Laparoscopic treatment of polycystic ovaries with insulated needle cautery: a reappraisal

Objective: To evaluate the reproductive outcome and adhesion formation afte r a standardized laparoscopic treatment of polycystic ovary syndrome (PCOS) in clomiphene-resistant infertile women. Design: Retrospective study. Setting: University teaching hospital. Patient(s): One hundred twelve clomiphene-resistant anovulatory women with PCOS. Intervention(s): Laparoscopic ovarian drilling using an insulated needle ca utery. Main Outcome Measure(s): Ovulatory rate, pregnancy rate, and adhesion forma tion. Result(s): After surgery, ovulation occurred spontaneously in 73.2% of pati ents. The cumulative probability of conception at 12, 18, and 24 months aft er surgery was 54%, 68%, and 72%, respectively. With use of Cox's proportio nal hazards model, the effects of age, body mass index, and duration of inf ertility were evaluated. These factors were not associated with the pregnan cy rate. Of 15 women who underwent a second-look laparoscopy, 11 women were found to be free of adhesions. Four women had periadnexal adhesions that w ere filmy, minimal, and found on the ovarian surface only. Conclusion(s): Laparoscopic ovarian drilling is an effective alternative tr eatment in clomiphene-resistant anovulatory women with PCOS. The use of an insulated needle cautery is associated with a minimal amount of adhesion fo rmation. (Fertil Steril(R) 2000;73:266-9. (C) 2000 by American Society for Reproductive Medicine.)