To evaluate novel surgical variations of laparoscopic ovarian drilling (LOD) and compare with standard bilateral LOD.
Electronic databases were searched including Cochrane database, CENTRAL, Ovid MEDLINE, Embase, PsycINFO, PubMed, Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, ISRCTN, The Chinese Clinical Trial Register in February 2019.
Randomized controlled trials (RCTs) evaluating LOD for patients with clomiphene-resistant polycystic ovary syndrome (PCOS) and infertility, reporting reproductive outcomes, surgical complications, serum indexes, menses resumption, and ultrasound results were included. Quality and risk of bias were evaluated by two authors, respectively.
Twenty RCTs with 1615 patients were included. Evaluation of the quality of evidence for each study was based on each study’s limitations of 5 outcome domains described by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and found to be moderate to very low. Live births were only reported by four studies. Unilateral LOD did not differ with bilateral LOD in reproductive outcomes, such as pregnancy (p = .11, I = 75%), ovulation (p = .08, I = 0%), miscarriage (p = .61), and menstruation resumption (p = .06). There was insufficient evidence regarding efficacy and safety of novel methods of LOD, such as transvaginal hydrolaparoscopy (one RCT) and micro-LOD (three RCTs). Evidence regarding the suitable number of ovarian punctures, duration of drilling, and anti-Mullerian hormone or antral follicle numbers following LOD was inconclusive.
Unilateral LOD seems to be suitable replacement for conventional bilateral LOD for clomiphene citrate-resistant PCOS, although more studies involving long-term reproductive efficacy, adverse events, and varying forms of LOD are warranted.

Copyright © 2020. Published by Elsevier Inc.