The effects of ovarian wedge resection on circulating gonadotropin and ovarian steroid levels in patients with polycystic ovary syndrome.

Abstract

Serum gonadotropin, estrogen, and androgen levels were measured daily before and up to 35 days after surgery in 8 patients with polycystic ovary syndrome (PCO) undergoing ovarian wedge resection (WR). To serve as controls, similar assessments were made in 5 women having hysterectomies for non-ovarian disease during the early follicular phases of their cycles. Preoperatively, LH but not FHS, estrone (E1) but not estradiol 17 beta (E2), and both androstenedione (delta) and testosterone (T) levels were higher in the PCO patients than in the normal women. In the PCO patients, surgery had no discernible effect on FSH levels. In the 5 PCO patients who apparently ovulated after WR, LH levels did not fluctuate significantly until the midcycle LH peaks occurred 13-25 days after surgery. In the 3 patients who did not ovulate, there was a transient fall of LH, which reached a nadir on the sixteenth postoperative day and then returned to preoperative levels. In the total PCO group there was a significant fall of E1 (P less than 0.05) and a decrease of E2, which reached nadirs on the third postoperative day. Preovulatory rises of both E1 and E2 were seen only in patients who ovulated following WR. For the androgens, significant decreases (P less than 0.05) of both T and delta were seen during the first 3 days after WR. These were followed by steady increases of both androgens back to preoperative levels. Delta levels remained elevated while T concentrations fell again and were significantly lower (P less than 0.005) at the end of the sampling period than preoperatively. This pattern was seen whether the patients did or did not ovulate. Except for a small transitory fall of androgens, surgery had no discernible effect on the circulating levels of any of the hormones in the control subjects. These results show that in PCO patients, ovarian WR is followed by a profound, temporary reduction of ovarian delta secretion and a persistent reduction of T secretion. Smaller, but significant, decreases of estrogen production were also observed. The mechanism responsible for ovulation following WR appears to be local (intra-ovarian) rather than central since the alterations in ovarian hormone secretion had no discernible effect on circulating gonadotropin levels prior to the onset of midcycle surges.