Laparoscopic Ovarian Drilling Under Transvaginal Ultrasonographic Guidance

Abstract

Gross sclerocytic changes in the ovary were related by (Stein and Leventhal in 1935), to a clinical syndrome consisting of "menstrural irregularity featuring amenorrhea, infertility, hirsutism, retarded breast development and obesity.

The polycystic ovary is usually enlarged and is characterized by a smooth pearly white capsule. For years it was erroneously believed that the thick sclerotic capsule acted as a mechanical barrier to ovulation. A more accurate concept is that the polycystic ovary is a consequence of the loss of ovulation and the achievement of the steady state of persistent anovulation.

The clinical spectrum is broad and extends from relatively normal menses to chronic oligomenorrhea or amenorrhea and from no hirsutism to virilization. Also the symptoms may range from simple cystic acne, cephalic hair loss, or mild facial hirsutism to instances of oligomenorrhea or amenorrhea, sterility and severe generalized hirsutism.

The diagnosis of polycystic ovarian disease depends on the clinical features, laboratory investigations as gonadotropins, androgens and sex steroid levels in the urine and plasma, also by ultrasonograpy color Doppler, MRI and Laparscopy.

The clinical consequences of persistent anovulation include infertility, menstrual problems, hirsutism and acne, increased risk of endometrial cancer, breast cancer, increased CVD and disbetes mellitus, spontaneous abortion risks and bone diseases.