Adashi, E. Y., Rock, J. A., Guzick, D., Wentz, A. C., Jones, G. S., & Jones, H. W. (1981). Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertility and sterility, 36(3), 320-325. https://doi.org/10.1016/s0015-0282(16)45732-8
Adashi EY, Rock JA, Guzick D, Wentz AC, Jones GS, Jones HW. Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertil Steril. 1981;36(3):320-325. doi:10.1016/s0015-0282(16)45732-8
Adashi, E. Y., et al. "Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome." Fertility and sterility, vol. 36, no. 3, 1981, pp. 320-325.
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73% estimated conception followed wedge resection in 90 PCOS cases
A Johns Hopkins team reviewed 90 women with polycystic ovary syndrome (PCOS, now PMOS) after wedge resection. Life table analysis estimated a 73% chance of conceiving over up to 10 years of follow-up. That is about 7 out of 10.
Key Findings
Ovulation resumed in 91.1% (82/90) of women after bilateral ovarian wedge resection. In this series, conception showed no significant association with age, race, ward status or length of infertility.
The crude conception rate was 47.8% (43 conceptions). Life table analysis put the cumulative chance of conceiving at 73% by the close of follow-up. Estimated monthly fecundability was 1.34%.
Conception rates were 60.3% with regular ovulation, 29.2% with oligo-ovulation and 12.5% with persistent anovulation. The authors call the anovulation figure unreliable because the group was small.
Tuboperitoneal disease, meaning tubal blockage or adhesions around the tubes and ovaries, was found in 23.3% (21/90). Monthly fecundability was 0.70 with it and 1.63 without (P < 0.05).
Of 7 women reinvestigated for persistent infertility despite ovulatory cycles, all 7 had significant pelvic adhesions. The authors document a minimum incidence of 7.8% for acquired post-BOWR pelvic disease.
Interpretation
The study is a retrospective cohort from one hospital's records, followed by chart review, mailed questionnaires and telephone calls. All 90 women had PCOS (now named polyendocrine metabolic ovarian syndrome, PMOS) and at least one year of follow-up. Semen analysis and postcoital test showed no male or cervical factor. Mean follow-up was 35.6 months, with substantial losses in the first 3 years. The 1.34% monthly figure rests on an assumed constant chance of conceiving, which the authors judged to fit this series. Conceptions included miscarriages and ectopic pregnancies. The authors state the data give no conclusive proof that wedge resection caused adhesion-related infertility.
RRM Context
The paper links ongoing missed ovulation and scarring around the tubes with lower conception after surgery. Restorative reproductive medicine looks for the cause of missed ovulation first. Scarring risk belongs in any surgical decision.
Our editorial summary of this paper, not the article's abstract.
Abstract
Fertility following bilateral ovarian wedge resection (BOWR) was evaluated in a retrospective cohort study of 90 consecutive cases of the polycystic ovary syndrome. Post-BOWR follow-up was available for varying time spans of up to 10 years. BOWR resulted in the resumption of menstrual cyclicity in 91.1% (82/90) of the cases. However, within this ovulatory group, 26 patients were characterized by oligo-ovulation and a significantly reduced conception rate (29.2%), as compared with that of 56 normo-ovulatory counterparts (60.3%). Although the crude overall conception rate for this series was 47.8%, the overall cumulative probability of conception at the end of follow-up as determined by life table analysis was 73%. The likelihood of conception at any given point in time was estimated by a monthly fecundability rate of 1.34%. Our findings also indicate that the probability of post-BOWR conception was unaffected by age, race, ward status, or duration of infertility. In contrast, persistent post-BOWR oligo- or anovulation and the presence of concurrent tuboperitoneal disease were reaffirmed as the most important determinants of the likelihood of post-BOWR conception. A minimum incidence of 7.8% was documented for acquired post-BOWR pelvic disease.
Wilcox AJ et al., 2020·Human reproduction (Oxford, England)·Free full text on PubMed Central
What proportion of fertilized human ova are lost before implantation? An estimated 40 to 50% of fertilized ova fail to implant. Preimplantation loss is not detectable with current technology. Published estimates of preimplantation loss range from 10 to 70%. STUDY DESIGN, SIZE, We combine data from epidemiologic, demographic, laboratory and in vitro fertilization studies to construct an empirical framework for the estimation of preimplantation loss. This framework is summarized in a user-friendly Excel file included in supplement. PARTICIPANTS/MATERIALS, SETTING, We draw from multiple sources to generate plausible estimates of fecundability, sterility, transient anovulation, intercourse patterns and the proportion of ova fertilized in the presence of sperm. We combine these estimates to generate a summary estimate of preimplantation loss. This estimate can be considered an average for couples in their prime reproductive years. MAIN Under a plausible range of assumptions, we estimate that 40 to 50% of fertilized ova fail to implant. LIMITATIONS, A crucial factor in estimating preimplantation loss is the probability that an ovum will be fertilized when exposed to sperm. Human data are available only from in vitro fertilization (IVF), which may not accurately represent events in vivo. We therefore assume a range of in vivo fertilization rates, from 64% (human IVF data) to 90% (mouse data). Our estimate of preimplantation loss takes into account the biological processes relevant to fertilization and loss. Using this empirical basis for estimation, we find support for the usual assumption that risk of loss is highest in the earliest days following fertilization. Furthermore, this framework can provide improved estimates as better reproductive data become available. To the extent that our estimates are accurate, more fertilized ova are apparently lost in vitro than in vivo, suggesting that further improvements in IVF success rates may be possible. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Intramural Program of the National Institute of Environmental Health Sciences, NIH. Professor Adashi serves as Co-Chair of the Safety Advisory Board of Ohana Biosciences, Inc. The other authors have no competing interests. N/A.
