What is Ovarian Drilling?

Ovarian drilling is a surgical technique dedicated to the treatment of Polycystic Ovary Syndrome. It consists of performing micro-perforations in ovaries in order to induce ovulation. Polycystic Ovary Syndrome (PCOS) is characterized by ovulation disorders and represents the most common cause of infertility in women of reproductive age.

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Ovarian drilling, which was commonly performed by laparoscopy, is now currently performed by fertiloscopy, benefiting in turn from its mini-invasiveness and physiological approach.

Procedure Treatment in India

This procedure is done under short general anesthesia. The patient can leave the hospital on the same day of surgery. Ovarian drilling is usually done through a laparoscope (small incision). The surgeon makes a small cut (incision) in the abdomen at the belly button. The surgeon then places a tube to inflate the abdomen with a small amount of carbon dioxide gas so that he or she can insert the viewing instrument (laparoscope) without damage to the internal organs. The surgeon looks through the laparoscope at the internal organs. Surgical instruments may be inserted through the same incision or other small incisions in the pelvic area. The ovaries are identified and several small holes made in each ovary, either with a fine hot diathermy probe or laser.

The Technique of Ovarian Drilling Treatment in India

In 1935 Drs Stein and Leventhal described 7 women with irregular periods (oligomenorrhea), increased body hair and obesity, who at the time of surgery were found to have enlarged ovaries with a smooth pearly white”appearance. The smooth appearance of the ovaries was presumed to be due to the lack of sites of ovulation that typically would leave scars. The ovaries were several times the normal size, which along with the elevated male hormone testosterone raised the possibility of ovarian tumors. Biopsies of these ovaries did not show tumors but instead revealed multiple, small cysts that were found to be immature follicles, and overgrowth of the part of the ovary that secretes testosterone. Surprisingly after the surgery, where up to 1/2 to 3/4 of each ovary had been removed for biopsy, the patients began having regular menstrual periods and 2 became pregnant.

In addition, the testosterone levels declined in these patients. Bilateral ovarian wedge resection of the ovaries was then introduced as a procedure that could assist patients with polycystic ovary syndrome to ovulate. It was the only method available until the introduction of the oral medicine clomiphene citrate in the mid-1960s. The problems with BOWER were that it required a major abdominal incision and that almost all patients developed scar tissue (adhesions) around the tubes and ovaries that further exacerbated their infertility.

The condition, polycystic ovarian syndrome, known as PCOS, is the commonest cause of ovulation disorders in women of reproductive age and is a familial condition. Polycystic ovarian syndrome (PCOS), is a primary ovarian condition and is characterized by the presence of many minute cysts in the ovaries and excess production of androgens. The polycystic ovarian syndrome can be found in apparently normal women and the full expression of the disease so-called “Stein-Leventhal syndrome” is very uncommon. The polycystic ovarian syndrome is frequently associated with weight gain, excessive hair growth in the face and body, irregular and infrequent periods or absent periods, infrequent or absent ovulation, miscarriage, and infertility. The cause of PCOS is not fully understood. There are long-term risks of developing type 2 diabetes, cardiovascular disease, and cancer of the womb. Women diagnosed as having PCOS before pregnancy have an increased risk of developing gestational diabetes.

Laparoscopic Ovarian Diathermy [Ovarian Drilling] Treatment in India

Surgery is recommended should the medical treatment fail and for women who have experienced OHSS. This may be ovarian drilling or ovarian wedge resection. It is not clear why women with PCOS ovulate after ovarian drilling or wedge resection. After surgery, ovulation occurs spontaneously in 70-90% of women and the probability of pregnancy after one year is in the region of 40-60%. There is no increased risk of multiple pregnancy or OHSS. If ovulatory cycles fail to restore after the surgery, the doctor may restart ovulation induction. A recent study up to 20 years after laparoscopic drilling has shown the persistence of ovulation over many years. Compared with medical treatment, it need only be performed once and intensive monitoring is not required. The main problems associated with surgery include adhesion formation, the risk of destruction of the ovaries leading to ovarian failure. In addition, there are risks associated with surgery and anesthesia.

What To Expect After Surgery

If you have a laparoscopy procedure, you can usually go home the same day and resume normal activities within 24 hours. Your return to normal activities will also depend on how quickly you recover from surgery, which may take a few days or as long as 2 to 4 weeks.

Why It Is Done

Ovarian drilling is done for women with PCOS who have not responded to weight loss and fertility medication. Partial ovarian destruction has been reported to restore regular ovulation cycles

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