title: Short-term changes in hormonal profiles after laparoscopic ovarian laser evaporation compared with diagnostic laparoscopy for PCOS.
abstract: OBJECTIVE
  Which reproductive endocrine changes are attributed exclusively to laparoscopic ovarian drilling in polycystic ovarian syndrome (PCOS)?
  
  
  CONCLUSIONS
  Laser evaporation-specific endocrine effects were the prevention of an immediate increase in inhibin B and a sustained decrease in testosterone, androstenedione and anti-Müllarian hormone (AMH).
  
  
  BACKGROUND
  All ovarian drilling procedures result in reproductive endocrine changes. It is not known which of these changes are the result of ovarian drilling and which are related to the surgery per se.
  
  
  METHODS
  This prospective controlled study was performed at an outpatient academic fertility clinic. Between 2007 and 2010, a total of 21 oligo- or amenorrheic PCOS patients were included.
  
  
  METHODS
  Included were oligo- or amenorrheic PCOS patients with all three of the Rotterdam criteria and luteinizing hormone (LH) >6.5 U/l. All PCOS patients had an indication for diagnostic surgery due to subfertility. There were 12 PCOS patients who chose to undergo ovarian laser evaporation (CO2 laser, 25 W, 20 times/ovary) and 9 PCOS who chose a diagnostic laparoscopy only (controls). Reproductive endocrinology was measured before, and until 5 days after, surgery, and four gonadotrophin-releasing hormone (GnRH) 'double pulse' tests were included. The main outcome measures were changes in reproductive endocrinology and pituitary sensitivity/priming to GnRH after laser evaporation compared with diagnostic laparoscopy only.
  
  
  RESULTS
  In the first hours after surgery, both groups showed an increase in LH, follicle stimulating hormone, estrogen and a decrease in testosterone, androstenedione, AMH and insulin growth factor-1 (P < 0.05). Inhibin B increased in the laparoscopy only group (P < 0.05). In the first days after surgery, testosterone, androstenedione and AMH remained at lower than baseline levels exclusively in the laser group (P < 0.05). Pituitary sensitivity/priming to GnRH was not altered after either laser evaporation or laparoscopy only.
  
  
  CONCLUSIONS
  The limitations of this study are the short follow-up period and the relatively small groups.
  
  
  CONCLUSIONS
  The strength of this study is the integrally measured endocrine profiles in combination with an optimal control group of PCOS patients undergoing diagnostic laparoscopy only. Interestingly, most of the immediate endocrine changes after laser evaporation could be related to the surgical context and not to the ovarian drilling procedure itself.
  
  
  BACKGROUND
  The study was funded by the Foundation of Scientific Research in Obstetrics and Gynaecology and the study medication, Lutrelef, was donated by Ferring, The Netherlands, Hoofdorphe There were no conflicts of interests mentioned by the authors.
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands m.hendriks@vumc.nl.
authors.forename: M L
authors.initials: ML
authors.lastname: Hendriks
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: König
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Korsen
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Melgers
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Dekker
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Mijatovic
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Schats
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: P G A
authors.initials: PG
authors.lastname: Hompes
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Homburg
authors.affiliation: Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, Amsterdam 1090 HM, The Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Kaaijk
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J W R
authors.initials: JW
authors.lastname: Twisk
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynecology, VU University Medical Center, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
authors.forename: C B
authors.initials: CB
authors.lastname: Lambalk
mesh_terms: D000328:Adult; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D010535:Laparoscopy; D053685:Laser Therapy; D007986:Luteinizing Hormone / Q000097:blood*; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000601:surgery; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D013739:Testosterone; D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: GnRH tests; PCOS; laser evaporation; ovarian drilling; reproductive endocrinology