Laparoscopic Ovarian Wedge Resection (LOWR)

Laparoscopic Ovarian Wedge Resection (LOWR) is surgery through small incisions that removes a wedge of the ovary to restore ovulation. Surgeons use it in select patients with polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS). The wedge goes through the full thickness of the ovary. It takes part of the cortex, the thick outer layer of the ovary. It also takes the theca-cell stroma, the tissue under the cortex that makes androgens. The goal is to bring hormones back into balance and restore ovulation.

The surgery lowers the androgens that the ovary makes. In PMOS / PCOS, those androgens drive a cycle of high LH, stalled follicle growth (follicular arrest), and absent ovulation (anovulation). Surgeons have done LOWR with microsurgery. One aim is for the ovary to ovulate again on its own. Another aim is to avoid the risk of ovarian hyperstimulation that comes with drugs that bring on ovulation.

In NaProTechnology practice, LOWR is a surgical option. It is for patients whose ovulation does not respond to medicine. Surgeons who do LOWR take care to control bleeding (hemostasis) and to prevent adhesions. They take this care to protect the ovarian reserve, the remaining supply of eggs in the ovaries. They also take it to lower the risk of scarring after surgery.