Q. I found your information
box, Polycystic Ovary Syndrome: Fertility in Famine (Chapter 2)
fascinating. I found what was written was true in my case. Before
I conceived my son, at weight 50 Kg [ 110 pounds ] I was having
a period every three months. Since having a child, at a weight
of now 60 Kgs [ 132 pounds ] I no longer have periods. My question
is whether this will be helped by wedge resection surgery of the
ovaries, which has been a treatment proposed to me by my gynecologist.
I have been unsuccessful in attempting to find success rates and
the exact way in which surgery would be helpful.
Wedge resection means cutting a slice (like a slice of cake) out of each ovary at an
open operation. It was first described as a treatment for PCO by Irving Stein, from
Northwestern University, Chicago, in the 1960s.
Wedge resection for polycystic ovaries works (usually for a few
months, sometimes longer) by rapidly decreasing the amount of ovarian
tissue in the body. This causes the ovarian hormones (including
estradiol and testosterone) to fall suddenly and sometimes permanently,
leading to a resetting of the pituitary-ovary relationship, with
an increase in serum FSH - and so to better development of follicles
and ovulation (for more on the technical details see the Member
Area or check Chapter 3 of the book).
In a large study reported
by Dr Eli Adashi and colleagues from Johns Hopkins in Baltimore
in 1981, there was a significant risk of developing pelvic disease
from tubo-ovarian adhesions, which (certainly in those days) meant
a different but permanent reason for sterility.
More modern ways of suddenly decreasing the ovarian tissue mass to achieve ovulation
consist of what's called "golf-balling" the ovary at laparoscopy, using cautery or
laser. Holes are burned all over the cortex of the ovary (which is where all the
follicles are) that make it look like a golf ball. There is still a risk of adhesions.
The other main risk is that too much of the ovary is destroyed,
resulting in primary ovarian failure.
In Dr Adashi's study, the monthly probability of pregnancy after
wedge resection was less than 2%. (Read about the math of this kind
of infertility treatment analysis in Appendix 1 of Overcoming Infertility.)
Because of these risks -- and because ovulation induction with
follicle stimulating hormone can always be made to work -- wedge
resection of the ovaries for PCO is not common these days.
I carry it out laparoscopically occasionally, when we can't get mature eggs without
Reliable avoidance of OHSS by freezing all recovered and fertilized
eggs has made the operative treatment for PCO virtually obsolete.