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11 - Laparoscopic surgical treatment of infertility related to PCOS revisited

Published online by Cambridge University Press:  29 September 2009

By
Jean Cohen
Edited by
Gabor T. Kovacs  and
Robert Norman
Jean Cohen
Affiliation:
France
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
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Summary

Introduction

Polycystic ovarian syndrome (PCOS) – characterized by chronic anovulation, and/or androgen excess, hypersecretion of luteinizing hormone (LH), obesity, and infertility – is a relatively common condition in women during reproductive years. The consistent morphologic feature is a peripheral ring of small follicles in association with increased ovarian stroma. It remains an incompletely understood entity with varying degrees of severity and partial symptomatologies.

Wedge resection of ovaries has been proposed by Stein in 1935 (Stein and Leventhal 1935). For long it has been the only treatment of polycystic ovaries (PCO). When treatments by antiestrogens (clomiphene citrate) became available (Greenblatt 1961) and when the good results of these treatments were known, the surgical technique which had the inconvenience of periovarian adhesion formation disappeared. Subsequently numerous publications have indicated the interest of laparoscopic techniques (biopsy, cauterization, multi-electrocoagulation, laser, etc.) in cases of non-response to the medical treatments. The first attemps were tried in France thanks to Raoul Palmer's ovarian biopsy forceps (Palmer and Cohen 1965, Cohen et al. 1972a, b).

Techniques

Electrocautery

Biopsy

The first publication concerning pregnancies obtained after laparoscopic ovarian biopsies with cauterization with Palmer forceps date back to 1972. At this time, Cohen and colleagues (Cohen et al. 1972a) reported 21 pregnancies after 51 successive ovarian biopsies. They came to the conclusion that this procedure has a therapeutic effect on some ovarian infertilities (Cohen et al. 1972b).

Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 159 - 176
Publisher: Cambridge University Press
Print publication year: 2007

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