Is There Still a Place for Surgery in Patients with PCOS? A Review
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Country | Type of Study | Sample Size, n° | Age (Years—Mean ± SD or Median (Range)) | Symptoms and Signs (n—%) | BMI (kg/m2) (Mean ± SD) | Medical Treatment, (n) | Surgical Treatment | Hormonal Levels in Plasma before Treatment (Mean ± SD or Median (Range)) | Ovarian Volume (mL—Mean ± SD) | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
LH (IU/L) | FSH (IU/L) | LH:FSH Ratio | AMH (ng/mL) | Testosterone (nmol/L) | ||||||||||
Gjønnaess, 1994 [15] | Norway | Retrospective study | 109 | NR | NS: oligomenorrhea and cystic glandular hyperplasia of the endometrium | 58.7 ± 6.2 | CC (109) | Ovarian electrocautery | 14.6 | 6.3 | NR | NR | 2.7 | NR |
Li et al., 1998 [16] | Japan | Retrospective study | 111 | 28.6 ± 3.9 | 24 (22) hirsutism 80 (72) oligomenorrhea 17 (15) amenorrhea | 26.0 ± 4.8 | CC (87) | LOD | 15.4 ± 9.1 | 5.4 ± 1.9 | 2.5 ± 2.1 | NR | NR | NR |
Kriplani et al., 2001 [17] | India | Prospective study | 70 | 26.4 | 59 (84.3) oligomenorrhea 11 (15.7) secondary amenorrhea | <29 kg/m2 in 42 (60%) | CC (70) | LOD | >10 IU/L in 42 (60%) | NR | >2 in 32 (45.7%) | NR | NR | NR |
Fernandez et al., 2001 [18] | France | Prospective study | 13 | 28.5 ± 3.9 | 2 (15.3) hirsutism 3 (23.07) oligomenorrhea 1 (7.69) amenorrhea | 24.1 ± 4.5 | CC (12) | THL | NR | NR | 2.0 ± 0.8 | NR | NR | NR |
Al Ojaimi, 2003 [19] | Asia | Prospective study | 198 | 30.5 ± 5.7 | 132 (66.7) oligomenorrhea 41 (20.7) amenorrhea | 29.8 | CC (184) and additional gonadotrophin therapy (72) | LOD | 13.3 ± 5.6 | 6.1 ± 3.0 | 2.3 ± 1.1 | NR | 2.4 ± 1.3 | NR |
Duleba et al., 2003 [20] | Poland | Prospective study | 33 | 26.8 | NS: oligomenorrhea, hirsutism, or acne | 29.3 | NR | Laparoscopic ovarian wedge resection using harmonic scalpel | 13.4 | 5.9 | 2.33 | NR | 0.8 | 12.6 |
Stegmann et al., 2003 [21] | Arizona | Prospective study | 86 | 30.2 | 49 endometriosis 54 adhesions NS hirsutism NS acanthosis | 29.35 | CC (NS) | LOD | NR | NR | 1.94 | NR | 17.39 | 4.2 (median left ovary) 4.3 (median right ovary) |
Amer et al., 2004 [22] | UK | Prospective study | 200 | 28.9 [3.9] | 149 (74) oligomenorrhoea 36 (18) amenorrhea 70 (35) hirsutism | 27.1 ± 4.9 | CC (200) | LOD | 14.2 ± 6.6 | 5.2 ± 1.4 | 2.8 ± 1.2 | NR | 2.6 ± 1.2 | 11.4 ± 3.6 |
Van Wely et al., 2005 [23] | Netherlands | Prospective study | 83 | 28.5 [1.0] | 35 (42.1) amenorrhea 47 (56.6) oligomenorrhea | 27 ± 6.2 | CC (83) | Ovarian electrocautery | NR | NR | NR | NR | NR | NR |
Palomba et al., 2006 [24] | Italy | Prospective study | 60 | 29.3 [5.2] | NS | 27.6 ± 1.9 | CC (60) | LOD | 18.0 ± 4.1 | 8.9 ± 3.4 | NR | NR | 3.8 ± 1.2 | NR |