The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial. A cross-sectional study of 491 women aged 50-80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry. Ever use of OC was associated with significantly higher BMD at the total body (6%, p<.001) and spine (4%; p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5-10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.94). Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance.
Yildirim M et al., 2003·Eur J Obstet Gynecol Reprod Biol
To determine the effects of ovarian wedge resection by minilaparotomy in infertile patients with polycystic ovarian syndrome (PCOS). One hundred and thirty-four anovulatory patients with PCOS, who were previously treated with clomiphene citrate and gonadotropins and did not conceive were operated via minilaparotomy with microsurgical principles and ovarian wedge resection was performed on each subject. Pregnancy rates and adhesion formation were investigated retrospectively. A total of 121 pregnancies were achieved in 2 years (90%). One hundred and four patients conceived within the first 6 months (78%) and the remaining 17 patients conceived within 2 years (13%) following the operation. Sixty-eight patients had a second pregnancy later. In the post-operative period, 24 patients had cesarean delivery and 20 had diagnostic laparoscopy. Out of these 44 patients, only 5 of them were found to have minimal adhesions. This technique offers high pregnancy rates and minimal adhesion formation. Ovarian wedge resection by minilaparotomy might be an alternative treatment approach in patients with PCOS who did not conceive with standard ovulation induction protocols.
Seven cases of polycystic ovarian disease were investigated by laparoscopy and endocrinologic tests after failure of ovarian resection to restore fertility. One case of bilateral and two cases of unilateral ovarian atrophy were recorded. In all seven patients the common features were extensive perivarian and peritubal adhesions. Four of the six patients amenable to cure were submitted to reconstructive surgery; three of them conceived and had normal deliveries. The present observations support the plea to relegate the surgical approach to a minor position in patients with Stein-Leventhal syndrome and stress the importance of meticulous surgical technique in the performance of ovarian surgery. Laparoscopic investigation is mandatory in all cases of unsuccessful ovarian resection.
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.
Twenty-nine consecutive patients with polycystic ovary (PCO) syndrome (defined as hirsutism plus oligomenorrhea or secondary amenorrhea, and excluding Cushing's syndrome, an androgen-secreting adrenal or ovarian tumor or adrenocortical hyperplasia) were treated with ovarian wedge resection leaving normal-sized ovaries. Long-term follow-up from 2.3-9.5 years (mean 5.7 years) showed that 26 of 29 patients (90%) had established normal menstrual cycles. Fertility and normal pregnancies were achieved in all 10 patients (100%) with normal postoperative menstrual cycles who desired to conceive, but not in the 3 patients with remaining postoperative oligomenorrhea. Eight of 9 patients who were obese preoperatively and who had normal postoperative menstrual cycles showed a major weight loss after wedge resection. In contrast, none of the preoperatively obese patients, who remained oligomenorrheic after surgery, lost weight. Hirsutism was not cured by wedge resection. It is concluded that ovarian wedge resection should still be considered useful in patients with PCO.
Reproductive Surgery › Ovarian Surgery › Cystectomy Technique · PMOS / PCOS › Surgical Treatment › Ovarian Wedge Resection
PMID 7286253 7286253 DOI 10.1016/s0015-0282(16)45732-8 10.1016/s0015-0282(16)45732-8 Adashi et al. 1981, Adashi 1981
Cite this article
Adashi, E. Y., Rock, J. A., Guzick, D., Wentz, A. C., Jones, G. S., & Jones, H. W. (1981). Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertility and sterility, 36(3), 320-325. https://doi.org/10.1016/s0015-0282(16)45732-8
Adashi EY, Rock JA, Guzick D, Wentz AC, Jones GS, Jones HW. Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome. Fertil Steril. 1981;36(3):320-325. doi:10.1016/s0015-0282(16)45732-8
Adashi, E. Y., et al. "Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome." Fertility and sterility, vol. 36, no. 3, 1981, pp. 320-325.
