Reply of the Authors: Is there any difference among the most frequently used laparoscopic ovarian drilling techniques?

LETTER TO THE EDITOR Reply of the Authors: We thank Dr. Api for the comments on our article. We disagree, however, over some statements made. Using a bovine ovary model instead of human ovaries is not ideal, but bovine ovaries do have a very high resemblance to human polycystic ovary syndrome ovaries, given that the size and cellular morphology approximately match. We stated in the article that direct interpolation of the bovine results to the human clinical situation cannot be done, but the results provide a good indication of the amount of expected tissue damage and the differences between the techniques. The aim of our study was to show the differences in tissue destruction between the three most frequently used ovarian drilling techniques. This study was not set up to provide an answer as to the best ovarian drilling procedure. From a theoretical perspective, one could expect ovoidshaped tissue damage using bipolar electrocoagulation. In our experience, bipolar electrocoagulation resulted in cylinder-shaped destruction, which is clearly seen in our Fig. 2e. Therefore, we used the formula of a cylinder to calculate the tissue damage. To make sure the visible tissue damage was

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comparable to the microscopic cellular damage, the sliced ovaries were assessed under a light microscope (see our Materials and Methods). Macroscopic damage was found comparable to the cellular damage, and therefore the macroscopic affected area was used as a marker for tissue destruction. We agree that reduction of the ovarian reserve after ovarian drilling is a requirement of the procedure, but too much ovarian destruction is not desirable because it could lead to problems in the long-term fertility prognosis and reduce the age of onset of menopause. It is therefore essential to realize the destructive effect of the various ovarian drilling procedures, and this article was the first to show the substantial differences between the techniques. Marja-Liisa Hendriks, M.D. Department of Obstetrics and Gynecology VU University Medical Center Amsterdam, The Netherlands February 27, 2009 doi:10.1016/j.fertnstert.2009.03.007

Fertility and Sterility Vol. 91, No. 6, June 2009 Copyright ª2009 American Society for Reproductive Medicine, Published by Elsevier Inc.

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