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PCOS-Infertility- When to do Laparposcopy
The basic problem in PCOS (Polycystic Ovary Syndrome) is that there are numerous eggs in the ovaries but they do not grow and Ovulate (release of eggs).

The first line of treatment in PCOS is weight control. Medicines like Metformin or Inositol can be added, if needed.

The second step is OVULATION INDUCTION (OI)- giving MEDICINES, ORALLY (Clomiphene or Letrozole) so that the eggs grow and get released ("Ovulation"). But while taking medicines, its important to see if the medicines are able to induce ovulation, by TVS Follicular Study.

What to do if the oral medicines are not working (you are not ovulating with oral medicines?)
In that case, we have 2 options-

1) Injection Gonadotrophin

2) Laparoscopy

Laparoscopic Ovarian Drilling (LOD)-
By Laparoscopy ("Microsurgery", putting camera inside the abdomen by key-hole), some of the follicles ("Cysts") are burned using electric current.

The Advantages of Laparoscopy are-
a) Any other possible diseases and causes of infertility can be detected (diseases of the tubes, endometriosis etc).

b) If the woman is having pain/ endometriosis/ cyst etc, these can be treated at the same time.

c) After laparoscopy, the chance of spontaneous conception increases (without need of frequent visits to the doctors).

The Disadvantages of Laparoscopy are-
a) If LOD is done in over-enthusiastic manner (many cysts are burned), it will damage the ovaries and the woman can land up in PREMATURE MENOPAUSE.

b) There is risk of anaesthesia and surgery.

c) The "Adhesion" (abnormal attachment between the organs) caused by Laparoscopy may further increase the risk of INFERTILITY.

So, LOD is done ONLY IF-
i) If the weight of the woman is normal;

ii) LH and AMH both are very high; and

iii) There was no response (Ovulation) with oral medicines.

All these 3 factors MUST be present before LOD.
Otherwise, LOD will do more harm than benefits.

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