Predictors of success of laparoscopic ovarian drilling in women with polycystic ovary syndrome: an evidence-based approach

Laparoscopic ovarian drilling (LOD) is currently recommended as a successful second-line treatment for ovulation induction in women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). To provide a comprehensive review of the current evidence regarding different clinical, biochemical and ultrasonographic parameters that help in predicting ovulation and or pregnancy after LOD. A PubMed search of published studies on LOD and reproductive outcome was conducted using defined keywords. Abstracts of 121 articles were screened and relevant articles were identified. Clinical studies were included with priority for level I evidence, i.e., randomized controlled trials (RCTs) followed by other levels. Based on the current evidence, LOD could be predicted to result in poor reproductive outcome in women with CC-resistant PCOS when they are obese (BMI > 25 kg/m(2)), long duration of infertility > 3 years, low basal LH levels < 10 IU/L, marked biochemical hyperandrogenism (testosterone levels a parts per thousand yen4.5 nmol/L, free androgen index > 15) and high basal AMH a parts per thousand yen7.7 ng/mL. Setting eligibility criteria based on the existing evidence concerning predictors of success of LOD is critical not only for improving its outcome, but also to avoid unnecessary surgery with possible risk of impairment of ovarian reserve and other complications.