Amer et al., 2009 [25] | UK | Prospective study | 47 | 28.4 [0.9] | NS—oligo/amenorrhea and/or hyperandrogenemia | 26.9 ± 0.6 | CC (18) | LOD (29/47) | 11.7 (4.6–23.7) | 5.1 (2.9–8.2) | 6.1 (1.0–21.0) | 2.5 (1.0–4.0) | 11.9 ± 1.1 | |
Gordts et al., 2009 [26] | Belgium | Retrospective study | 39 | 30.4 [3.8] | NS—amenorrhea or oligomenorrhea, with or without hirsuitism | 29.4 ± 9.7 | CC (16) | THL | 15 ± 10 | 5.5 ± 2 | 2.7 | NR | 1.7 ± 1.2 | NR |
Ott et al., 2009 [27] | Austria | Retrospective cohort study | 100 | 28.2 | NS—anovulation, oligomenorrhea, hirsutism, acne, and infertility | 26.5 | CC (100) | LOD | 15.1 (6.0) | 6.2 (1.7) | NR | NR | 0.8 (0.4) | NR |
Kaur et al., 2013 [28] | India | Observational retrospective study | 100 | 27 [3.2] | NS- anovulation, oligomenorrhea, hirsutism, acne, and infertility | 26.6 ± 4.2 | CC (100) | LOD | NR | NR | 2.1 (1.1) | NR | NR | NR |
Giampaolino et al., 2016 [31] | Italy | Prospective randomized study | 123 | 27.5 ± 6.8 | NR | 27.3 ± 5.6 | CC (123) | THL | NR | NR | NR | 5.84 ± 1.16 | 1.2 ± 0.3 | NR |
123 | 30.1 ± 7.5 | NR | 25.9 ± 7.1 | CC (123) | LOD | NR | NR | NR | 6.06 ± 1.18 | 1.6 ± 0.2 | NR | |||
Giampaolino et al., 2017 [29] | Italy | Prospective observational study | 117 | 29.5 [3.9] | NS—oligomenorrhea and amenorrhea, hyperandrogenism, acne, hyrsutism, and androgenic alopecia | NR | CC (117) | THL | 8.85 (1.39) | 5.35 (0.71) |
1.68
(0.35) | NR | NR | 11.78 (1.61) |
Gordts et al., 2021 [30] | Belgium | Retrospective cohort study | 2288 | 31.25 [3.8] | 366 (15.9) endometriosis 144 (6.3) adhesions | - | CC (NS) | THL | NR | NR | NR | NR | NR | NR |
Menstrual Cycle Pattern, n (%) | Ovulation, n (%) | Pregnancy Outcomes, n (%) | Hormonal Levels in Plasma Post-LOD Treatment Mean ± SD or Median (Range) | |||||
---|---|---|---|---|---|---|---|---|
LH (IU/L) | FSH (IU/L) | LH/FSH Ratio | AMH (ng/mL) | Testosterone (nmol/L) | ||||
Gjønnaess 1994 [15] | NR | 105 (96.3) | 76 (69.7) | NR | ||||
Li et al., 1998 [16] | 160 (88) regular 23 (21) irregular | 74 (67) spontaneously 22 (20) via CC 15 (13) none | 58 (52) ongoing/delivery 7 (6) miscarriages 2 (2) ectopic 44 (40) none | 7.7 (1) vs. 10 (1.3) * | 5.6 (0.6) vs. 6.9 (1.7) * | NR | NR | NR |
Kriplani et al., 2001 [17] | NR | 54 (81.8) spontaneously 6 (9.1) via CC 2 (3) via gonadotropins | 50 (71.4):
| NR | ||||
Al Ojaimi et al., 2003 [19] | 160 (88.4) regular 21 (11.6) irregular | 127 (70.1) spontaneously 51 (28.2) via CC 3 (1.7) none | 120 (66.3) ongoing/delivery 31 (17.2) miscarriages 2 (1.1) ectopic 28 (15.5) none | 13.3 (5.6) | 6.1 (3.0) | 2.3 (1.1) | NR | NR |
Duleba et al., 2003 [20] | NR | NR | 22 (67) | 8.9 (1.9) | 5.8 (0.6) | 1.4 (0.3) | NR | 0.47 (0.04) |
Stegmann et al., 2003 [21] | 57 (66) regular | (>50) spontaneously | 43 (89.6), of which 9 by IVF 1 (2.1) ectopic 1 (2.1) triplet gestation abortion 3 (6.2) miscarriages | NR | ||||
