I am 25 years old female having pcos problem and I trying to conceive for one and half years. I tried clomid for ovulation. I ovulated well but not got pregnant. Now 6 cycles of clomid completed. Now my doctor told me to go for laparoscopic ovarian drilling. Is it better or else may I go for injections protocol. Because I am just scared about laparoscopy. Many people told me to try injections for few cycles. Which one is better to get conceive. I have done hsg which results both tubal patency. My husbands semen analysis result came normal.

Dr. Sujoy DasguptaGynaecologist18yrs exp

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The basic problem in pcos (polycystic ovary syndrome) is that there are numerous eggs in the ovaries but they do not grow and ovulate (release of eggs). The first line of treatment in pcos, therefore, is ovulation induction (giving medicine to grow and release the eggs). This has to be done very carefully. If medicines are ineffective, eggs won't grow. On the other hand, slight increase in dose can cause many follicles to grow, leading to serious complications like ohss (ovarian hyperstimulation syndrome- ovaries enlarge, water can accumulate in various body parts) and multiple pregnancy (twin, triplet etc). That's why we must do tvs follicular scan to see if eggs are growing and whether there is chance of ohss or not. The first line of agents in ovulation induction (oi) are usually oral tablets like cc (clomiphene citrate) and letrozole. Sometimes we add metformin tablet to improve the response to the oral medicines. What to do if the oral medicines are not working (you are not ovulating with oral medicines?) if these do not work we have 2 options- 1) injection gonadotropin (that carries small risk of ohss and multiple pregnancy, therefore, needs intense monitoring by tvs) 2) surgery called lod (laparoscopic ovarian drilling- the electric current is used to burn few follicles in pco). However, lod carries surgical, anesthetic risks and also the risk of ovarian damage, if not done in proper way. What to do if you had ovulation with oral medicines but failed to conceive? If oi is done with oral medicine, the success rate is 15% per cycle. That means, out of 100 women taking the tablet, having regular intercourse and undergoing tvs follicular study, 15 will conceive at the end of one month. It is useless to take the medicines for oi years after years. Pregnancy should happen within 6-9 cycles of oi. If oral tablets has been tried for 4-6 months, it's better to add injections for next 3-4 months. How to take the injections? Injections are usually started from day 2/ 3/ 4 of the period. The number of injection depends on your response. The injections are not painful and need to be taken under the skin. Tvs follicular study is done from day 8/9, once in every 2-3 days (until day 14-16) to confirm that the injection is working. You should have regular physical relationship as well. How long injections can be taken? How long you can take injections, depends on your age and the duration of infertility. It is useless to take the injections for oi years after years. Pregnancy should happen within 3-4 cycles of oi. If still pregnancy cannot happen, it's better to consider iui or ivf. The basic problem in pcos (polycystic ovary syndrome) is that there are numerous eggs in the ovaries but they do not grow and ovulate (release of eggs). The first line of treatment in pcos is weight control. Medicines like metformin or inositol can be added, if needed. The second step is ovulation induction (oi)- giving medicines, orally (clomiphene or letrozole) so that the eggs grow and get released ("ovulation"). But while taking medicines, its important to see if the medicines are able to induce ovulation, by tvs follicular study. What to do if the oral medicines are not working (you are not ovulating with oral medicines?) in that case, we have 2 options- 1) injection gonadotrophin 2) laparoscopy laparoscopic ovarian drilling (lod)- by laparoscopy ("microsurgery" putting camera inside the abdomen by key-hole), some of the follicles ("cysts") are burned using electric current. The advantages of laparoscopy are- a) any other possible diseases and causes of infertility can be detected (diseases of the tubes, endometriosis etc). B) if the woman is having pain/ endometriosis/ cyst etc, these can be treated at the same time. C) after laparoscopy, the chance of spontaneous conception increases (without need of frequent visits to the doctors). The disadvantages of laparoscopy are- a) if lod is done in over-enthusiastic manner (many cysts are burned), it will damage the ovaries and the woman can land up in premature menopause. B) there is risk of anaesthesia and surgery. C) the "adhesion" (abnormal attachment between the organs) caused by laparoscopy may further increase the risk of infertility. So, lod is done only if- i) if the weight of the woman is normal; ii) lh and amh both are very high; and iii) there was no response (ovulation) with oral medicines. All these 3 factors must be present before lod. Otherwise, lod will do more harm than benefits. 

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Dr. Sonali TawdeGynaecologist19yrs exp

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If you ovulated with clomid, then better to try with injections and plan iui if you wish to get pregnant soon. You qualify for iui as semen report and hsg is normal.  

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