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Human Reproduction Update Advance Access published online on January 5, 2007
Human Reproduction Update, doi:10.1093/humupd/dml058
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Why does ovarian surgery in PCOS help? Insight into the endocrine implications of ovarian surgery for ovulation induction in polycystic ovary syndrome

M.L. Hendriks1,3, J.C.F. Ket2, P.G.A. Hompes1, R. Homburg1 and C.B. Lambalk1

1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center 2 Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

To whom correspondence should be addressed at: 3 To whom correspondence should be addressed at: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: m.hendriks{at}vumc.nl

Polycystic ovary syndrome (PCOS) is a complex disorder with heterogeneity of clinical and endocrine features. Ovarian surgery for ovulation induction has been used in the management of clomiphene citrate-resistant anovulatory women with PCOS. Various types of ovarian surgery have been employed (wedge resection, electrocautery, laser vaporization, multiple ovarian biopsies and others) and all operations result in an altered endocrine profile after surgery. The mechanism behind the reversal of endocrinological dysfunction in PCOS after ovarian surgery remains incompletely understood. This review scans the literature systematically to identify the endocrine changes after ovarian surgery in PCOS, in order to glean some knowledge of the mechanism involved. After ovarian surgery in PCOS, a rapid reduction of all ovarian hormones is seen, in combination with increased serum levels of pituitary hormones. Folliculogenesis is then initiated and ovarian hormone production increases, synchrone with a reduction of pituitary hormones. Continuation of follicle growth in subsequent cycles after ovarian surgery occurs in an environment with less androgens and lower LH and FSH levels compared with pretreatment levels. The endocrine changes found after ovarian surgery in PCOS women seem to be governed by the ovaries themselves. Rapid reduction of all ovarian hormones restores feedback to the hypothalamus and pituitary, resulting in appropriate gonadotrophin secretion. Initiation of follicular development seems to be induced by increasing FSH levels following a reduction of the follicle excess and (intra-ovarian) androgen levels. Additionally, anti-Müllarian hormone and gonadotrophin surge attenuating factor probably have a role in the endocrine changes.

Key words: endocrinology / infertility / ovulation induction / polycystic ovary syndrome / surgery


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M.L. Hendriks and C.B. Lambalk
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