Laparoscopic Ovarian Drilling (LOD)

Who Needs LOD?

LOD is specifically indicated for women suffering from clomiphene-resistant PCOS, particularly those who:

1. Have not ovulated or conceived after a number of cycles of ovulation induction. 
2. Are unable to tolerate or do not have a good response to fertility medications. 
3. Have persistently elevated androgen levels (hyperandrogenism). 
4. Have irregular menstrual cycles and anovulation due to PCOS. 
5. Prefer not to consider the risks of gonadotropin therapy, including ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies. 

LOD may also be useful for women with insulin resistance or elevated luteinizing hormone (LH) levels that inhibit ovulation.

Types of LOD Procedures

The fundamental principle of LOD remains the same, but based on the energy source, there are two common techniques:

Electrocautery Ovarian Drilling

Uses a monopolar needle electrode to create 4-10 punctures in each ovary.  The electrode is applied to deliver a specific current to the surface of the ovary. It is done to stimulate ovulation in women with PCOS (polycystic ovary syndrome) who are not ovulating. 

Laser Ovarian Drilling

Uses a laser beam to puncture the ovarian cortex.  The laser has the additional benefit of precision and a lower thermal spread, although it is less frequently used due to the increased cost of the equipment. It is also done to stimulate ovulation in women with PCOS, who are not ovulating and have not responded to fertility medications or weight loss treatments. 

Both procedures are designed to destroy the androgen-producing stroma and restore ovulatory function while preserving the maximal amount of ovarian tissue.

Pre-Treatment Evaluation and Diagnostics

When preparing for the LOD procedure, a full diagnostic work-up must be completed first, including:

• Hormonal Profile: Blood tests to ascertain levels of LH, FSH, AMH, testosterone, insulin, and thyroid hormones.
• Pelvic Ultrasound: to determine the size of the ovaries and confirm there are multiple follicles (polycystic ovaries).
• Glucose Tolerance Test: to check insulin resistance or metabolic syndrome.
• Semen Analysis: to ensure that there is no male factor infertility.
• Tubal Patency: This is usually done around the same time via laparoscopy or hysterosalpingography (HSG).
• Physical Assessment: BMI, hirsutism score, menstrual history, etc.

The patient is counseled in great detail regarding the procedure, success rates, risks, and options.

Selection and Procedure Planning

There are a number of considerations when selecting patients for LOD:

• Previous failures of ovulation induction therapies for infertility
• Duration of infertility and etiology of infertility to assess prognosis
• Ovarian size and number of antral follicles
• Hormonal imbalance or hormonal levels, including circulating levels of androgens
• Body weight and metabolic status of the patient

LOD is performed as a minimally invasive day-case surgical procedure under general anesthesia.  Depending on the size and hormonal profile of the ovaries, the surgeon will determine the number of punctures to make to avoid other potential sources of ovarian damage.

LOD Procedure

The procedure is performed via laparoscopy, which allows direct visualization of the ovaries and surrounding reproductive organs.

1. Anesthesia - General anesthesia is performed to ensure better pain management and comfort throughout the procedure. 
2. Trocar Insertion - Small incisions are made, mostly around the lower abdomen or navel, and then a laparoscope is inserted through one of them. Carbon dioxide gas is then used for abdominal inflation, ensuring more space for instrument manipulation and visualization. 
3. Ovary Examination - Surgeons can visualize the ovaries and the surrounding structures on a monitor with a laparoscope at this stage of the process. 
4. Ovarian Drilling - Specialized instruments are inserted through the other incisions, and multiple small punctures or holes are created in the ovarian tissues. It may be done with heat (electrocautery) or a laser. The aim here is to lower androgen production and promote ovulation. 
5. Completion - After completion, the instruments are removed before the gas is released from the abdomen. The incisions are then closed with the help of sutures. 
6. Recovery - Patients may sometimes experience mild bloating, pain, or fatigue after the procedure. However, recovery is usually quick for most patients, with ovulation resuming within a few weeks to months. 

Risks & Potential Complications of LOD

While LOD is generally safe, there are some risks and complications to be aware of:

• Infection of incisions 
• Bleeding or damage to surrounding organs 
• Adhesions (scar tissue) 
• Complications from anesthesia (rare) 
• Premature ovarian insufficiency (rare with proper techniques)
• Over-treatment leads to diminished ovarian reserve
• Mild discomfort in the abdomen
• Shoulder tip pain from gas used in laparoscopy 
• Transient irregularities in the menstrual cycle

The risks associated with LOD are minimized when patients are selected properly and surgical techniques are used appropriately.

What to Expect After LOD?

Recovery after LOD is usually quick, with most women resuming daily activities within a few days.

• Hospital Stay: Typically discharged the same day or within 24 hours.
• Pain Management: Mild painkillers are prescribed for post-operative discomfort.
• Menstrual Cycles: Ovulation may resume as early as 4–6 weeks after the procedure.
• Ovulation Monitoring: Hormonal testing and ultrasound tracking may be used to confirm ovulation in subsequent cycles.
• Conception Timing: Natural conception is often encouraged for several months post-procedure before considering further fertility treatments.

