“Hormonal Wedge Resection”: An Effective Treatment Method of Anovulatory Infertility Associated with Polycystic Ovary Syndrome
The greatest contradiction in the CC treatment of polycystic ovary syndrome is that – even with permeable fallopian tube and normospermia – despite achieving 70–80 % actual ovulation, only 30–40 % of patients will conceive. The diagnostic method we developed made it evident that different levels of insufficient folliculo-luteal function (FLF) underlie this observation and the high prevalence of clinical abortion (~30 %) in patients. After normalising FLF, ovulatory and pregnancy rates became almost equal.
We developed an effective method, which we called “hormonal wedge resection”, to cure anovulatory infertility associated with PCOS. This was inspired by our observation that when dexamethasone (DEX) treatment (0.5 mg/day) is continued after the combined suppression of the adrenal cortex and the ovaries (oestrogen-gestagen + DEX), ovarian hyperandrogenism does not recur (or only recurs after a long time). DEX treatment combined with the appropriate dose of CC – together with the control of luteal progesterone (P) – resulted in ovulation in 97.6 % of patients (120/123), and 95.9 % (118/123) became pregnant 167 times (with at least one permeable fallopian tube and normospermia).
During hormonal wedge resection therapy, every pregnancy occurred within 1–7 months with physiological FLF (N = 111, P > 23 ng/ml), the average monthly pregnancy rate was 38.6 % (!), the cumulative pregnancy rate was 95.5 % and the time to pregnancy was 2.44 ± 1.3 cycles. Pregnancy outcome was also favourable with physiological FLF: miscarriage occurred in 2.7 % of cases, preterm birth in 1 % and IUGR in 1 %, and there were no cases of preeclampsia. Twin births took place in 9.3 % of patients. Concerning pregnancy outcome, the most optimal P value appears to be the average of 26–32 ng/ml: average singular newborn weight is 3,716 g, length 56 cm, weight percentile 75 % and length percentile 73 %, and the incidence of twin births is 5.6 %.
Hormonal wedge resection proved to be an effective, simple, repeatable and low-cost therapy for anovulatory infertility associated with PCOS, and it is also suitable for treating CC-resistant cases.
KeywordsPreterm Birth Adrenal Cortex Polycystic Ovary Syndrome Clomiphene Citrate PCOS Patient
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