A 29-year-old woman with PCOS and anovulatory infertility fails to ovulate on clomiphene 150 mg × 3 cycles. Letrozole was not tried. She is now counselled regarding laparoscopic ovarian drilling (LOD). Which statement about LOD is MOST accurate?

• A LOD offers the advantage of multiple follicle development, increasing live birth rates over gonadotrophins
• B LOD produces unilateral drilling results equivalent to bilateral drilling
• C LOD is effective by permanently increasing FSH secretion through destruction of androgen-producing stromal tissue ✓
• D LOD is the preferred second-line treatment over gonadotrophins per ESHRE/ASRM 2023 guidelines

Explanation

LOD reduces ovarian androgen production by destroying androgen-secreting stroma, which secondarily lowers inhibin secretion and raises FSH, restoring folliculogenesis. This is the primary mechanism. LOD is NOT preferred over gonadotrophins in modern guidelines — both are acceptable second-line options, and gonadotrophins with careful monitoring may give comparable or better cumulative pregnancy rates. LOD's advantage is spontaneous ovulation for multiple cycles without OHSS risk, but it carries surgical risk and potential for adhesions and reduced ovarian reserve.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.