Current trends in surgical treatment for infertility associated with polycystic ovary syndrome
DOI: 10.32364/2618-8430-2022-5-3-209-214
I.I. Grishin, T.G. Chirvon, O.R. Oguede
Pirogov Russian National Research Medical University, Moscow, Russian Federation
Polycystic ovary syndrome (PCOS) is a common endocrine disorder and one of the main causes of anovulation in women of childbearing age. Surgical procedures for infertility treatment in women with PCOS have been used in clinical practice for a long time. As a rule, they are considered as a second-line therapy after the first-line pharmacological treatment. Since recently the focus has shifted to the comparison of different types of surgical treatment techniques, their effects on the ovarian function, and the development of adhesions. The article reviews the most common surgical options for PCOS treatment in various patient groups and the key results obtained in the top importance studies undertaken in this area. Surgical treatment of PCOS in properly selected patients seems to be a cost-effective therapeutic option that has comparable success rates to ovulation induction with gonadotropins. Laparoscopic ovarian drilling is one of the preferable minimally invasive techn iques. This procedure is recommended for patients who have other indications for laparoscopy, or if there is a high risk of ovarian hyperstimulation syndrome and multiple pregnancy, or if there are contraindications to multiple pregnancy. At the same time, it is emphasized that the uniform regimens and standards of PCOS surgical treatment have not been optimized so far. Their outcomes are understudied and the issue is still open for discussion.
Keywords: laparoscopic ovarian drilling, polycystic ovary syndrome, ovarian hyperstimulation syndrome, anovulation, infertility, adhesions.
For citation: Grishin I.I., Chirvon T.G., Oguede O.R. Current trends in surgical treatment for infertility associated with polycystic ovary syndrome. Russian Journal of Woman and Child Health. 2022;5(3):209–214 (in Russ.). DOI: 10.32364/2618-8430-2022-5-3-209-214.
About the authors:
Igor I. Grishin — Dr. Sc. (Med.), Professor of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0001-5839-1858.
Tatiana G. Chirvon — postgraduate student of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0002-8302-7510.
Olade R. Oguede — postgraduate student of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0000-0003-1433-8144.
Contact information: Tatiana G. Chirvon, e-mail: tkoltinova@gmail.com.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 22.04.2022.
Revised 23.05.2022.
Accepted 16.06.2022.
2. Adamyan L.V., Andreeva E.N., Gasparyan S.A. et al. Polycystic ovary syndrome in reproductive age (modern approaches to diagnosis and treatment). Clinical recommendations (treatment protocol). 2015 (in Russ.).
3. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University. 2018. (Electronic resource.) URL: https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf (access date: 08.02.2022).
4. Clinical recommendations. Polycystic ovary syndrome. 2021. (Electronic resource.) URL: https://cr.minzdrav.gov.ru/schema/258_2 (access date: 07.02.2022 (in Russ.).
5. Chitra T., Papa D., Sinha P., Nandeesha H. Laparoscopic ovarian drilling reduces serum homocysteine levels in women with Polycystic Ovary Syndrome. Eur J Obstet Gynecol Reprod Biol. 2018;221:135–138. DOI: 10.1016/j.ejogrb.2017.12.048.
6. Neven A.C.H., Laven J., Teede H.J., Boyle J.A. A summary on polycystic ovary syndrome: diagnostic criteria, prevalence, clinical manifestations, and management according to the latest international guidelines. Semin Reprod Med. 2018;36(1):5–12. DOI: 10.1055/s-0038-1668085.
7. Legro R.S., Arslanian S.A., Ehrmann D.A. et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(12):4565–4592. DOI: 10.1210/jc.2013-2350.
8. Mitra S., Nayak P.K., Agrawal S. Laparoscopic ovarian drilling: An alternative but not the ultimate in the management of polycystic ovary syndrome. J Nat Sci Biol Med. 2015;6(1):40–48. DOI: 10.4103/0976-9668.149076.
9. Darwish A.M., Kamel M.A., Othman E.R. et al. Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility. Int J Reprod Contracept Obstet Gynecol. 2017;6(11):4771–4777. DOI: 10.18203/2320-1770.ijrcog20174985.
