title: Three decades after Gjönnaess's laparoscopic ovarian drilling for treatment of PCOS; what do we know? An evidence-based approach.
abstract: BACKGROUND
  The introduction of laparoscopic ovarian drilling (LOD) by Gjönnaess in 1984 as a substitute for ovarian wedge resection created opportunities for extensive research given its worldwide application for ovulation induction in women with polycystic ovary syndrome (PCOS).
  
  
  OBJECTIVE
  To critically evaluate and summarize the current body of literature regarding the role of LOD for the management of PCOS entailing its different preoperative, operative and postoperative aspects. In addition, long-term efficacy, cost-effectiveness, patient preference and health-related quality of life issues will be evaluated together with other available alternatives of ovulation induction treatments.
  
  
  METHODS
  A PubMed search was conducted looking for the different trials, reviews and various guidelines relating to the role of LOD in the management of PCOS.
  
  
  RESULTS
  LOD whether unilateral or bilateral is a beneficial second-line treatment in infertile women with clomiphene citrate (CC)-resistant PCOS. It is as effective as gonadotrophin treatment but without the risk of multiple pregnancy or ovarian hyperstimulation and does not require intensive monitoring. Increased responsiveness of the ovary to CC especially in patients who remain anovulatory following LOD is another advantage. Recent evidence suggests that relatively novel oral methods of ovulation induction, e.g. CC plus metformin, CC plus tamoxifen, rosiglitazone plus CC and aromatase inhibitors represent a successful alternative to LOD in CC-resistant PCOS. Meanwhile current evidence does not support LOD as a first-line approach in PCOS-related anovulation or before IVF.
  
  
  CONCLUSIONS
  LOD is currently recommended as a successful and economical second-line treatment for ovulation induction in women with CC-resistant PCOS.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt. hatem_ah@hotmail.com
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
authors.forename: Hesham
authors.initials: H
authors.lastname: Al-Inany
authors.forename: Michel
authors.initials: M
authors.lastname: De Vos
authors.forename: Herman
authors.initials: H
authors.lastname: Tournaye
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007986:Luteinizing Hormone / Q000097:blood; D010062:Ovulation Induction / Q000009:adverse effects / Q000191:economics / Q000379:methods; D018579:Patient Selection; D011085:Polycystic Ovary Syndrome / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011788:Quality of Life; D012086:Reoperation; D013739:Testosterone / Q000097:blood
chemical_list: D013739:Testosterone; D007986:Luteinizing Hormone