The effects of laparoscopic ovarian drilling on flow mediated dilation in women with PCOS: relationship with insulin resistance and IGF-I.
OBJECTIVE
The aim of this paper was to investigate whether laparoscopic ovarian drilling (LOD) has an effect on endothelial function in women with polycystic ovary syndrome (PCOS) using well validated marker of brachial artery flow-mediated dilation (FMD) and to determine which hormonal and/or metabolic parameters are responsible for postoperative endothelial response.


METHODS
In a prospective pilot trial, 34 infertile women with PCOS were studied for measurement of brachial artery FMD and insulin-like growth factor (IGF)-I. Blood samples for total testosterone (T), sex hormone binding globulin (SHBG), lipid profile as well as insulin resistance index (HOMA-IR) were measured before and 3 months after LOD. Twenty-six normal fertile subjects matched for age and body mass index (BMI) served as control group.


RESULTS
Baseline %FMD in patients with PCOS was significantly lower than that in control subjects. After LOD 24 women had increased %FMD (responders), whereas 10 women had decreased or unchanged %FMD (non-responders). However, neither fasting plasma glucose, insulin levels nor HOMA-IR changed after LOD. Serum levels of T, IGF-1, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and sex-hormone binding globulin (SHBG) significantly decreased whereas high-density lipoprotein cholesterol (HDL-C) significantly increased (P<.05). Responders had significantly lower baseline %FMD than did non-responders and both IGF-I and T significantly decreased in responders, but not in non-responders after LOD (P<0.05). Simple regression analysis revealed that the change of %FMD showed a significant negative correlation (r=-0.731, P=0.007) with that of LDL-C, but not with IGF-1 nor T in responders.


CONCLUSIONS
Women with PCOS have evidence for endothelial dysfunction which might be improved shortly after LOD. This results from decrease in LDL-C rather than decrease in androgens and/or IGF-1 per se.
Department of Obstetrics and Gynecology Mansoura University Hospital Mansoura Faculty of Medicine, Mansoura, Egypt - tarekshokeir1@hotmail.com.
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Shokeir
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El-Kannishy
D000328:Adult; D001916:Brachial Artery; D016022:Case-Control Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D010535:Laparoscopy / Q000379:methods*; D008055:Lipids / Q000097:blood; D010053:Ovary / Q000601:surgery*; D010865:Pilot Projects; D011085:Polycystic Ovary Syndrome / Q000098:blood supply / Q000601:surgery*; D011446:Prospective Studies; D012039:Regional Blood Flow; D012044:Regression Analysis; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013739:Testosterone / Q000097:blood; D055815:Young Adult
D008055:Lipids; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D007334:Insulin-Like Growth Factor I