Adhesions after Laparoscopic Ovarian Drilling in the Treatment of Women with Polycystic Ovary Syndrome: Should it be a Concern?

Context: In order to restore ovulation, puncturing ovaries with a needle powered by electricity, under laparoscopic observation, in women with anovulatory infertility with polycystic ovarian syndrome is called laparoscopic ovarian drilling (LOD). Although peri-adnexial adhesion after the surgery is inevitable, there is lack of evidence regarding the clinical significance. The objective of the present study is to review the available literature in order to determine the rate of periadnexial adhesions following LOD, and to assess the effect of these adhesions on pregnancy rates..Evidence Acquisition: Electronic search of MEDLINE and EMBASE for English-language and non-English-language articles from 1984 to 2012 and manual search of bibliographies from identified articles were evaluated. Sixteen articles were found to be eligible to obtain main outcome measures. Post-operative adhesion rates were reported to be 0-100% (mean 35.5%, 95%CI: 30.8-40.4) while pregnancy rates after the procedure in these articles were 35-87% (mean 64.3% 95%CI: 58.2-70.7) of the cases.. There were no correlation between the adhesion rates and pregnancy rates (Spearman''s rho=.055, P=.858). None of the preventive measures during or after the procedure were found to be effective in reducing the rate of post-operative adhesions, thereby increasing the pregnancy rates. The incidence of peri-adnexial adhesions after LOD might not be associated with adverse reproductive outcomes.. Until more effective, safer and non-invasive treatments become available, LOD is a relatively safe and effective second-line procedure in anovulatory infertile women with PCOS resistant to clomiphene citrate..