Surgical Management of PCOS & Ovarian Drilling – Restore Ovulation with Precision & Safety
Tried Everything and Still Not Ovulating? Surgery May Be Your Next Safe, Effective Step.
For the vast majority of women with Polycystic Ovary Syndrome (PCOS), effective management begins with lifestyle modifications and medical treatments. Approaches such as dietary changes, regular exercise, and medications like Letrozole or Clomid often successfully restore hormonal balance and ovulation. However, for a subset of patients, these conservative treatments may not yield the desired results, leaving them feeling frustrated and without a clear path forward.
In these specific cases, when medical interventions have been exhausted, surgical management – particularly a minimally invasive procedure known as Laparoscopic Ovarian Drilling (LOD) – can offer a safe and highly effective solution to restore ovulation and significantly improve fertility prospects. At Minnerva Clinic, led by the experienced Dr. Pragya Gupta (MBBS, MD-OBGYN, DNB, FCG), we specialize in comprehensive PCOS care, including advanced surgical options. Our approach is step-by-step, ensuring that surgery is considered only when it is the most appropriate and beneficial next step for your unique situation.
When is Surgery Considered in PCOS?
Surgical intervention for PCOS is not a first-line treatment. Dr. Pragya Gupta carefully evaluates each patient to determine if it is the right course of action.
Medical Treatments Have Failed
This is the primary indication. If you've undergone multiple cycles of ovulation induction (Letrozole, Clomid) and still haven't achieved consistent ovulation, LOD may be recommended.
No Ovulation Despite Hormonal Correction
Even after addressing underlying hormonal imbalances, some women with PCOS continue to experience chronic anovulation. LOD can help stimulate natural ovulation.
Severe Androgenic Symptoms
While its primary benefit is ovulation, LOD can also help alleviate severe symptoms like excess hair growth (hirsutism) and acne that haven't responded to other treatments.
IVF Not Preferred or Affordable
For some couples, LOD offers a less invasive and often more affordable alternative to achieve ovulation and natural conception compared to IVF.
High AMH / Chronic Anovulation
Women with very high AMH levels and classic polycystic ovaries on ultrasound are often good candidates, as their ovaries are hyperactive in producing androgens.
Types of Surgical Management for PCOS
Laparoscopic Ovarian Drilling (LOD)
This is the cornerstone of surgical management for anovulatory PCOS. It is a minimally invasive procedure designed specifically to restore ovulation.
Diagnostic Laparoscopy for Other Issues
In some cases, a diagnostic laparoscopy may be performed to investigate and treat other potential causes of infertility like endometriosis, tubal blocks, or adhesions.
Adhesion Removal (Adhesiolysis)
If scar tissue (adhesions) is found around the ovaries or fallopian tubes, it can be carefully removed to improve reproductive function.
Myomectomy / Ovarian Cystectomy
If uterine fibroids or ovarian cysts are impacting fertility, they may be removed during the same laparoscopic procedure to address co-existing conditions.
What is Ovarian Drilling?
Ovarian Drilling, or Laparoscopic Ovarian Drilling (LOD), is a minimally invasive surgical procedure performed to induce ovulation in women with PCOS who haven't responded to conventional medical treatments.
The Procedure: Keyhole Surgery with Tiny Punctures
LOD is a keyhole surgery performed through very small incisions (0.5 to 1 cm) in the abdomen. A thin, lighted telescope (laparoscope) allows the surgeon to view the pelvic organs. Using specialized instruments, the surgeon makes a few tiny punctures (typically 4-10 per ovary) on the surface of each ovary using electrical energy or a laser.
How it Works: Reducing Androgen Production
These small punctures destroy a small amount of the ovarian tissue that produces androgens (male hormones). This reduction in testosterone production leads to improved hormonal balance and enhanced sensitivity to FSH, the hormone essential for follicle growth and ovulation.
Promoting Natural Ovulation in 60–80% of Women
Studies show that 60-80% of women with PCOS who undergo ovarian drilling will start ovulating spontaneously within a few months post-surgery, significantly increasing the chances of natural conception.
The procedure is performed under general anesthesia and typically requires only a short, one-day hospital stay.
Benefits of Ovarian Drilling
Natural Ovulation Without Long-Term Meds
For many, LOD restores spontaneous ovulation, reducing or eliminating the need for cyclical fertility medications.
Increases Sensitivity to Fertility Drugs
The ovaries become more responsive to lower doses of medications like Clomid or Letrozole if they are needed later.
Minimal Scarring, Short Recovery
Being a minimally invasive surgery, it involves tiny incisions, leading to a shorter and less painful recovery period.
Addresses Androgen Excess
By targeting androgen-producing tissue, LOD helps lower testosterone levels, improving symptoms like hirsutism and acne.
Cost-Effective Alternative to IVF
For certain patients, LOD can be a more cost-effective and less invasive alternative to immediate IVF.
Risks & Considerations
Rare Risk of Reduced Ovarian Reserve
There's a very low risk of damaging too much ovarian tissue, which could reduce the egg count. This risk is minimized when performed by an experienced surgeon.
