Laparoscopic ovarian electrocautery is used as an alternative to wedge resection in patients with severe PCOS whose condition is resistant to clomiphene citrate. In a recent series, ovarian drilling was achieved laparoscopically with an insulated electrocautery needle, using 100-W cutting current to assist entry and 40-W coagulating current to treat each microcyst over 2 seconds (8-mm needle in ovary) (134). In each ovary, 10 to 15 punctures were created. This led to spontaneous ovulation in 73% of patients, with 72% conceiving within 2 years. Of those who underwent a follow-up laparoscopy, 11 of 15 were adhesion free. To reduce adhesion formation, a technique that cauterized the ovary in only four points led to a similar pregnancy rate, with a miscarriage rate of 14% (135). Other laparoscopic techniques using laser instead of electrocautery for laparoscopic ovarian drilling were described (136). Most series report a decrease in both androgen and LH concentrations and an increase in FSH concentrations (137,138). The beneficial endocrinological effects of laparoscopic ovarian drilling and the improvement in hirsutism were sustained for up to 9 years in patients with PCOS (139). Unilateral diathermy results in bilateral ovarian activity (140). Further studies are anticipated to define candidates who may benefit most from such a procedure. The risk of adhesion formation should be discussed with the patient.
Physical Methods of Hair Removal
Depilatory creams remove hair only temporarily. They break down and dissolve hair by hydrolyzing disulfide bonds. Although depilatories can have a dramatic effect, many women cannot tolerate these irritative chemicals. The topical use of corticosteroid cream may prevent contact dermatitis. Eﬂornithine hydrochloride cream, also known as diﬂuoromethylornithine (DMFO), irreversibly blocks ornithine decarboxylase (ODC), the enzyme in hair follicles that is important in regulating hair growth. It is effective in the treatment of unwanted facial hair (141). Noticeable results take about 6 to 8 weeks of therapy. Treatment must be continued while inhibition of hair growth is desired, and when the cream is discontinued, hair returns to pretreatment levels after about 8 weeks (4).
Shaving is effective and, contrary to common belief, it does not change the quality, quantity, or texture of hair. Plucking, if done unevenly and repeatedly, may cause inﬂammation and damage to hair follicles and render them less amenable to electrolysis. Waxing is a grouped method of plucking in which hairs are plucked out from under the skin surface. The results of waxing last longer (up to 6 weeks) than shaving or depilatory creams (142).
Bleaching removes the hair pigment through the use of hydrogen peroxide (usually 6% strength), which is sometimes combined with ammonia. Although hair lightens and softens during oxidation, this method is frequently associated with hair discoloration or skin irritation and is not always effective (141).
Electrolysis and laser hair removal are the only permanent means recommended for hair removal. Under magnification, a trained technician destroys each hair follicle individually. When a needle is inserted into a hair follicle, galvanic current, electrocautery, or both used in combination (blend) destroy the hair follicle. After the needle is removed, a forceps is used to remove the hair. Hair regrowth ranges from 15% to 50%. Problems with electrolysis include pain, scarring, and pigmentation. Cost can be an obstacle (143). Laser hair removal destroys the hair follicle through photoablation. These methods are most effective after medical therapy arrests further growth.