Polycystic Ovarian Disease (PCOD) and infertility are two of the most common gynecological concerns faced by women in reproductive age. While lifestyle modification, medications, and non-invasive diagnostic methods form the initial approach, certain situations demand surgical evaluation and intervention. Diagnostic laparoscopy with ovarian drilling and tubal patency test is a comprehensive minimally invasive procedure that helps both in diagnosing the underlying cause of infertility and treating it in the same sitting.

What is Diagnostic Laparoscopy?

Diagnostic laparoscopy is a minimally invasive surgical procedure performed under general anesthesia to visualize the pelvic and abdominal organs. A thin telescope (laparoscope) is inserted through a small incision near the umbilicus, allowing the surgeon to examine the uterus, fallopian tubes, and ovaries. Unlike ultrasound or X-rays, laparoscopy provides direct visualization, making it a gold standard in infertility evaluation.

This procedure is particularly valuable for:

Detecting endometriosis

Identifying pelvic adhesions

Evaluating tubal blockages

Assessing ovarian health

By combining it with other interventions like ovarian drilling and tubal patency testing, the surgeon can address both diagnostic and therapeutic aspects simultaneously.

Ovarian Drilling for PCOD

Polycystic Ovarian Disease (PCOD), also known as Polycystic Ovary Syndrome (PCOS), is characterized by irregular menstrual cycles, excess androgen levels, and multiple small cysts in the ovaries. One of the main problems in PCOD is anovulation, where the eggs are not released regularly, leading to infertility.

When medications such as clomiphene citrate or letrozole fail to induce ovulation, laparoscopic ovarian drilling becomes an effective second-line treatment.

Procedure of Ovarian Drilling:

Performed during laparoscopy under general anesthesia.

A monopolar or bipolar electrocautery needle or laser is used to make 4–10 small punctures on the thickened ovarian capsule.

This reduces androgen-producing tissue and lowers intra-ovarian androgen levels.

The hormonal balance is restored, improving the chances of spontaneous ovulation.

Benefits of Ovarian Drilling:

Improves ovulation rates in women resistant to oral medications.

Increases fertility without long-term hormonal therapy.

Reduces ovarian volume and stromal thickness.

Unlike medications, it does not carry a high risk of multiple pregnancies.

However, ovarian drilling should be performed cautiously, as excessive puncturing can lead to adhesion formation or ovarian reserve reduction.

Tubal Patency Test

Fallopian tubes play a crucial role in conception, as they transport the egg from the ovary to the uterus. Blockage or damage to the tubes is a major cause of female infertility. A tubal patency test checks whether the fallopian tubes are open or blocked.

During diagnostic laparoscopy, a chromopertubation test is usually performed:

A colored dye, commonly methylene blue or diluted indigo carmine, is introduced through the cervix into the uterus.

The surgeon observes laparoscopically whether the dye passes through the fallopian tubes into the abdominal cavity.

Free spillage of dye indicates that the tubes are open. Absence of spillage suggests a blockage.

This test is highly reliable and considered superior to non-invasive methods such as HSG (Hysterosalpingography) or sonohysterography because it allows real-time visualization of both tubes and surrounding pelvic structures.

Combined Approach: Diagnostic Laparoscopy + Ovarian Drilling + Tubal Patency

Performing ovarian drilling and tubal testing during the same laparoscopy offers multiple advantages:

Comprehensive infertility assessment – Both ovarian and tubal factors can be evaluated in one procedure.

Immediate intervention – If PCOD is identified as the main issue, ovarian drilling can restore ovulation right away.

Detection of hidden problems – Endometriosis, adhesions, or pelvic infections can be identified and treated.

Minimally invasive – Small incisions, faster recovery, and less postoperative pain compared to open surgery.

Recovery and Outcomes

Most women are discharged the same day or within 24 hours.

Mild abdominal pain, bloating, or shoulder-tip discomfort is common for 1–2 days.

Normal activities can be resumed within a week.

Ovulation often resumes within 4–6 weeks after ovarian drilling.

Pregnancy rates improve significantly in women with PCOD after successful ovarian drilling and confirmation of tubal patency.

Risks and Considerations

While generally safe, some potential risks include:

Adhesion formation around ovaries or tubes

Bleeding or infection

Rare injury to bowel, bladder, or blood vessels

Decreased ovarian reserve if over-drilling is done

Thus, the procedure should only be performed by experienced laparoscopic surgeons, ensuring careful technique and minimal thermal damage.

Conclusion

Diagnostic laparoscopy with ovarian drilling and tubal patency testing is a vital tool in the management of infertility, particularly in women with PCOD and suspected tubal problems. It not only provides an accurate diagnosis but also offers immediate therapeutic intervention, thereby increasing the chances of natural conception. With advancements in minimally invasive surgery, this combined approach has become one of the most effective and patient-friendly options in reproductive medicine.