Laparoscopic ovarian drilling (LOD) is a surgical option for clomiphene-resistant PCOS anovulation. Which of the following best describes its mechanism of restoring ovulation?

• A Resection of the ovarian wedge directly reduces ovarian volume and LH secretion
• B Destruction of theca cells permanently eliminates all androgen production
• C Creation of cortical defects increases ovarian blood supply and FSH delivery
• D Removal of androgen-producing ovarian stroma reduces intraovarian androgens, restoring follicular sensitivity to FSH ✓

Explanation

Laparoscopic ovarian drilling uses laser or electrocautery to puncture 4-10 cortical sites per ovary. This destroys androgen-producing ovarian stroma, reducing intraovarian androgen levels and restoring FSH sensitivity, leading to monofollicular ovulation. Option B is incorrect as theca function is not permanently eliminated. Option C misstates the mechanism. Option A describes obsolete wedge resection, not modern drilling.

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

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Written and medically reviewed by the StethoPrep medical team.