Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome

Adashi EY; Rock JA; Guzick D; Wentz AC; Jones HW Jr; Jones GS

doi:10.1016/s0015-0282(16)45732-8

Reproductive Surgery Ovarian Surgery

Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome

Adashi EY, Rock JA, Guzick D, Wentz AC, Jones HW Jr, Jones GS

Published September 1981 Fertility and Sterility, 36(3), 320-325

DOI 10.1016/s0015-0282(16)45732-8 PMID 7286253

RRM Academy Synopsis

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.

About 7 in 10 women with PCOS were estimated to conceive after wedge resection. Source: Adashi EY et al., 1981, PMID 7286253.

Study at a glance, retrospective cohort study: An estimated 73% conceived after wedge resection in 90 PCOS cases — Study at a glance, retrospective cohort study of 90 women with polycystic ovary syndrome: An estimated 73% conceived after wedge resection in 90 PCOS cases. Source: Adashi EY et al., 1981, PMID 7286253.

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

This retrospective cohort study followed 90 women with PCOS (now named PMOS, or polyendocrine metabolic ovarian syndrome) for at least one year after bilateral ovarian wedge resection. The team used chart review, mailed surveys and phone calls. Tests ruled out male and cervical factors. Follow-up averaged 35.6 months. The totals include miscarriages and ectopic pregnancies. The findings support larger, forward-looking studies of ovulation and pelvic scarring after ovarian surgery.

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.

Read the guides

Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.

12 min read
PMOS / PCOS: Causes, Diagnosis, and Treatment

PMOS / PCOS has four diagnostic phenotypes and distinct metabolic, reproductive, and mental health implications. How RRM-trained clinicians approach diagnosis and treatment differently.

20 min read

Topics

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

Keywords

Adolescent, Adult, Anovulation/etiology, Female, Fertility, Follow-Up Studies, Humans, Infertility, Female/etiology, Ovary/surgery, Ovulation, Polycystic Ovary Syndrome/complications/surgery, Postoperative Complications, Pregnancy, Retrospective Studies, Time Factors

Fertility following bilateral ovarian wedge resection: a critical analysis of 90 consecutive cases of the polycystic ovary syndrome

73% estimated conception followed wedge resection in 90 PCOS cases

Key Findings

Interpretation

RRM Context

Abstract

Read the guides

Topics

By this author

Related research

Keywords