Success of laparoscopic ovarian wedge resection is related to obesity, lipid  profile, and insulin levels

Antoni J Duleba; Beata Banaszewska; Robert Z Spaczynski; Leszek Pawelczyk

doi:10.1016/s0015-0282(02)04848-3

Reproductive Endocrinology Ovarian Hormones

Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels

Duleba AJ, Banaszewska B, Spaczynski RZ, Pawelczyk L

Published April 2003 Fertility and Sterility, 79(4), 1008-1014

DOI 10.1016/s0015-0282(02)04848-3 PMID 12749446

RRM Academy Synopsis

Wedge resection led to pregnancy in 22 of 33 women with PCOS

Of 33 women with PCOS who desired pregnancy, 22 conceived a mean of 4.9 months after laparoscopic ovarian wedge resection. PCOS is now also called Polyendocrine Metabolic Ovarian Syndrome (PMOS). Women who conceived were leaner and had lower insulin before surgery.

Key Findings

Clinical pregnancy occurred in 22 of 33 women (67%), at a mean of 4.9 months after surgery (range: 1–14 months).
Among women the authors classed as lean, 82% became pregnant, compared with 41% of the obese women.
Before surgery, women who later conceived were on average less obese (by 24%), with lower fasting insulin (by 24%) and lower triglycerides (by 30%).
In Cox regression, BMI was the only independent predictor of pregnancy; once BMI was accounted for, no other measured variable added predictive power.
In 15 women not pregnant at 12 weeks, testosterone fell 44%, LH fell 30%, insulin sensitivity index decreased 27%, and ovarian volume was on average 41% lower.

Interpretation

The study is a prospective single-group study at a university hospital in Poland. All 33 women wanted pregnancy and had confirmed tubal patency, and their male partners had adequate sperm. Women who did and did not conceive overlapped in weight, insulin and cholesterol measures, and the authors found no threshold value that ensures a response to surgery. The authors note that the repeat tests covered only women not pregnant at 12 weeks, which may bias the post-surgery drop in insulin sensitivity.

RRM Context

Restorative Reproductive Medicine looks for why ovulation fails in PCOS (PMOS) and treats that cause. Ovarian surgery here targets the ovulation problem directly. The authors observe that metformin has worked better in heavier women with high insulin, the reverse of the best surgical responders here. They suggest matching therapy to each woman's clinical and metabolic profile.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To evaluate the effects of laparoscopic ovarian wedge resection on hormonal and metabolic parameters of polycystic ovary syndrome (PCOS) and to compare profiles of women who achieved pregnancy with those who did not.

Design

Prospective study.

Setting

University hospital.

Patients

Thirty-three women with PCOS.

Interventions

Laparoscopic ovarian wedge resection using harmonic scalpel.

Main Outcome Measures

Pregnancy; levels of testosterone, DHEAS, gonadotropins, sex hormone-binding globulin (SHBG), and glucose and insulin during 2-hour glucose tolerance test; lipid profile; body mass index; and waist-to-hip ratio.

Results

Twenty-two women (67%) achieved clinical pregnancy within the mean of 4.9 months after surgery. Baseline parameters of women who became pregnant differed from those who did not: those who became pregnant were less obese, had lower levels of total cholesterol, low-density lipoprotein, and triglycerides; higher levels of SHBG; lower levels of fasting insulin; lower insulin area under the curve; and higher insulin sensitivity index. Subjects not pregnant by 12 weeks after surgery underwent repeat endocrine and metabolic evaluations. In these women, wedge resection was followed by declines in testosterone, LH, and insulin sensitivity index. Wedge resection had no significant effect on SHBG, DHEAS, or lipid profile.

Conclusions

Laparoscopic wedge resections are associated with the highest pregnancy rates among less obese subjects with favorable lipid profiles and lower insulin. In this study, the postoperative decline of serum testosterone and LH is not attributable to improvement of insulin sensitivity.

Read the guide

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

Topics

Reproductive Endocrinology › Ovarian Hormones › Androgens · Reproductive Surgery › Ovarian Surgery › Ovarian Reserve Preservation · Infertility › Ovulation Induction › Clomiphene Citrate

Antoni J Duleba, Beata Banaszewska, Robert Z Spaczynski, Leszek Pawelczyk

A Duleba, B Banaszewska, Bob Spaczynski, Rob Spaczynski, Bobby Spaczynski, R Spaczynski, L Pawelczyk

PMID 12749446 12749446 DOI 10.1016/s0015-0282(02)04848-3 10.1016/s0015-0282(02)04848-3 Duleba et al. 2003, Duleba 2003

Keywords

Blood Glucose, Gonadotropins, Insulin, Lipids, Sex Hormone-Binding Globulin, Triglycerides, Testosterone, Dehydroepiandrosterone Sulfate, Cholesterol

Success of laparoscopic ovarian wedge resection is related to obesity, lipid profile, and insulin levels

Wedge resection led to pregnancy in 22 of 33 women with PCOS

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

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

Topics

By this author

Medical management of metabolic dysfunction in PCOS

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Keywords