PCOS/PCOD Treatment Options: What You Need to Know Before Considering Surgery

Understanding PCOS and Its Impact on Fertility

PCOS (Polycystic Ovarian Syndrome) is not just a hormonal disorder—it’s a life-changing diagnosis for many women.

If you’ve been living with PCOS (Polycystic Ovary Syndrome) for a while, you probably already know it doesn’t just affect your periods. Over time, it can severely impact your ability to conceive naturally. This chronic condition, unfortunately, doesn’t have a permanent cure, but it can be managed effectively, and in many cases, fertility can be restored with the right treatment plan.

As someone who sees a lot of patients with resistant PCOS, I often get asked, “When should I consider surgery for PCOS/PCOD?” Let’s talk about that.

Most PCOS patients don’t need surgery. The first-line treatment is still ovulation induction, typically using medications like letrozole, HPHMG, or recombinant FSH.

However, some women don’t respond well to these drugs. In such resistant cases, before considering surgery, we need to ask:

• Was the protocol optimized?
• Were extended letrozole protocols used?
• Was the dose and timing right?

Often, it’s not the drugs, but how they’re used. That’s why many patients come to us for a revised stimulation plan, which we customize based on ultrasound, hormone levels, and past cycle performance.

If there is no response even after optimizing the protocol, we then consider surgical options. 

So let us try and discuss an address. What are the most convenient surgical options that are available to the patient whenever they are suffering from PCOS?

When medication fails, there are two surgical options, both involving ovarian drilling:

• LOD – Laparoscopic Ovarian Drilling (Standard Procedure)
• TVOD – Transvaginal Ovarian Drilling (Experimental Procedure)

Let’s understand each.

Transvaginal Ovarian Drilling (TVOD)

TVOD is still an experimental procedure and has very limited indications. It may be considered in women who:

• Have extremely severe PCOS and need immediate stimulation
• Show poor egg quality or low AMH
• Had poor embryo quality in previous IVF cycles
• Display poor ovarian response despite stimulation

⚠️ Important: This is not a routine option, and it should not be a procedure that is recommended to each and every patient with PCOS. It’s only for very select patients and must be performed in highly specialized centers. It is not recommended for general PCOS management.

Laparoscopic Ovarian Drilling (LOD)

This is a well-established surgical technique that’s been around for decades. Still, many support groups and online platforms criticize it—often unfairly.

Let me clarify: when done properly, LOD can be a game-changer for women with severe PCOS or those with lean PCOS who haven’t responded to medications or ovarian stimulation.

Once upon a time, when the practice of doing LOD started, it was predominantly done by drilling holes in the ovary by using something called mono-polar electrodes, which could cause:

• Deep burns to the ovary
• Scar tissue (adhesions)
• Damage to ovarian reserve

Naturally, it led to backlash. But this is not how we do it anymore.

In a referral unit like the one that covers where we entertained patients with PCOS from across the country. 

In our center, we use micro bipolar electrodes, which:

• Require high surgical precision
• Don’t burn the ovarian cortex
• Minimize the risk of adhesions
• Allow targeted drilling for better results

It is also important for patients to understand and remember that there is no set specific standardization available for the number of holes that lead to a patient who is having PCOS while performing the technique of micro bipolar LOD. 

We decide the number of holes based on:

• Ultrasound appearance
• Laparoscopic findings

Usually, we drill 4 to 10 holes, depending on ovarian size and structure. No two ovaries are treated the same—this is a personalized procedure.

We are a national referral unit for resistant PCOS cases. Patients travel to us from all over India for this micro-bipolar surgical technique. Here’s why:

✅ Minimally invasive

✅ Quick discharge (usually within 8 hours)

✅ Return to the home city the next day

✅ Can try conceiving next month

✅ Can avoid unnecessary IVF

We’ve helped countless women who were wrongly advised to get IVF—even when it wasn’t needed—conceive naturally after LOD.

Many patients with severe PCOS are prematurely advised to have IVF, even when it’s not indicated. In our experience, these are the very women who often benefit the most from laparoscopic ovarian drilling using the micro-bipolar surgical technique. This approach has helped countless women conceive naturally, sparing them the emotional and financial burden of unnecessary IVF treatments.

• Not everyone with PCOS needs surgery
• Always try optimized stimulation protocols first
• Surgery is considered only in resistant or complex cases

If done right, LOD is safe, effective, and fertility-friendly

If you’re frustrated, confused, or tired of trying without results, let’s talk. As a gynecologist and PCOS specialist in India, I see many complex PCOS and PCOD cases every day. We’ll evaluate whether you even need surgery or just a smarter protocol and effective treatment plan.

📞 Book your consultation today at our PCOS Clinic in Mumbai, India — Call  1800-268-4000. The right guidance can turn your struggle into success.