Treatment of Polycystic Ovary Syndrome (PCOS)

An alternative treatment option for infertility in patients with PCOS who exhibit resistance to ovulation-inducing medications is laparoscopic ovarian drilling and cauterization. However, the decision to undergo this procedure should be made after careful evaluation through the following examinations

1) After a detailed medical history, including ultrasound and blood tests for FSH, LH, PRL, TSH, glu ac, insulin, and testosterone, if it is confirmed that the patient has PCOS and further determined to have insulin resistance, the latest treatment method using Metformin can be attempted for 3-6 months. If spontaneous ovulation does not occur, low-dose stimulation medication (Clomid 50mg) can be administered to induce ovulation, resulting in approximately 80% of patients experiencing spontaneous ovulation.

2) If the patient is confirmed to have PCOS without insulin resistance, ovulation-inducing medication (Clomid 50mg per day) can be directly used, starting from day 3-5 of the menstrual cycle for 5 days. If ovarian response is poor or no follicles are formed, the dosage can be increased by one pill per cycle, up to a maximum of 4 pills per day, totaling 200mg. If this approach is ineffective, artificial insemination or laparoscopic surgery can be considered. For artificial insemination, Clomid can be taken orally at a dose of 50 to 100mg per day from day 3 to 5 of the cycle, combined with HMG or FSH injections, administered intramuscularly every other day from day 6 to 10. The dosage and duration of injections should be determined based on factors such as the patient's age, weight, and menstrual cycle length. When the average ovarian diameter reaches 18-20mm, intracervical insemination can be performed, usually 38 to 40 hours after the administration of HCG.

3) If laparoscopic ovarian drilling is chosen, a modified technique developed by Canadian scholar Tulandi has shown promising results. According to the latest issue of a renowned journal, the pregnancy rate can reach 60% one year after the surgery and nearly 80% after two years. However, it is crucial to use the correct cauterization method, instruments, and proper surgical techniques to minimize damage to the ovaries and potential adhesions. This method is particularly suitable for individuals who do not respond well to or are resistant to stimulation medication and serves as an alternative treatment option.