For some, it’s an alternative to IVF.
The bad news about Polycystic Ovary Syndrome (PCOS) is that people still suffer with it. The good news is that more people are talking about it. On a recent episode of Teen Mom, cast member Maci Bookout went to her doctor to frankly discuss her own experiences with PCOS and her options for treatment. Something to consider, Bookout’s doctor told her, was a procedure called laproscopic ovarian drilling (LOD).
Before we get into the nitty gritty about this outpatient procedure, it’s important to understand what happens when you have PCOS. “PCOS is the most common hormonal disorder in women,” says Dr. Mark Trolice of The IVF Center. “There is an unexplained abnormal synchrony from the brain to the ovaries resulting in an elevation of the male hormone testosterone and in a lack of ovulation.” Folks who have PCOS experience unpredictable periods (Bookout herself says she’s had months where she doesn’t have her period at all, and then others when she’ll bleed for two weeks straight), unwanted hair growth, and have enlarged ovaries with cysts on the outer edges.
PCOS is not something you cure. Rather, it’s managed via weight loss (people with PCOS often struggle with weight because the condition makes the body more resistant to insulin), which aims to restore ovulation, as well as medication. If you want to get pregnant, PCOS can make it complicated, and if regular ovulation doesn’t come as the result of weight loss and/or medication, that’s when one might consider other alternatives, like IVF, or laproscopic ovarian drilling.
Here’s how it works: A laproscope (a viewing device) is inserted into your belly button and a balloon inflated so that the doctor can see your pelvic organs. (While your doctor is performing the procedure, they can also assess if any other reproductive issues are happening.) Multiple punctures are made in the ovary – that’s the drilling part – which reduce the amount of cells producing testosterone. The idea is that by destroying ovarian tissue, the hormone balance is restored and you’ll start to ovulate regularly again. With that comes a decreased risk of uterine cancer, as well as a cessation of PCOS symptoms, a regular ovulation rate of around 0%, and pregnancy rates around 40-60%. You can go home within hours after the surgery, and likely resume your normal life after a few days, although full recovery can take up to 4 weeks.
It’s not always as simple as it sounds, though. Scar tissue from the drilling can prove challenging, as it can decrease future ovarian reserve (your capacity to produce viable eggs), says Dr. Carolyn Alexander of Southern California Reproductive Center. She has performed LOD, mainly on folks who aren’t eligible for IVF or have religious objections to it. While studies have shown that LOD can result in long term ovulation, you also might have regular periods for a while, particularly right after the procedure, only to have them become irregular again. You could experience resistance to the surgery, and there is the possibility of destroying the ovary and inducing menopause. If the surgery isn’t successful, your doctor might suggest you try medication again.
Because reproductive technologies have advanced, LOD is no longer commonly performed. Dr. Tami Prince is an OB/GYN at Women’s Health and Wellness Center of Georgia, LLC, as well as a Medical Director with U.S. HealthWorks/Concentra. She says LOD (also known as laproscopic ovarian cautery) is I still considered a “second line treatment” for PCOS – the first line being medication to induce ovulation. Some folks, such as those with glucose intolerance, are resistant to these treatments, Clomiphene in particular, and that’s when LOD might be an option. In other words, if you want to have kids, it’s the step between medicinal treatment of PCOS and pursuing IVF.
It goes without saying that you should discuss LOD with your doctor to see if it’s the right option for you. Insurance companies may or may not cover it, although if you can show that you’ve gone through the first line of PCOS treatment unsuccessfully, that could work in your favor. “There are plenty of studies that have proven the success rate of LOC,” says Prince. “If an insurance company denies treatment, the treating physician can write a letter of support and usually can get a denial reversed.”