title: Drilling: medical indications and surgical technique.
abstract: BACKGROUND
  anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation.
  
  
  OBJECTIVE
  to identify the current indications of laparoscopic ovarian drilling and the best surgical technique.
  
  
  METHODS
  a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling.
  
  
  RESULTS
  we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling.
  
  
  CONCLUSIONS
  laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.
authors: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Cristina Kallás
authors: CK
authors: Hueb
authors: Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors: João Antônio
authors: JA
authors: Dias Júnior
authors: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors: Maurício Simões
authors: MS
authors: Abrão
authors: Faculdade de Direito do Sul de Minas, Pouso Alegre, MG, Brazil.
authors: Elias Kallás
authors: EK
authors: Filho
mesh_terms: D000858:Anovulation / Q000601:surgery*; D015992:Body Mass Index; D002996:Clomiphene; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007986:Luteinizing Hormone / Q000097:blood; D011085:Polycystic Ovary Syndrome / Q000601:surgery*; D011247:Pregnancy
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D007986:Luteinizing Hormone