Polycystic ovarian disease treated by laparoscopic argon laser capsule drilling: comparison of vaporization versus perforation technique.

Forty-four anovulatory women with polycystic ovarian disease (PCOD) were laparoscopically treated with the argon laser. Eighty percent of them were previously resistant to clomiphene citrate therapy. After surgery spontaneous ovulation occurred in 80% of the women. Spontaneous conception occurred in 55% of patients, and another 18% of the women who were previously resistant to clomiphene citrate conceived post-operatively after clomiphene citrate therapy. This gives an overall conception rate of 73% after 18 months (using life table analysis). Two different drilling techniques were used: classical vaporization of the ovarian capsule (22 women), and simple perforation of the ovarian capsule with subcapsular destruction of the ovarian stroma (22 women). No different ovulation or pregnancy rates were observed post-operatively between the two techniques. These results suggest that patients with PCOD can be induced to ovulate, and subsequently conceive, by laparoscopic argon laser treatment. The technique with minimal trauma to the ovarian capsule seems preferable.