Best Performed by Experienced Surgeons
The skill of the laparoscopic surgeon is crucial to minimize risks and maximize benefits. Dr. Pragya Gupta has extensive experience in such procedures.
Post-Surgery Monitoring Needed
Ongoing monitoring of your cycle and hormonal profile is essential to track the effectiveness of the surgery and plan next steps.
Not Suitable for Everyone
LOD is most effective for women with specific characteristics, such as high AMH and resistance to oral medications. Strict criteria must be met.
Dr. Pragya Gupta’s Approach to Surgical PCOS Management
Dr. Gupta's philosophy is centered on patient safety, informed decision-making, and achieving the best outcomes with the least invasive methods. She ensures all conservative treatments have been explored first and follows international guidelines for LOD. Her approach includes comprehensive pre- and post-op hormone reviews and minimally invasive, fertility-sparing techniques, all performed in collaboration with a highly skilled surgical and anesthesia team.
Post-Surgery Recovery & Monitoring
Understanding the recovery process is crucial for a smooth transition and effective fertility planning.
- Recovery Period: Most women need only 1–3 days of downtime, with mild discomfort manageable with pain relievers.
- First Period: It's important to be patient; your first period may take 4–6 weeks to arrive as your body adjusts.
- Post-Surgery Tracking: Dr. Gupta will schedule follow-up TVS scans and ovulation tracking to confirm if spontaneous ovulation has resumed.
- Fertility Planning: The window of opportunity for natural conception is typically within 3–6 months post-surgery. Dr. Gupta will guide you on the best time to start trying.
Why Choose Minnerva Clinic for PCOS Surgery?
Female Gynecologist with Laparoscopic Experience
Dr. Pragya Gupta brings extensive experience, ensuring precision, safety, and a deep understanding of women's reproductive health.
Trusted Surgical Partners & Teams
We ensure your surgery is performed in a state-of-the-art environment with a highly skilled anesthesia team, whether in-house or with our reputable partners.
Clear, Informed Consent & Patient Education
We empower you with knowledge, providing a thorough explanation of the procedure, its benefits, risks, and alternatives so you can make an informed decision.
Emotional and Fertility Support Post-Op
Our team provides ongoing emotional support and expert guidance on your fertility planning post-procedure, helping you navigate the next steps with confidence.
Patient Testimonials
"After 2 failed IUI cycles and no ovulation despite trying multiple medications, I felt hopeless. Dr. Pragya suggested ovarian drilling. I ovulated naturally the very next month! I conceived soon after. It truly was the reset my body needed."
"My severe acne and hair growth were impacting my confidence. Medical treatments helped a little, but not enough. Dr. Pragya discussed LOD. The surgery was smooth, and within a few months, my periods became more regular, and my skin significantly cleared."
"I struggled with chronic anovulation. When we decided to try for a baby, Dr. Pragya recommended ovarian drilling. The recovery was quick, and I started ovulating consistently. We are now excitedly planning for IUI, feeling much more optimistic."
FAQs
Is ovarian drilling painful?
The procedure is performed under general anesthesia, so you feel no pain. Post-surgery, you may experience mild to moderate discomfort manageable with prescribed pain relievers, which usually subsides within a few days.
Will I need IVF after surgery?
Not necessarily. The goal of LOD is to restore spontaneous ovulation, increasing your chances of natural conception. For many women, it eliminates the need for IVF or makes them responsive to less intensive treatments like IUI.
Is the procedure safe for unmarried women?
Yes, it is safe. It is a fertility-sparing procedure that aims to restore hormonal balance without affecting future fertility potential. The decision is based on medical necessity, not marital status.
Will the surgery affect my egg count?
When performed by an experienced surgeon like Dr. Pragya Gupta, the risk of significantly reducing your ovarian reserve (egg count) is very low. Precise techniques are used to minimize any impact.
Can the ovaries get damaged?
The goal is to improve ovarian function. While there's a theoretical risk of damage, it is extremely rare with skilled surgeons. The procedure is designed to be very targeted to preserve ovarian health.
How soon can I try to conceive after surgery?
You can typically start trying to conceive within 3 to 6 months after the procedure. This period allows for recovery and for the ovaries to resume ovulation. Dr. Gupta will provide personalized guidance.
Surgery isn’t failure — it’s another step forward when your body needs a reset.
When conservative treatments for PCOS have been exhausted, surgical management like Laparoscopic Ovarian Drilling offers a powerful and effective solution. It's not a sign of failure, but a strategic, safe step toward achieving hormonal balance and your dream of conception.
At Minnerva Clinic, we are committed to guiding you through every option with clarity, compassion, and clinical excellence.
Other Important Links
Infertility treatments in Lucknow
Things to Know before any Infertility treatments
Our Clinic Location in Lucknow
Meet Dr Pragya Gupta (MBBS, MD, DNB Obstetrician and Gynaecologist)
Contact Minnerva Clinic