.
• You are already having a laparoscopy for another reason, such as checking the tubes, and drilling can be done in the same sitting if it is clearly indicated.

It is generally not the answer if your tubes are blocked, your partner’s semen report is the main problem, you are not trying to conceive, or your ovarian reserve is already low. In those situations we look at other treatments first, such as IUI or IVF through our IVF and fertility team.

“My friend had drilling and conceived in two months. Why are you asking me to try tablets for longer first?” Because tablets are safer and reversible, and drilling is neither. Your friend was probably a woman for whom everything else had already been tried. If you have not yet had a proper trial of letrozole with the right dose and scans, we owe it to you to try that before we touch the ovary.

How it is done

You arrive fasting and the anaesthetist puts you to sleep.

A small cut is made near the navel, the abdomen is gently filled with carbon dioxide gas to create working space, and the telescope goes in. Two slim ports are placed low down in the lower abdomen.

The first thing we do is look at everything — both ovaries, the tubes, the womb and the lining of the pelvis. This is useful in itself: it is common to find something the scan did not show, and we can check that the tubes look healthy and open.

Each ovary is then held steady and a fine insulated needle is touched to its surface a handful of times — usually about four punctures per ovary, each a few millimetres deep and for a few seconds. The aim is to treat just enough tissue to shift the hormones and no more. Overdoing it is the one thing that can harm an ovary, so we keep it conservative. The ovaries are then cooled with saline, which limits heat damage.

The pelvis is washed, the gas is released and the small cuts are closed. If your tubes need a dye test in the same sitting, that can usually be done at the same time.

Anaesthesia, duration and hospital stay

The operation is done under general anaesthesia.

The drilling itself is brief. Including the inspection of the pelvis, the whole procedure usually takes 30 to 45 minutes, a little longer if another step such as a tubal check is added.

Most women go home the same evening or after one night. You will be sipping water within a few hours, eating a light meal, and walking before you leave.

Recovery

Day 1. Soreness at the small cuts and a bloated feeling. A dull ache near the shoulder is common and comes from the gas, not from anything going wrong; walking clears it faster than lying still. Normal food and short walks.

The first week. Mild tiredness. Pain tablets are rarely needed beyond the first two or three days. Showers are fine from day three, with the dressings kept dry. Light spotting can happen.

Weeks 2 to 4. Desk work, driving and household work are fine as you feel able. Avoid heavy lifting and strenuous exercise for these weeks.

By six weeks. Back to everything, including exercise. Your first period after surgery may be early, late or different; what we are watching for is the pattern over the following two or three cycles. We will plan follow-up visits and, if needed, a scan to see whether you are ovulating. Call us sooner for fever, spreading redness at a cut, worsening pain or vomiting.

Why keyhole rather than open surgery

This operation was designed for the laparoscope, and I cannot think of a reason to do it any other way. A telescope gives a magnified view of the ovary surface, which lets us place punctures precisely and keep them to a minimum. The cuts are tiny, the pain is mild, hospital stay is short, and — importantly for a woman trying to conceive — there are far fewer adhesions than after open surgery. If you have the choice between the two, keyhole is the better one by a long way.

Risks and complications

This is a safe procedure in experienced hands, but you are entitled to the full picture.

• Loss of ovarian reserve. Each puncture removes a small amount of healthy tissue. Done conservatively the effect is usually small, but heavy or repeated drilling can reduce the egg supply, and in rare cases bring on early ovarian failure.
• Pelvic adhesions. Scar tissue can form around the ovaries and tubes after any heat treatment, which can affect fertility. Gentle technique and washing out the pelvis reduce this.
• No response. Some women do not start ovulating, and in others the benefit fades after a time. This is a limit of the operation, not a failure of effort.
• Bleeding from the ovary, usually minor and controlled during the operation.
• Injury to bowel, bladder or blood vessels — rare, and a risk of any laparoscopy.
• Infection at a cut or within the pelvis.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.
• Conversion to open surgery, which is very unusual for this operation.

Alternatives

Lifestyle and weight management. For women who are overweight, even a modest loss can bring back ovulation. Our blog on a PCOS diet plan with Indian food is a practical starting point.

Ovulation tablets. Letrozole is usually the first-line medicine, with clomiphene as another option. They are tried first, at proper doses and with scans, before any operation is considered.

Metformin, in selected women, especially where insulin resistance is a clear part of the picture.

Injectable ovulation treatment (gonadotropins), which works well but needs close monitoring and carries a higher chance of multiple pregnancy and ovarian over-response.

IUI or IVF, when ovulation induction alone has not worked or other factors are involved. See our IVF and fertility treatments page.

“If drilling works, why not do it for every woman with PCOS?” Because most women with PCOS do not need an operation. Many ovulate with lifestyle changes or tablets, and an operation that touches the ovary should be kept for the women who truly cannot be helped any other way.

What it costs

Laparoscopic ovarian drilling at Shubham Hi-Tech Hospital: ₹35,000 – ₹55,000. This is an all-inclusive figure — surgeon’s fee, operation theatre, anaesthesia, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring every report you have: scans, hormone tests, and notes on earlier fertility treatment, including which tablets you took, at what dose and for how many cycles.
• Bring your partner’s semen report, if it has been done. We like to know that the other pieces are in place before operating.
• Tell us if you have diabetes, thyroid problems or are on blood thinners. Some medicines need adjusting beforehand; please do not stop anything on your own.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise.
• Leave jewellery, nail polish and contact lenses at home.
• Arrange for an attendant to stay with you and someone to take you home.
• Plan a week of light activity and tell us about your periods in the months afterwards.

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PCOS can feel like a long road, and an operation is only one possible turn on it. If tablets have not worked and you are wondering whether drilling is right for you, bring your reports to the gynaecology and laparoscopy team at Shubham Hi-Tech Hospital, Amravati, and we will tell you plainly whether it makes sense or whether another route is better. Call +91-8668954915, get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.