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


METHODS
Prospective study.


METHODS
University hospital.


METHODS
Thirty-three women with PCOS.


METHODS
Laparoscopic ovarian wedge resection using harmonic scalpel.


METHODS
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.
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520, USA. antoni.duleba@yale.edu
Antoni J
AJ
Duleba
Beata
B
Banaszewska
Robert Z
RZ
Spaczynski
Leszek
L
Pawelczyk
D000328:Adult; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D006062:Gonadotropins / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood*; D010535:Laparoscopy / Q000379:methods*; D008055:Lipids / Q000097:blood*; D009765:Obesity / Q000097:blood / Q000503:physiopathology*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000601:surgery*; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D006062:Gonadotropins; D007328:Insulin; D008055:Lipids; D012738:Sex Hormone-Binding Globulin; D014280:Triglycerides; D013739:Testosterone; D019314:Dehydroepiandrosterone Sulfate; D002784:Cholesterol