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What is ovarian drilling?

What is ovarian drilling?

Ovarian drilling is treatment that is given to patients with polycystic ovary syndrome in order to encourage spontaneous ovulation.

Polycystic ovary syndrome (PCOS) is a common disorder and the women who have it can have a number of signs and symptoms. One of the most significant characteristics is that, in 50% of patients, there is a decrease in the number of ovulatory cycles or even no ovulation whatsoever (anovulation). This makes getting pregnant incredibly difficult. Sufferers can also have other symptoms linked to excess androgens. These include excess body hair, acne and obesity. They are also predisposed to metabolic diseases such as diabetes mellitus.

A healthy lifestyle and pharmaceutical drugs, such as clomiphene, aimed at inducing ovulation are the bases for any course of treatment. However, a significant number of women (between 15 and 50%) are resistant to therapies of this kind and have to undergo more complex and costly techniques such as in vitro fertilisation in order to get pregnant.

Patients who do not manage to achieve ovulation following treatment can also attempt ovarian drilling in order to try and get pregnant naturally before they opt for assisted reproduction techniques.

What is it?

Ovarian drilling consists of making numerous perforations on the surface of the ovary in order to decrease its size and make it easier to select an ovulating follicle and release the ova. A significant number of patients achieve restored ovulation with this treatment and their PCOS symptoms also improve.

Use of this technique traditionally entailed surgery (surgical removal of part of the ovary or laparoscopic electrosurgery). However, nowadays, it is possible to get similar results with a non-invasive method. In other words, by using transvaginal follicle puncture and aspiration from both ovaries using a fine needle. It is always performed with ultrasound imaging and no thermal energy sources are needed. It is a painless procedure and the patient only needs to be lightly sedated. Overnight stays in hospital are not required. Furthermore, this method eliminates the risk of complications associated with surgical drilling such as pelvic adhesions or the complications associated with having a general anaesthetic.

After the procedure, the patient is monitored in order to see if she is ovulating spontaneously and, should this be the case, we are able to recommend the most appropriate time for her and her partner to have sexual intercourse. If the patient does not ovulate or get pregnant despite trying this course of treatment, assisted reproduction techniques such as in vitro fertilisation can be used.

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Dr Ana Fuentes, a gynaecologist at Instituto Bernabeu.

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