Laparoscopic ovarian drilling (LOD) for PCOS-associated anovulatory infertility is thought to work by which mechanism?

• A Directly destroying mature follicles to allow new folliculogenesis
• B Reducing ovarian androgen production (by destroying androgen-secreting stromal tissue), thereby lowering circulating androgens and restoring FSH-responsive folliculogenesis ✓
• C Stimulating GnRH pulse frequency by ovarian afferent nerve signals
• D Creating pelvic adhesions that mechanically assist ovum capture by the tube

Explanation

LOD destroys androgen-secreting ovarian stromal tissue, reducing intraovarian and circulating androgen levels. This results in a fall in LH, a relative rise in FSH, and resumption of normal folliculogenesis and ovulation. It is indicated for clomiphene-resistant PCOS-associated anovulation, particularly in lean women without severe hyperandrogenism. It avoids the risk of multiple pregnancy seen with gonadotropin therapy.

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

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Written and medically reviewed by the StethoPrep medical team.