Endocrine changes after laparoscopic ovarian cautery in polycystic ovarian syndrome

Recently, laparoscopic ovarian cautery has been described as a method of ovulation induction in women with polycystic ovarian disease. In an attempt to determine the mechanism of action, serum levels of androstenedione, testosterone, luteinizing hormone, follicle-stimulating hormone, and estradiol were determined before and after the laparoscopic ovarian cautery in six women with polycystic ovarian disease who had failed to ovulate with clomiphene citrate and human chorionic gonadotropin. Six regularly cycling women undergoing laparoscopy for investigation of infertility or tubal ligation served as controls. In patients with polycystic ovarian disease but not in controls, serum androstenedione, testosterone, estradiol, and luteinizing hormone significantly decreased to nadir levels on postoperative days 3 and 4. In contrast follicle-stimulating hormone levels rose after operation. These results resemble those reported after ovarian wedge resection. Of the six treated women, five ovulated postoperatively and four conceived. Laparoscopic ovarian cautery appears to be a promising alternative treatment for patients with polycystic ovarian disease in whom initial medical management fails.