10. Sosnova E.A. Polycystic ovary syndrome. Archiv akusherstva i ginekologii im. V.F. Snegireva. 2016;3(3):116–129 (in Russ.). DOI: 10.18821/2313-8726-2016-3-3-116-129.
11. Yusubova V.R. Laparoscopic ovarian drilling pros and cons. Archiv akusherstva i ginekologii im. V.F. Snegireva. 2017;4(2):68–72 (in Russ.). DOI: 10.18821/2313-8726-2017-4-2-68-72.
12. Giampaolino P., Morra I., Tommaselli G.A. et al. Post-operative ovarian adhesion formation after ovarian drilling: a randomized study comparing conventional laparoscopy and transvaginal hydrolaparoscopy. Arch Gynecol Obstet. 2016;294(4):791–796. DOI: 10.1007/s00404-016-4146-2.
13. Conway G., Dewailly D., Diamanti-Kandarakis E. et al. The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol. 2014;171(4):P1–29. DOI: 10.1530/EJE-14-0253.
14. Lepine S., Jo J., Metwally M., Cheong Y.C. Ovarian surgery for symptom relief in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2017;11(11):CD009526. DOI: 10.1002/14651858.CD009526.pub2.
15. Fernandez H., Morin-Surruca M., Torre A. et al. Ovarian drilling for surgical treatment of polycystic ovarian syndrome: a comprehensive review. Reprod Biomed Online. 2011;22(6):556–568. DOI: 10.1016/j.rbmo.2011.03.013.
16. Gjønnaess H., Norman N. Endocrine effects of ovarian electrocautery in patients with polycystic ovarian disease. Obstet Gynaecol. 1987;94(8):779–783. DOI: 10.1111/j.1471-0528.1987.tb03726.x.
17. Medvedeva I.N., Khuraseva A.B., Svyatchenko K.S., Biryukova T.A. Laparoscopy for the recovery of reproductive health in women with polycystic ovary syndrome. Obstetrics, gynecology and reproduction. 2017;11(4):30–34 (in Russ.). DOI: 10.17749/2313-7347.2017.11.4.030-034.
18. Lapina I.А., Ozolinya L.А., Dobrokhotova Yu.E. et al. Complex assessment of the effect of glycosaminoglycans on the system of haemostasis in patients with polycystic ovary syndrome. Gynecology, Obstetrics and Perinatology. 2019;18(5):35–41 (in Russ.). DOI: 10.20953/1726-1678-2019-5-35-41.
19. Bordewijk E.M., Ng K.Y.B., Rakic L. et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2020;2(2):CD001122. DOI: 10.1002/14651858.CD001122.pub5.
20. Ovcharenko D.V. Choice of method of surgical treatment of infertility in polycystic ovary syndrome: thesis. M.; 2021 (in Russ.).
21. Helmy M., Saleh S., El-Khouly N. et al. Transvaginal needle versus laparoscopic ovarian drilling in drug-resistant polycystic ovary syndrome: a randomized, controlled study. Menoufia Med J. 2019;32(2):436–440. DOI: 10.4103/mmj.mmj_651_17.
22. Lizneva D., Suturina L., Walker W. et al. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106(1):6–15. DOI: 10.1016/j.fertnstert.2016.05.003.
23. Gadzhanyan E.S., Ishchenko A.I., Zuev V.M. et al. Comparative analysis of laser ovarian drilling in surgical management of polycystic ovarian syndrome. Sechenovskiy vestnik. 2016;4(26):46–52 (in Russ.).
24. Campbell I.W., Howlett H., Holman R.R., Bailey C.J. Metformin. 60 years of clinical experience. Br J Diabetes. 2017;17:167–169. DOI: 10.15277/bjd.2017.154.
25. Gasimova D.M. Ovarian reserve and fertility after urgent ovarian surgery: thesis. SPb.; 2018 (in Russ.).
26. Peters A., Rindos N.B., Lee T. Hemostasis during ovarian cystectomy: systematic review of the impact of suturing versus surgical energy on ovarian function. J Minim Invasive Gynecol. 2017;24(2):235–246. DOI: 10.1016/j.jmig.2016.12.009.
