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.
IN CONCLUSION
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. It is therefore very important for your doctor to INDIVIDUALISE your treatments.
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 treatment may be required before pregnancy occurs. About 30% 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.
Dr David Molloy
Clinical Director
Queensland Fertility Group
