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Infertility

Ovarian Cautery

11/07/2008

Question:

Dear doctor, I was diagnosed with PCOS and treated with clomiphene for three cycles. In the first cycle 50mg of the drug resulted in follicle maturation but no pregnancy. In the next cycle no follicle appeared and I had to increase the dose. This resulted in ovarian hyperstimulation. Thereafter a new follicle was found on ultrasound without any stimulation, but I don`t know weather it ovulated or not. Now my doctor offers laparoscopic ovarian electrocautery. Do you find I have indications for the procedure? How safe is it? What are the chances of pregnancy? Thank You very much!

Answer:

The use of laparoscopic ovarian drilling can be used for patients who do not respond to oral medications. Approximately 60% of patients who did not ovulate using fertility pill, are able to ovulate with fertility pills after undergoing laparoscopic ovarian drilling.

However, you have clearly responded to adequate doses and have even hyperstimulated (although this is quite unusual for patients taking oral medications such as clomiphene citrate).  I would suggest trying a different fertility pill such as letrozole (femara) with ultrasound monitoring.  Low dose fertility shots can also be helpful in patients who become resistant to clomiphene citrate. 

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Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati