Honey I drilled your Ovaries....Oops!!

Laparoscopy has come in the fertility management as a boon..or so I thought.
It was once a simple minimally invasive way to have a look at the woman's reproductive organs, treat the disease if any and get out safely, without causing the mayhem of an open surgery. But as they say, too much of anything is not good. Along came the enthusiastic laparoscopic surgeons who took up a diagnostic laparoscopy as the first line management of any couple seeking help with their fertility issues. And the brunt was born by the poor ovaries!

Drilling of ovaries, a term that you may see on the surgery summary of your papers has a lot of explaining to do. Drilling means making small points with some form of heat, cautery, laser etc. This is essentially done for women with PCOS who DO NOT , I repeat DO NOT ovulate with routine drugs in from of tablets and injections. Apart from the fact that drilling is a surgical intervention, it can cause long lasting irreversible effects if done in the wrong group of patients. Ideally, a doctor should have an indication BEFORE they take you in the OT, for laparoscopy, whether a drilling will be needed. The woman needs to be explained the need, pros and cons and the effects and side effects of the same before contemplating the procedure.

When I say side-effects, what I mean is beyond the surgical intervention related problems, there could be actually an iatrogenic reduction in the existing pool of eggs in the ovaries due to the intense heat that ovaries were subjected to in the process of drilling. This could translate to lower number of eggs in the ovaries leading to diminished chances of pregnancy.

Of late we Fertility Specialists are seeing a lot of these young women with not so young ovaries which were drilled and not for the right reasons. Don't get me wrong, Ovarian drilling is something that works well but for a select group of resistant anovulatory PCO women.
It is finally the duty of a doctor to educate the patient about their problems, treatment and possible outcomes and a right of the patient to ask for as well.
Let's do our duty well and look for evidence before we intervene.

"Spare the rod and spoil the lad" is not true for lads, and certainly not true for the ovaries! Lets spare them!

Comments

  1. Syed Zaheer AhmedApril 21, 2014 at 8:15 AM

    Dr.Richa Ma'am,

    I have gone through your article, truely its an eye opener for me.

    ReplyDelete
  2. Dr.Richa JagtapMay 11, 2014 at 9:27 AM

    Thanks Mr Ahmed, I hope to open a lot of shut eyes on this road!

    ReplyDelete

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