Amer et al., 2004 [22] | 15 (8) regular 185 (92) irregular | 113 (57) spontaneously 43 (21) by CC 44 (22) none | 86 (45) ongoing/delivery 9 (4) miscarriages 2 (1) ectopic 96 (50) none |
| NR |
| NR |
|
Van Wely et al., 2005 [23] | NR | 38 (46) spontaneously 21 (25) via CC 24 (29) none | 41 (49) ongoing/delivery | 11.5 (5.6) | 6.1 (2.1) | 2.0 (9.6) | NR | 4.0 (1.7) |
Palomba et al., 2006 [24] | NR | 3 (0.5%) | 33 (60) | A 19.0 (3.7) B 17.6 (4.2) C 18.1 (3.9) D 18.4 (4.9) *** | A 7.6 (1.6) B 8.6 (3.1) C 9.3 (3.4) D 10.6 (4.7) *** | NR | NR | A 3.7 (1.2) B 3.9 (3.2) C 3.8 (1.1) D 3.8 (1.3) *** |
Amer et al., 2009 [25] | NR | 24 (83) 5 (17) none | 15 (52) | 7.9 (1.9–21.0) | 5.5 (1.7–7.7) | NR | 4.3 (0.3–15.1) | 2.2 (1.1–3.6) |
Ott et al., 2009 [27] | NR | 71 (71) 29 (29) none | 36 (36) ongoing/delivery | 6.4 ± 4.0 | NR | NR | NR | NR |
Kaur et al., 2013 [28] | 18 (18) regular 82 (82) irregular | NR | 35 (85.4) ongoing/delivery 5 (12.2) miscarriages 1 (2.4) ectopic | NR | NR | 2.1 ± 1.1 | NR | NR |
Giampaolino et al., 2016 [31] | NR | NR | (68—cumulative rate) | NR |
Ovulation, n (%) | Pregnancy, n (%) | Hormonal Levels in Plasma Post-THL Treatment Mean ± SD or Median (Range) | |||||
---|---|---|---|---|---|---|---|
LH (IU/L) | FSH (IU/L) | LH/FSH Ratio | AMH (ng/mL) | Testosterone (nmol/L) | |||
Fernandez et al., 2001 [18] | 6/13 (46) regular 5/13 (39) amenorrhea 2/13 (15) immediately pregnant | 6/13 (46):
| NR | ||||
Gordts et al., 2009 [26] | 12/28 (43) spontaneously 16/18 (57) by CC plus hMG | 25/33 (76)
| 8 ± 3 | 6.1 ± 1.5 | 1.3 | NR | 1.1 ± 0.7 |
Giampaolino et al., 2016 [31] | NR | (68—cumulative rate) | NR | ||||
Giampaolino et al., 2017 [29] | 64.1% after 1 month 79.5% after 3 months 82.9% after 6 months | (70.1) | NR | ||||
Gordts et al., 2021 [30] | NR | (25.6) | NR |
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Della Corte, L.; Boccia, D.; Palumbo, M.; Mercorio, A.; Ronsini, C.; Bifulco, G.; Giampaolino, P. Is There Still a Place for Surgery in Patients with PCOS? A Review. Life 2023, 13, 1270. https://doi.org/10.3390/life13061270
Della Corte L, Boccia D, Palumbo M, Mercorio A, Ronsini C, Bifulco G, Giampaolino P. Is There Still a Place for Surgery in Patients with PCOS? A Review. Life. 2023; 13(6):1270. https://doi.org/10.3390/life13061270
Chicago/Turabian StyleDella Corte, Luigi, Dominga Boccia, Mario Palumbo, Antonio Mercorio, Carlo Ronsini, Giuseppe Bifulco, and Pierluigi Giampaolino. 2023. "Is There Still a Place for Surgery in Patients with PCOS? A Review" Life 13, no. 6: 1270. https://doi.org/10.3390/life13061270
APA StyleDella Corte, L., Boccia, D., Palumbo, M., Mercorio, A., Ronsini, C., Bifulco, G., & Giampaolino, P. (2023). Is There Still a Place for Surgery in Patients with PCOS? A Review. Life, 13(6), 1270. https://doi.org/10.3390/life13061270