Which statement about laparoscopic ovarian drilling in PCOS is CORRECT?
- A It is the first-line ovulation induction agent in all anovulatory PCOS
- B It carries a higher multiple pregnancy rate than gonadotropin therapy
- C Drilling of one ovary alone is sufficient, as the effect is largely endocrine ✓
- D It restores ovulation by destroying granulosa cells and lowering inhibin B
Correct answer: C. Drilling of one ovary alone is sufficient, as the effect is largely endocrine
Explanation
Ovarian drilling destroys stromal tissue producing androgens and inhibin, reducing the negative feedback on FSH and restoring ovulation through a systemic endocrine shift, so unilateral diathermy is as effective as bilateral and limits ovarian reserve damage. It is a second-line option after failed oral ovulation induction, not first-line, ruling out A. Its main advantage over gonadotropins is a lower, not higher, multiple pregnancy rate, ruling out B. The target is stroma and theca, not granulosa cells specifically.
Reference: Berek and Novak's Gynecology, 16th ed.
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