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Hum. Reprod. Advance Access published online on November 4, 2004
Human Reproduction, doi:10.1093/humrep/deh597
© 2004 by European Society of Human Reproduction and Embryology
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Received April 6, 2004
Revised July 26, 2004
Accepted October 14, 2004

Case Report

Bilateral oophorectomy in a pregnant woman: hormonal profile from late gestation to post-partum: Case report

Paulina Villaseca 1*, Carmen Campino 1, Eveline Oestreicher 1, David Mayerson 2, María Serón-Ferré 3, and Eugenio Arteaga 1

1 Department of Endocrinología, Facultad de Medicina, Santiago, Chile
2 Department of Obstetricia y Ginecología, Facultad de Medicina, Santiago, Chile
3 Department of Ciencias Fisiológicas, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile

* To whom correspondence should be addressed.
Paulina Villaseca, E-mail: pvillase{at}med.puc.cl


  Abstract

BACKGROUND: A 16 week pregnant woman presented with massive theca-lutein cysts requiring bilateral oophorectomy. Pregnancy progressed uneventfully and spontaneous lactation ensued after delivery. METHODS: To study the role of the ovary on the hormonal profile at the end of gestation and in post-partum, we measured FSH, estradiol (E2), unconjugated estrone (E1), unconjugated estriol (E3), sex hormone-binding globulin, progesterone, dehydroepiandrosterone sulphate and prolactin at 37 weeks gestation and at 8 h, 4 days, 5 weeks, and 2 months post-partum. RESULTS: These hormones were within the range expected for ovary-intact pregnant and puerperal women until 4 days post-partum. At 5 weeks post-partum, FSH increased to a peri-menopausal range (31.4 IU/l) while estrogens remained within the normal puerperal range (E2=239 pmol/l; E1=102 pmol/l), contrasting with their rapid changes in non-pregnant women after bilateral oophorectomy. At 2 months, while partially breastfeeding, FSH, E2 and E1 were closer to menopausal range (68 IU/l, 136 and 70.2 pmol/l respectively), and hormone replacement was started. CONCLUSIONS: We conclude that the ovary is not required to maintain a normal hormonal profile in late pregnancy and early puerperium. However, the increase in FSH to peri-menopausal levels at 5 weeks post-partum, despite breastfeeding, suggests that the ovary is needed to maintain low FSH concentrations during lactation.

Keywords: bilateral ovariectomy; estrogens; FSH; pregnancy; premature menopause.
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