27. Saprykina L.V., Gulshin V.A. Possibilities of ovulation control in patients with polycystic ovary syndrome on the background of therapy. RMJ. 2018;5(I):29–32 (in Russ.).
28. Amer S.A., Shamy T.E., James C. et al. The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis. Reproduction. 2017;154(1):R13–R21. DOI: 10.1530/REP-17-0063.
29. Posadzka E., Nocuń A., Jach R. et al. Assessment of ovarian reserve in patients with ovarian endometriosis following laparoscopic enucleation of a cyst accompanied by CO₂ laser ablation or electroablation. Przegl Lek. 2016;73(1):6–10. PMID: 27120941.
30. Paul C., Laganà A.S., Maniglio P. et al. Inositol’s and other nutraceuticals’ synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome: state-of-the-art and future perspectives. Gynecol Endocrinol. 2016;32(6):431–438. DOI: 10.3109/09513590.2016.1144741.
31. Laganà A.S., Rossetti P., Sapia F. et al. Evidence-based and patient-oriented inositol treatment in polycystic ovary syndrome: changing the perspective of the disease. Int J Endocrinol Metab. 2017;15(1):e43695. DOI: 10.5812/ijem.43695.
32. Hendriks M.L., König T., Korsen T. et al. Short-term changes in hormonal profiles after laparoscopic ovarian laser evaporation compared with diagnostic laparoscopy for PCOS. Hum Reprod. 2014;29(11):2544–2552. DOI: 10.1093/humrep/deu237.
33. Debras E., Fernandez H., Neveu M.E. et al. Ovarian drilling in polycystic ovary syndrome: Long term pregnancy rate. Eur J Obstet Gynecol Reprod Biol X. 2019;4:100093. DOI: 10.1016/j.eurox.2019.100093.
34. Ferraretti A.P., Gianaroli L., Magli M.C. et al. Transvaginal ovarian drilling: a new surgical treatment for improving the clinical outcome of assisted reproductive technologies in patients with polycystic ovary syndrome. Fertil Steril. 2001;76(4):812–816. DOI: 10.1016/s0015-0282(01)02001-5.
35. Giampaolino P., De Rosa N., Della Corte L. et al. Operative transvaginal hydrolaparoscopy improve ovulation rate after clomiphene failure in polycystic ovary syndrome. Gynecol Endocrinol. 2018;34(1):32–35. DOI: 10.1016/s0015-0282(01)02001-5.
36. Lebbi I., Ben Temime R., Fadhlaoui A. et al. Ovarian drilling in PCOS: is it really useful? Front Surg. 2015;2:30. DOI: 10.3389/fsurg.2015.00030.
37. Mercorio F., Mercorio A., Di Spiezio Sardo A. et al. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second-look minilaparoscopy. Fertil Steril. 2008;89(5):1229–1233. DOI: 10.1016/j.fertnstert.2007.05.009.
38. Legro R.S., Dodson W.C., Kunselman A.R. et al. Benefit of delayed fertility therapy with preconception weight loss over immediate therapy in obese women with PCOS. J Clin Endocrinol Metab. 2016;101(7):2658–2666. DOI: 10.1210/jc.2016-1659.
39. Zhang J., Tang L., Kong L. et al. Ultrasound-guided transvaginal ovarian needle drilling for clomiphene-resistant polycystic ovarian syndrome in subfertile women. Cochrane Database Syst Rev. 2021;11(11):CD008583. DOI: 10.1002/14651858.CD008583.pub3.
40. Zhang J., Zhou K., Luo X. et al. Variation of Laparoscopic Ovarian Drilling for Clomiphene Citrate-resistant Patients with Polycystic Ovary Syndrome and Infertility: A Meta-analysis. J Minim Invasive Gynecol. 2020;27(5):1048–1058. DOI: 10.1016/j.jmig.2019.06.022.

This work is licensed under a Creative Commons «Attribution» 4.0 License.
















