Successful IVF outcome after repeat laparoscopic ovarian drilling in a case of resistant PCOS

Ovulation induction (OVI) is the first-line treatment option for infertile women with polycystic ovary syndrome (PCOS). We report a case of resistant PCOS who responded to OVI after laparoscopic ovarian drilling (LOD) but suffered miscarriages in first trimester on three occasions, had late-onset moderate ovarian hyperstimulation syndrome (OHSS) in one cycle and recurrent anovulation. She underwent one in vitro fertilisation (IVF) cycle but it resulted in poor oocyte yield (four oocytes) and failed conception. Second LOD followed by IVF resulted in successful outcome in terms of good oocyte yield and successful live birth as well as supernumerary embryos frozen for future use. Repeat LOD may be considered in selected PCOS patients who fail to have successful pregnancy outcome despite multiple OVI cycles, have chronic anovulation, persistently raised serum antimullerian hormone and luteinising hormone, history of OHSS during OVI and prior poor response in IVF cycle.