The three main symptoms of women with Polycystic Ovarian Syndrome (PCOS) are: menstruation related disorders; androgen-related symptoms; and infertility. Management strategies depend on the dominant one. The history of management of PCOS has been taking sharp turns from surgical management to medical therapy and later a renewed interest in surgery.

At present, Laparoscopic ovarian drilling (LOD) is indicated in clomiphene (CC) resistant cases and another approach of gonadotropin therapy. In LOD treatment, high success pregnancy rates of around 60 % are expected within 12 months of surgery, and peak pregnancy rate is seen around 6–9 months after surgery.

The exact mechanism of induction of ovulation by LOD is not understood. This may be attributed to the improved intraovarian stromal blood flow following the procedure. It has been suggested that physical opening of subcapsular cysts led to the removal of androgen-containing follicular fluid from the ovarian environment, thus lowing the androgen content of ovaries. The total and free testosterone is decreased to 40–50 % of the preoperative levels. LH levels also decreased follow- ing the procedure. Change in FSH levels is less marked and normal inhibin pulsatility is restored. The normalization of hormonal relationships leads to recruitment of a new cohort of follicles and resumption of ovarian function. These endocrine changes occur rapidly and are sustained for years. The number of holes to be drilled depends upon the size of the ovaries and the sonographic appearance which had been noted during the preoperative work-up. In moderately enlarged ovaries, about 10–12 holes are sufficient but more may be required in voluminous ovaries. Treatment patients when followed sonographically show spontaneous ovulation or much more improved sensitivity to CC and lesser chances of multiple pregnancies. Overall LOD is simple procedure with lots of benefits for fertility preservation, but it should be judiciously employed with strict selection protocol.