ABSTRACT
Polycystic ovary syndrome (PCOS) is the most frequent cause of WHO II anovulation affecting ~10% of women of reproductive age. In 1935, Stein and Leventhal were the first to describe the association between polycystic ovaries (seen at laparotomy) and menstrual irregularities, sterility, hirsutism, and obesity. They performed laparotomies on a group of these patients to obtain ovarian biopsies for diagnostic purposes. Unexpectedly, they observed postoperative resumption of regular menses and fertility in most of their patients. Surgical ovarian wedge resection (OWR) was therefore established as the first effective treatment for anovulatory PCOS patients with high success rates (80% resumption of regular menses and ~60% conception). In the 1960s, OWR was largely abandoned (due to its associated morbidity) in favor of the newly introduced clomiphene citrate, which became the standard first-line ovulation induction therapy in PCOS. In the late 1960s and with the development of minimal invasive surgery, there was a renewed interest in surgical ovulation induction carried out laparoscopically. In 1967, Palmer and De Brux in France and Steptoe in Great Britain were the first to describe laparoscopic ovarian biopsy in PCOS women. However, this new approach did not find its way to clinical practice possibly due to the limited number of centers performing laparoscopic surgery, which was still in its early days. In 1984, Gjönnaess published the first study on laparoscopic electrocautery of the ovary (LEO) reporting very encouraging success rates (91% ovulation rate). Following this publication, LEO gained much popularity worldwide, and a plethora of studies has since been published confirming its efficacy and safety. The underlying mechanisms of LEO actions remain largely uncertain. Several hypotheses have been postulated, such as removal of a mechanical barrier to ovulation or decreased ovarian androgen synthesis due to thermal tissue destruction. Whatever the mechanism may be, it is evident that a small amount of damage to ovarian tissue seems to restore the ovulatory cycle in a high proportion of patients.