Post-Treatment Recovery & Long-Term Care

Long-term care after LOD focuses on maximizing fertility outcomes and maintaining hormonal balance.

• Ovulation Monitoring: Regular tracking of menstrual cycles and ovulation through basal body temperature, ovulation predictor kits, or ultrasound.
• Weight Management: Essential for PCOS patients to maintain hormonal equilibrium and improve ovulatory function.
• Lifestyle Adjustments: Includes dietary changes, regular exercise, and management of insulin resistance.
• Additional Fertility Support: If ovulation does not resume within 3–6 months, low-dose fertility medications may be introduced.
• Psychological Support: Addressing anxiety or emotional stress associated with infertility.

LOD can offer a prolonged period of restored ovulation, sometimes lasting up to 12 months or longer.

LOD Success Rate in India

The success rates of LOD in India are comparable to international standards, particularly when performed by experienced gynecologic laparoscopic surgeons.

• Ovulation Rate Post-LOD: Approximately 70–80% of women resume ovulatory cycles within 6 months.
• Conception Rate Post-LOD: 50–60% achieve natural pregnancy within 6–12 months.
• Lower Multiple Pregnancy Risk: Compared to gonadotropin therapy.
• Improved Menstrual Regularity: Reported in the majority of patients post-surgery.

Success is higher in women with lower BMI and less severe PCOS profiles.

Cost of LOD in India

Laparoscopic ovarian drilling is a minimally invasive surgical procedure often used to treat women with polycystic ovary syndrome (PCOS). In India, the cost of this surgery typically ranges from approximately USD 1,500 to USD 3,000, depending on various factors such as the hospital's location, the surgeon's experience, and the patient's specific condition. This price generally includes pre-operative evaluations, the procedure itself, and post-operative care. Many medical facilities in India offer advanced technologies and experienced specialists, making it a sought-after destination for such procedures. 

Why Choose India for LOD?

India is a global destination for high-quality, affordable reproductive surgeries, including LOD.

• Expert gynecologic laparoscopic surgeons with vast experience in PCOS management
• Availability of minimally invasive, daycare procedures
• Advanced operating theaters and state-of-the-art laparoscopic equipment
• Affordable treatment packages compared to Western countries
• Short waiting times and dedicated international patient services
• Seamless coordination with fertility clinics for integrated care

Documents Required for Patients Traveling to India for LOD

For international patients looking for LOD in India, it is necessary to present certain documentation to have a smooth medical journey. These include:

• Valid Passport: Valid for a minimum of six months after the date you travel.
• Medical Visa (M Visa): Granted by the Indian Embassy/Consulate on medical grounds.
• Invitation Letter from Indian Hospital: A formal letter explaining the course of treatment and how long it will last.
• Recent medical records: X-rays, MRIs, blood tests, and a referral note by a doctor in the home country.
• Completed visa application form: With passport-size photographs according to specifications.
• Proof of means: Bank statements dated in the past few months or health insurance.
• Medical Attendant visa: Needed for a companion or caregiver traveling with the patient.

It is advisable to refer to the Indian consulate or your medical facilitator for the latest information and help with documentation.

NOTE: Single parents and same-sex couples should confirm legal requirements with the clinic before starting.

Top LOD Specialists in India

Here are some of the leading LOD specialists in India. 

1. Dr. Hrishikesh Pai, Fortis Bloom IVF Centre, Delhi and Mumbai
2. Dr. Nandita Palshetkar, Fortis Bloom IVF, Mumbai
3. Dr. Firuza Parikh, Jaslok Hospital & Research Centre, Mumbai
4. Dr. Kamini Rao, Milann Fertility Centre, Bangalore
5. Dr. Aradhana Kalra Dawar, Nova IVF Fertility, Delhi

Best Hospitals for LOD in India

Here are some of the top hospitals for LOD in the country. 

1. Nova IVF Fertility, Multiple Locations
2. Cloudnine Fertility, Gurgaon
3. Indira IVF, Multiple Locations
4. Apollo Fertility Hospital, Noida
5. Jaslok Hospital, Mumbai

Frequently Asked Questions (FAQs)

Is laparoscopic ovarian drilling painful?

The procedure itself is performed under general anesthesia, so there is no pain during surgery. Mild postoperative discomfort is normal and managed with pain medication.

How soon can I get pregnant after LOD?

Many women ovulate within 4–6 weeks after LOD, and natural conception is often possible within 6–12 months post-surgery.

Does LOD permanently cure PCOS?

LOD can restore ovulation but does not cure PCOS. Lifestyle changes and regular monitoring remain essential for long-term hormonal balance.

Is there a risk of ovarian damage with LOD?

When performed carefully with controlled energy settings, the risk of ovarian damage is minimal.

Can LOD be repeated if it fails?

LOD is generally not repeated due to the potential risk of reducing ovarian reserve. Alternative fertility treatments may be considered if the initial procedure is unsuccessful.