Hum. Reprod. Advance Access originally published online on May 24, 2007
Human Reproduction 2007 22(7):2073; doi:10.1093/humrep/dem131
Letters to the Editor |
Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome
Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
1 Correspondence address. E-mail: m.hendriks{at}vumc.nl
We read with interest the recently published article of Amer et al. (2007) on the effect of laparoscopic ovarian diathermy on inhibin B levels in women with polycystic ovary syndrome (PCOS).
The authors have chosen to measure inhibin B levels before and one week after ovarian diathermy and found no change in inhibin B levels. Unfortunately, due to the late timing of blood sampling essential endocrine changes directly after surgery have possibly been missed. One could expect lower inhibin levels shortly after the procedure, as serum levels of all other ovarian hormones decrease temporarily after ovarian surgery and FSH (which is normally restrained by inhibin) increases (Hendriks et al., 2007
).
So far three papers have been published on inhibin B levels after ovarian surgery in PCOS (Kovacs et al., 1991; Lockwood et al., 1998; Kandil and Selim, 2005), whereas only one is referred to by the authors. All three show a decline of inhibin levels after the surgery. Kovacs et al. (1991) showed a rapid decrease of inhibin levels after ovarian electrocautery followed by a subsequent rise, and the others found lower inhibin levels in the early follicular phase after (bilateral) ovarian surgery, in combination with decreased ovarian reserve (Lockwood et al., 1998; Kandil and Selim, 2005). Decreased inhibin B levels, as a marker of ovarian reserve is a likely consequence of destructive ovarian surgery.
In our opinion, the timing of sampling has been chosen unfortunate and based on the currently available data it seems that the conclusion by the authors that ‘inhibin B does not seem to play any role in the mechanism of action of LOD’ is unjustified.
References
Amer SA, Laird S, Ledger WL, Li TC. Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome. Hum Reprod (2007) 22:389–394.
Hendriks ML, Ket JC, Hompes PG, Homburg R, Lambalk CB. Why does ovarian surgery in PCOS help? Insight into the endocrine implications of ovarian surgery for ovulation induction in polycystic ovary syndrome. Hum Reprod Update (2007) 13:249–264.
Kandil M, Selim M. Hormonal and sonographic assessment of ovarian reserve before and after laparoscopic ovarian drilling in polycystic ovary syndrome. BJOG (2005) 112:1427–1430.[CrossRef][ISI][Medline]
Kovacs G, Buckler H, Bangah M, Outch K, Burger H, Healy D, Baker G, Phillips S. Treatment of anovulation due to polycystic ovarian syndrome by laparoscopic ovarian electrocautery. Br J Obstet Gynaecol (1991) 98:30–35.[ISI][Medline]
Lockwood GM, Muttukrishna S, Groome NP, Matthews DR, Ledger WL. Mid-follicular phase pulses of inhibin B are absent in polycystic ovarian syndrome and are initiated by successful laparoscopic ovarian diathermy: a possible mechanism regulating emergence of the dominant follicle. J Clin Endocrinol Metab (1998) 83:1730–1735.
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