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Reply: Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome
1 The Medical School, Derby City General Hospital, Derby, East Midlands, DE22 3NE, UK 2 Reproductive Medicine and Surgery Unit, University of Sheffield, Sheffield Teaching Hospitals, Sheffield, UK
3 Correspondence address. E-mail: saad.amer{at}nottingham.ac.uk
We would like to thank Hendriks and Lambalk for their interest in our paper (Amer et al., 2007
). In their letter, Drs Hendricks and Lambalk suggest that plasma inhibin B concentrations should have been measured shortly after laparoscopic ovarian diathermy (LOD) rather than after one week as described in the paper. In their view, postoperative changes in inhibin B may have been missed due to the late timing of blood sampling. However, we believe that clinically important postoperative changes in inhibin B, which may explain the actions of LOD, are those which are sustained for a long duration. Immediate changes, which are only short-lived, may not explain the effects of LOD, which in many cases last for several months/years (Gjonaess et al., 1998; Amer et al., 2002). Interestingly, in the two studies quoted by Drs Hendriks and Lambalk, including Lockwood et al. (1998) and Kandil and Selim (2005), the authors measured inhibin B levels postoperatively after a duration much longer than that in our study. Lockwood et al. (1998) measured inhibin B on day 5 of their first menstruation after LOD or after a progestogen withdrawal bleed if no menstruation had occurred after six weeks. Kandil and Selim (2005) measured inhibin B three months after LOD.
The discrepancy between our results and those of Lockwood et al. (1998) has been explained and discussed in details in our paper. The same explanation applies to the results of Kandil and Selim (2005). On the other hand, the disagreement between our results and those of Kovacs et al. (1991) may be explained by the difference in the assay methods used. It is well established that the ultrasensitive two-site-specific enzyme-linked immunosorbent assay used in our study is more sensitive and specific than those used in the early 1990s.
References
Amer S, Laird S, Ledger WL, Li TC. Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovarian syndrome. Hum Reprod (2007) 22:389–394.
Amer S, Li TC, Gopalan V, Ledger WL, Cooke ID. Long term follow up of patients with polycystic ovarian syndrome after laparoscopic ovarian drilling: clinical outcome. Hum Reprod (2002) 17:2035–1042.
Gjonnaess H. Late endocrine effects of ovarian electrocautery in women with polycystic ovary Syndrome. Fertil Steril (1998) 69:697–701.[CrossRef][ISI][Medline]
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. BJOG (1991) 98:30–35.[CrossRef]
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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