Transvaginal ovarian drilling: a new surgical treatment for improving the clinical outcome of assisted reproductive technologies in patients with polycystic ovary syndrome

Objective: To evaluate the efficacy of transvaginal ovarian drilling (TVOD) in patients with polycystic ovary syndrome (PCOS) who were undergoing IVF treatment. Design: Pilot study. Setting: Reproductive medicine unit. Patient(s): Eleven patients with PCOS undergoing treatment with assisted reproductive technology (ART). Intervention(s): Selection criterion for TVOD was repeated poor performance in greater than or equal to2 previous IVF cycles. Main Outcome Measure(s): Controlled ovarian hyperstimulation parameters, number of eggs collected, fertilization rate. embryo cleavage rate, implantation rate, pregnancy rate compared with the cycles before TVOD. Result(s): In the cycle after TVOD, a significantly higher dosage of FSH was used (33.5 +/- 12 IU vs. 52.2 +/- 15 IU) to collect a higher number of oocytes in the presence of similar E-2 values at the day of hCG administration. This resulted in significantly higher fertilization and cleavage rates (27% vs. 66% and 54% vs. 72%, respectively). The pregnancy and the implantation rates after TVOD were similar to those for normovulatory patients undergoing IVF for tubal factor infertility during the study period. Conclusion(s): Our data suggest that the TVOD is effective in improving IVF results in difficult to treat patients with PCOS, and it is less invasive and less expensive when compared with laparoscopic ovarian diathermy. (Fertil Steril(R) 2001;76:812-6. (C) 2001 by American Society for Reproductive Medicine.).