Role of Laparoscopic Ovarian Drilling in Women with Polycystic Ovarian Syndrome and Elevated Anti-Müllerian Hormone Concentrations

Abstract

One of the most prevalent endocrine conditions affecting women of reproductive age, polycystic ovarian syndrome (PCOS) is a leading cause of anovulatory infertility globally. Hyperandrogenism, persistent anovulation, and polycystic ovarian shape are its defining characteristics. Its pathogenesis is influenced by intricate interactions among hormonal, metabolic, and inflammatory pathways. Even with the availability of first-line ovulation induction drugs like letrozole and clomiphene citrate, a significant percentage of women continue to be resistant to medical treatment. With the benefit of restoring ovulation without raising the risk of multiple pregnancies or ovarian hyperstimulation syndrome, laparoscopic ovarian drilling (LOD) has been reintroduced as an efficient second-line treatment for clomiphene-resistant PCOS. It is believed that the operation improves follicular dynamics and restores normal endocrine function by destroying the androgen-producing ovarian stroma. Women with PCOS often have elevated levels of anti-Müllerian hormone (AMH), a sign of ovarian reserve that reflects the increased number of tiny antral follicles. Elevated AMH levels may be a predictor of treatment results and have been linked to a worse response to ovulation induction. However, there is still disagreement over the effectiveness of LOD and how it affects ovarian reserve in women with noticeably high AMH levels. With an emphasis on its potential to improve ovulation and fertility outcomes, this study attempts to assess the processes, indications, and clinical results of laparoscopic ovarian drilling in PCOS patients with elevated AMH levels.