Polycystic ovarian syndrome (PCOS) has remained an enigma since it was first described as a clinical entity by Stein and Leventhal in 1935. The treatment of this condition has evolved through ovarian wedge resection at laparotomy, induction of ovulation with clomiphene citrate (CC) to laparoscopic ovarian drilling or other chemotherapeutic agents when CC treatment has failed. Evidence shows that laparoscopic ovarian drilling (LOD) reverses all the abnormalities associated with PCOS especially in those with CC treatment failure. The same could be said for these chemotherapeutic agents (metformin, gonadotropin-releasing hormone analogues (GnRHa), or follicle stimulating hormone (FSH) alone or in combination with CC). The seeming comparative advantage of LOD is in its one off therapy, sustained reversal of the pathology, high ovulation and pregnancy rates, cost safety reduced risk of multiple pregnancy and acceptability by patients.
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