What is Ovarian Drilling? What is its Role in PCOS?

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women of reproductive age. It manifests with symptoms such as lack of ovulation, increased hair growth, acne, and menstrual irregularity. The first line of treatment is usually medication; however, in some women, these medications are not enough to trigger ovulation. In such cases, one of the methods that comes into play is a surgical procedure called ovarian drilling.

What is Ovarian Drilling?

"Ovarian drilling" literally means "making small holes in the ovary". This procedure is performed using a laparoscopic (closed) surgical method. The aim is to puncture the thickened capsule on the surface of the ovary, reducing the production of androgens that suppress ovulation, and to restart ovulation. In short, it is a small but effective intervention performed to naturally restart ovulation in women with PCOS who are resistant to drug treatment.

How is it Applied?

The procedure is performed under general anesthesia and usually takes 15–30 minutes. The abdomen is entered with a laparoscope (a thin device with a camera) through a small hole made from the navel. Usually, 4–10 small holes are made in both ovaries. These holes are created with the help of an electrocautery or laser. The goal is to reduce the androgen-secreting cells in the ovary. Thus, the FSH and LH balance is restored, and the ovulation function resumes.

Who is it Suitable For?

Ovarian drilling is especially considered in the following patient group:

• Diagnosed with PCOS,
• Weight control and lifestyle adjustments have been made,
• No response has been obtained from drugs such as clomiphene or letrozole,
• Women who want to try ovulation naturally as a final step before moving on to IVF treatment.

In other words, it is recommended not for all PCOS patients, but for selected patients who are resistant to medication.

Advantages of Ovarian Drilling

• It can restart ovulation by 60–80%.
• Spontaneous pregnancy can be seen within 3–6 months after surgery in some women.
• If IVF treatment is applied later, the dose of medication used may be lower.
• A decrease in hormone levels (especially testosterone) is achieved.

Risks and Things to Consider

As with any surgical intervention, there are some risks:

• Risk of diminishing ovarian reserve (if excessively drilled),
• Intra-abdominal adhesions,
• Complications related to anesthesia,
• Rarely, infection.

Therefore, it is very important that the surgeon performing the procedure is experienced. Additionally, ovarian reserve (AMH level) and hormone balance should be monitored after the procedure.

The Process After Ovarian Drilling

After surgery, the menstrual cycle usually returns to normal within 4–6 weeks. Ovulation resumes within the first few months in most patients. Pregnancy generally occurs within the first 6 months. However, factors such as age, weight, and insulin resistance can still affect the outcome. In some cases, low-dose medication may be required to support ovulation after the procedure.

Conclusion

Ovarian drilling is an effective surgical option to restart ovulation in PCOS patients who do not respond to drug treatment. However, it is not suitable for every patient; the decision is based on the patient's age, ovarian reserve, and previous treatment history. In short, this procedure does not mean "surgery for every PCOS patient"; when applied to the right person at the right time, it can increase the chances of natural pregnancy.