Clinical outcome of unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome: a comparative study

Poonam Laul, Pinkee Saxena, Sonali Kurrey, Vijay K. Kadam, Urvashi Migalani


Background: The aim of the current study is to compare the efficacy of laparoscopic unilateral ovarian drilling with bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome in terms of clinical response, change in biochemical parameters, ovulation rate, pregnancy rate and miscarriage rate.

Methods: The study was conducted on 45 women with anovulatory infertility due to PCOS with clomiphene citrate resistance. By random selection, all patients were divided in two groups. In group 1, unilateral ovarian drilling was done and in group 2, bilateral ovarian drilling was done. A maximum of 5 drills were performed using insulated unipolar diathermy needle. Patients were followed up for one year and the clinical outcome in two groups were recorded and compared.

Results: Post ovarian drilling it was seen that no major differences were noted between the two groups in return of spontaneous menstruation at 6 weeks (65% vs 60%), overall ovulation rate (55% vs 65%) and pregnancy rate (45% vs 40%). The mean fall in serum LH, serum FSH and serum testosterone were also similar in the two groups.

Conclusions: Unilateral laparoscopic ovarian drilling had similar efficacy as bilateral laparoscopic ovarian drilling in terms of restoration of normal menstrual pattern, ovulation and achieving pregnancy. It is an effective alternative minimally invasive procedure for patients with resistant PCOS.


Bilateral, Clomiphene citrate resistance, Laparoscopic ovarian drilling, PCOS, Unilateral

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Fleming R, Hopkinson ZE, Wallace AM, Greer IA, Sattar N. Ovarian function and metabolic factors in women with oligomenorrhea treated with metformin in a randomized double blind placebo-controlled trial. J Clin Endocrinol Metab. 2004;87:569-74.

Dickey RP, Taylor SN, Curole DN, Rye PH, Pyrzak R. Incidence of spontaneous abortion in clomiphene pregnancies. Hum. Reprod.1996;11:2623-8.

Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea (Cochrane Review). Cochrane Database Syst Rev. 2000;2:CD000056

Fritz MA, Speroff L. Clinical Gynecologic Endocrinology and Infertility: Eight ed. Wolters Kluwer;2011.

Bayram N, Van Wely M, Kaaijk E, Bossuyt P, Van Der Veen F. Using an electrocautery strategy of recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomized controlled trial. BMJ. 2004;328:192-6.

Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscopic. Fertil Steril. 1984;41:20-5.

Greenbalt EM, Casper RF. Adhesion formation after laparoscopic ovarian cautery for polycystic ovarian syndrome: lack of correlation with pregnancy rate. Fertil Steril. 1993 Nov;60(5):766-70.

Mercorio F, Mercorio A, Di Spiezio Sardo A, Barba GV, Pellicano M, Nappi C. Evaluation of ovarian adhesion formation after laparoscopic ovarian drilling by second look minilaparoscopy. Fertil Steril. 2008 May;89(5):1229-33.

Balen AH, Jacobs HS. A prospective study comparing unilateral and bilateral laparoscopic ovarian diathermy in women with the polycystic ovary syndrome. Fertil Steril.1994;62:921-5.

Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008;89:505-22.

Stein IF Sr. Duration of fertility following ovarian wedge resection-stein-leventhal syndrome. West J Surg Obstet Gynecol. 1964;72:237-42.

Yousef H, Atallah MM. Unilateral ovarian drilling in polycystic ovarian syndrome: a prospective randomized study. Reprod Biomed. 2007;15(4):457.

Roy KK, Baruah J, Moda N, Kumar S. Evaluation of unilateral versus bilateral ovarian drilling in clomiphene citrate resistant cases of polycystic ovarian syndrome. Arch Gynecol Obstet. 2009;280(4):573-8.

Abdelhafeez MA, Ali MS, Sayed SN. Unilateral versus bilateral laparoscopic ovarian drilling in clomiphene citrate resistant polycystic ovary syndrome. Life Sci J. 2013;10(1):3057-60.

Sunj M, Canic T, Baldani DP, Tandara M, Jeroncic A, Palada I. Does unilateral laparoscopic diathermy adjusted to ovarian volume increase the chances of ovulation in women with polycystic ovary syndrome? Hum Reprod. 2013;28(9):2417-24.

Sorouri ZZ, Sharami SH, Tahersima Z, Salamat F. Comparision between unilateral and bilateral ovarian drilling in clomiphene citrate resistance polycystic ovary syndrome patients: a randomised clinical trial of efficacy. Int J Fertil Steril. 2015;9(1):9-1.

Adashi EY, Rock JA, Guzick D, Wentz AC, Jones GS, Jones HW Jr. Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertil Steril. 1981;36(3):320-5.

Kaya H, Sezik M, Ozkaya O. Evaluation of a new surgical approach for the treatment of clomiphene citrate-resistant infertility in polycystic ovary syndrome: laparoscopic ovarian multi-needle intervention. J Minim Invasive Gynecol. 2005;12(4):355-8.

Api M. Is ovarian reserve diminished after laparoscopic ovarian drilling? Gynecol Endocrinol. 2009 Mar;25(3):159-65.