Surgical therapy

In the past, ovarian wedge resection, a procedure whereby a portion of the ovary is removed and the ovary sewn back together, resulted a significant reduction in LH and androgen production, reestablishment of regular menses in more than 75 percent of patients and a pregnancy rate of about 60 percent. However, pelvic adhesive disease, which was often severe, occurred in about 30 percent of patients. There is probably no longer an indication for wedge resection by laparotomy, although electrosurgical incisions, or ‘ovarian drilling,’ has become relatively common place. Success rates of microcautery vary by operator and, while adhesion formation may be considerably less, it is still common. A fine cautery needle is used to make four to 20 punctures on each ovary.

Alternatively, lasers have been used for the same effect with the possible disadvantage possibly greater surface injury and scar tissue formation. Laparoscopic outcomes seem somewhat less effective than traditional wedge resection. The mechanism by which surgical therapy works is not known. It is unclear whether it is surface destruction and thinning of the cortex or reduction of ovarian mass which causes the procedure to be effective. Long term effects are largely unknown.

Earlier menopause due to partial destruction of the oocyte pool is a theoretical risk. Surgical intervention should not be considered first line therapy in treatment PCOS. If hysterectomy is performed for other reasons, it may be justified to remove the ovaries as well. The value of removal of ovaries has not been studied in enough detail to make a comment on the usefulness of this procedure.

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