Surgery for PCOS
A limited number of patients may benefit from surgery on their polycystic ovaries. Historically PCOS has been treated by an open operation done through a large incision called wedge resection. A segment of the ovaries (a little bit like a segment of an orange) is cut out and the ovary repaired. This was quite successful in starting ovulation and creating some pregnancies. However there was a high risk of adhesions and patients were in hospital for quite a long time with the big cut that was made on their abdomens. Wedge resections slowly fell into disrepute through the 1960’s and 1970’s.
A more modern way of operating on polycystic ovaries is to use the laparoscope as previously described. A laser or burning tool called a cautery is used to drill little holes in the surface of the thick capsule of the ovary. At the end of the procedure the ovary looks rather like a golf ball that has been dimpled. This procedure in fact is called laparoscopic golf balling of the ovary. It too can cause adhesions in 20% of patients.
As the operation is done laparoscopically without a big cut it can be done as day surgery and patients recover much more quickly. There will also be fewer adhesions as there are no surgeons’ hands inside the abdomen, only a laparoscope. The success rate of this operation is quite high in inducing ovulation and enhancing pregnancy chances.
In general terms surgery is not usually used as a first option but is used with patients who are having longer term difficulty in becoming pregnant.
IVF for PCOS and ovulation disorders
IVF is rapidly becoming the treatment of choice for many couples who are having difficulty falling pregnant. IVF pregnancy rates have dramatically improved over the past 10 years, and a woman under the age of 35 can expect a 40-50% pregnancy chance for one month or cycle of treatment.
This compares to clomid treatment (4%-15% per month) and FSH treatment (12-15% per month). Whilst IVF is more expensive and complex it is far more successful.
One cycle of IVF gives the same pregnancy rate as 6 months of clomid treatment. A surprising advantage of IVF is that multiple pregnancy risk can be more tightly controlled by only replacing one or two embryos. This is safer than FSH treatment and if 1 embryo is replaced safer than Clomid.
You can find out more about IVF by asking Dr Molloy or QFG for an information pack.
| TREATMENT | PREGNANCY RATE FOR 1 CYCLE/MONTH |
| Clomid only | 4% |
| Clomid, Bloods & Intercourse | 7-8% |
| Clomid, Bloods & Intrauterine Insemination | 12-15% |
| FSH Injections, Monitoring and IUI | 12-15% |
| IVF | Age Dependent: 45-50% < 35 30-40% 36-38 yrs |
Do you need more information about PCOS?
“Each patient who has an ovulation and menstrual problem is different. The causes of ovulation problems are many and there are a wide variety of treatments depending on whether the patient wishes to become pregnant or not. For that reason, I will always tailor an individual treatment plan for my patients.” Dr David Molloy
Do not hesitate to discuss your treatment with your doctor, particularly if problems are occurring. The majority of patients with ovulation problems will get pregnant. However 6 to 10 cycles of IVF treatment may be required before pregnancy occurs. About 50% of patients with ovulation problems will not become pregnant with the above treatment and versions of the IVF program will be required. Separate information kits are available for these programmes.
Find out more at www.qfg.com.au, or contact my practice for more information about PCOS.
