Surgical Management of Polycystic Ovarian Disease

Abstract

Polycystic ovarian disease (PCO) was first described in 1935 by Stein and Leventhal.¹ Their first ovarian wedge resection was performed successfully in 1929. A follow-up article by Stein et al.² reported long-term results in 75 cases treated with his surgical procedure. Although hormonal therapies were suggested and used throughout the 1940s and 1950s, it was not until clomiphene citrate became commercially available that medical treatment of PCO became satisfactory. With the popularity of clomiphene citrate and later human menopausal gonadotropins (hMG), the need for surgical treatment of PCO has become less frequent. With the reports in the 1970s of significant number of patients undergoing laparotomy and ovarian wedge resection who developed postoperative adhesions, the classic operation of wedge resection fell into disfavor. Over the last decade laparoscopic techniques for performing various ovarian traumatizing procedures have been reported with varying degrees of successful subsequent ovulation and pregnancy. Because of these two facts (the success of ovulation induction therapy for PCO and the knowledge of post-wedge-resection adhesion formation), techniques for surgical treatment of PCO have fallen into disrepute, and the surgical skills are not often learned by physicians in training today. This chapter reviews the history of surgical treatment of PCO and discusses the techniques and results obtained by investigators over the last 60 years.