Laparoscopic procedures for treatment of infertility related to polycystic ovarian syndrome

The use of laparoscopic techniques for the treatment of polycystic ovarian syndrome (PCOS) has included many different approaches in the 1980s and 90s. Broadly similiar results have been obtained using biopsy, cauterization, multi-electrocoagulation and laser surgery; i.e. > 50% ovulation and a mean pregnancy rate of 50%. Evaluation of the data is complicated by the lack of uniformity in these clinical studies and the variation in diagnostic criteria. None of the studies included a treatment-independent control group. Endocrine changes following laparoscopy have been identified in many studies, but the mode of action of these treatments remains a mystery. In conclusion, laparoscopic techniques have the advantage over surgical wedge resection of cost saving and a lower risk of post-operative adhesions. For clomiphene resistant patients, laparoscopic techniques have many advantages over gonadotrophin therapy including serial repetitive ovulation events, no increased risk of ovarian hyperstimulation or multiple pregnancies and a lower incidence of spontaneous abortion, but these procedures must not be considered as the first line treatment for the anovulatory patient with PCOS, for whom clomiphene citrate remains the first choice mode of therapy.