Ovarian Drilling

Ovarian drilling is an operation that involves making small holes of 2 mm in each ovary

Fertiloscopy with ovarian drilling and tubal blue test

What is ovarian drilling?

Ovarian drilling is an operation that involves making small holes of 2 mm in each ovary (“drilling” means piercing in English). It can be performed by laparoscopy or fertiloscopy.

Why is this operation preferable?

This process lets patients suffering from infertility related to a lack of ovulation get treated as part of the polycystic ovary syndrome (PCOS).

What is polycystic ovarian syndrome (pcos)?

This is the most frequent endocrine disorder in women of reproductive age (10%). PCOS alone represents 70% of infertilities related to a lack of ovulation.

Under what circumstances is ovarian drilling indicated?

Absence of ovulation related to PCOS is treated first with a drug for inducing ovulation, the Clomid. In cases of overweight women, a diet is prescribed. Indeed, the return to a normal weight can also have a beneficial effect on ovulation and fertility. Medical treatment requires regular ultrasounds throughout the cycle to control ovulation and synchronize medical treatments. This medical treatment enables pregnancy in 50% of cases in 6 months of treatment.

Ovarian drilling is one of the second-line treatment options after medical treatment failure. It has a 50 to 60% average pregnancy rate within 6 to 12 months after the operation.

Ovarian drilling offers several advantages:

Once the drilling is done, if the patient finds her cycles back, she will not need additional treatment or special follow-up for a minimum of 6 months.

In pregnancy obtained after drilling, there is not, contrary to medical treatment, a particular risk of multiple pregnancy and ovarian hyperstimulation.

Moreover, in the same operational time, it is possible to complete the fertility test by checking the uterine cavity by hysteroscopy and tube permeability using methylene blue testing.

The ovarian drilling remains nevertheless recommended as second-line treatment after failure of medical treatment, due to:

exceptional but potential surgical risk related to laparoscopy and general anesthesia

a recent randomized study that showed that drilling was not more effective than medical treatment to achieve pregnancy as a treatment of first intention in PCOS.

However, ovarian drilling performed by fertiloscopy represents a less invasive approach than laparoscopy, achievable on an outpatient basis under loco-regional anesthesia.

In this context, the place of ovarian drilling by fertiloscopy in 1st intention can therefore be discussed depending on the choice of the patient.