from Section 3 - Difficulties and Complications of Ovarian Stimulation and Implantation
Published online by Cambridge University Press: 14 April 2022
Surgical methods of ovulation induction for women with clomiphene (clomifene) citrate-resistant polycystic ovary syndrome (PCOS) include laparoscopic ovarian drilling with diathermy. This technique has replaced the more invasive and damaging technique of ovarian wedge resection first introduced by Gjønnaess in the early 1980s [1]. Laparoscopic ovarian surgery is free from the risks of multiple pregnancy and ovarian hyperstimulation, which makes it an attractive procedure for PCOS women, but surgery is not without risks. The techniques of laparoscopic ovarian diathermy have been described previously [2;3]. Studies suggest that four punctures per ovary with application of diathermy current via needle cautery set at 30 watts for 5 seconds per puncture (i.e., no more than 600 J per ovary) should produce an optimal response. The greater the damage to the surface of the ovary the greater the risk of peri-ovarian adhesions estimated at 60 percent (ranging from 0 to 100 percent) in treated women.
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