The rate of adhesion formation after ovarian electrocauterization has been described in two selective and unselective groups of patients with PCOS. The rate of this complication in the selective group was 0 from 16 ovaries and in the unselective group (5/25). However, the rate of major adnexal adhesion in the unselective group was 1 from 25 ovaries.
PMID 2037115 2037115 DOI 10.1016/s0015-0282(16)54377-5 10.1016/s0015-0282(16)54377-5 Dabirashrafi et al. 1991, Dabirashrafi 1991
Cite this article
Dabirashrafi, H., Mohamad, K., Behjatnia, Y., & Moghadami-Tabrizi, N. (1991). Adhesion formation after ovarian electrocauterization on patients with polycystic ovarian syndrome. Fertility and sterility, 55(6), 1200-1201. https://doi.org/10.1016/s0015-0282(16)54377-5
Dabirashrafi H, Mohamad K, Behjatnia Y, Moghadami-Tabrizi N. Adhesion formation after ovarian electrocauterization on patients with polycystic ovarian syndrome. Fertil Steril. 1991;55(6):1200-1201. doi:10.1016/s0015-0282(16)54377-5
Dabirashrafi, H., et al. "Adhesion formation after ovarian electrocauterization on patients with polycystic ovarian syndrome." Fertility and sterility, vol. 55, no. 6, 1991, pp. 1200-1201.
To evaluate the incidence and extent of periovarian adhesion formation subsequent to laparoscopic electrocoagulation of the ovarian surface in infertility patients with polycystic ovarian disease (PCOD). From a total of 199 PCOD patients treated with ovarian electrocautery, 50 cases of laparoscopy and 12 cesarean sections served as second-look investigation. A subgroup of 30 patients had abdominal lavage and artificial ascites after surgery; they underwent "early" second-look (2 to 14 days after laparoscopy). All patients were referred to our fertility outpatient clinic affiliated with the university hospital. Infertility patients with polycystic ovarian reaction to hormonal stimulation therapy underwent laparoscopic electrocoagulation of the ovarian surface. Adhesion formation was detected in 19.3%; the incidence reduced to 16.6% with the use of abdominal lavage. The adhesions found were obviously due to bleeding of the ovarian capsule caused by electrocautery. Adhesiolysis was easily possible during "early" second-look. The incidence of de novo adhesion formation caused by laparoscopic electrocoagulation of the ovarian surface seems to be lower than after ovarian wedge resection; it can be reduced by abdominal lavage and artificial ascites.
A homogeneous group of 214 infertile women with endometriosis treated at the Johns Hopkins Hospital from 1960 to 1979 received conservative surgery as the sole therapeutic modality. Among this group, 115 patients (54%) conceived following surgery; of these conceptions, 109 resulted in a living child. Among 49 patients with secondary infertility, the spontaneous abortion rate was reduced from 49% to 20% after conservative surgery (P less than or equal to 0.01). Three contemporary classification systems were utilized to categorize patients according to the sites and amount of endometriosis at the time of conservative surgery. Those systems suggested by Buttram (Fertil Steril 30:240, 1978) and by Kistner and coauthors (Fertil Steril 28:108, 1977) revealed differences among fecundability rates among the different categories (P less than or equal to 0.01); however, the system suggested by The American Fertility Society (AFS) (Fertil Steril 32:633, 1979) revealed significant differences only if categories were combined (mild plus moderate versus severe plus extensive, P less than or equal to 0.05). Nevertheless, the AFS system revealed that pregnancy success was significantly reduced if an ovarian endometrioma was greater than 3 cm or had ruptured (P less than or equal to 0.01).
More than twenty-five years ago Edward Reynolds gave an excellent description of the polycystic ovary, and expressed the opinion that ovarian surgery was the most important single feature in the treatment of sterility of the female. This view was not accepted by later workers in the field. Indeed, the tendency has been to consider retention cysts as items of small importance, unlikely to cause symptoms and rarely calling for treatment on their own account. It remained for Stein15- 18 and his followers to define a type of case where the presence of multiple cysts evidently interferes both with ovulation and with endocrine activity, and to show that surgery frequently succeeds in restoring normal function. I propose to discuss certain aspects of this clinical problem, and to report my own series of 65 operated cases.
The fundamental cause of retention cysts is probably, as Zondek believes, a phase of hypergonadotropism. Under normal conditions large numbers of primordial follicles start to mature but never complete the process. At some point along the way the ova die, whereupon the follicles regress and ultimately become insignificant corpora fibrosa. Under the influence of excessive pituitary stimulation, however, such follicles may continue to secrete liquor and to grow after the disappearance of their ova.
Some of them eliminate themselves by delayed resorption and atrophy or, less often, by rupturing through the tunica albuginea. Others remain as permanent cystic structures. These retention cysts are pathologic, whereas atretic follicles in various stages of regression represent nothing more than phases of the normal ovulatory cycle.
1. Define premature ovarian insufficiency, diagnostic criteria, risk factors and comorbidities.
2. Discuss health concerns, as well as health and hormone management of patients suffering with POI.
3. Discuss restorative fertility approaches to those with POI.