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I'm very aware. But there are other health risks associated with not correcting PCOS. Infertility is not the only problem it causes. The surgery does correct the hormonal imbalance in the body, which not only helps with fertility but overall health of the woman.
There may be risks associated with surgery, but there are also long-term risks with not correcting the PCOS. There's a quality of life factor too. This isn't the goal of a fertility doctor. The fertility doctor isn't treating PCOS. The fertility doctor is simply trying to help them achieve pregnancy.
The cost of the surgery is the MAIN reasons insurance companies push for doctors to do surgery alternatives. These articles downplaying the benefits of the surgery are just part of that scam. I'm very aware of ovarian drilling being the 'latest' surgery treatment. But as someone who was COMPLETEY CURED by an ovarian wedge resection, I strongly support it based on experience.
And Tuck has a right to know that this surgery exists and the future health risks of only focusing on fertility and not curing her PCOS. What if they achieve pregnancy and have a baby and she later develops Insulin Resistant Diabetes and dies? It's important he knows that fertility could be the least of her health problems in her lifetime.
Here are the future health risks of PCOS:
Quote:
Women with PCOS are at risk for the following:
Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible, due to overaccumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by estrogen. It is not clear if this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia, and hyperandrogenism[35][36][37][38]
Insulin resistance/Type II diabetes. A review published in 2010 concluded that women with PCOS had an elevated prevalence of insulin resistance and type II diabetes, also when controlling for body mass index (BMI).[39]
High blood pressure
Depression/Depression with Anxiety
Dyslipidemia - disorders of lipid metabolism — cholesterol and triglycerides. PCOS patients show decreased removal of atherosclerosis-inducing remnants, seemingly independent on insulin resistance/Type II diabetes.[40]
Cardiovascular disease
Strokes
Weight gain
Miscarriage[1][2]
Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)
After my first pregnancy, I had a tubal pregnancy which left me with no fallopian tube on the left side. I still went on to have two additional normal full term pregnancies a couple of years later. It never gave me any problems at all. I am now in my 50's.
I recommend your wife get on metformin. Metformin is often all it takes to get a woman with PCOD ovulating regularly, and it helps many of the other symptoms associated with PCOD. Not all docs agree, but metformin is often helpful even with non-insulin resistant PCOD. I would definitely push to get your wife put on metformin. If metformin alone isn't enough to get her ovulating, metformin + clomid or metformin + femara is often successful. And beyond that, there are more aggressive injectable ovulation inducing drugs. Lots of luck to you, even with 1 tube your wife has a great shot at pregnancy. (And don't quote me on this, but I think a HSG and possibly a lap is neccessary to positively diagnose a bad or blocked tube anyway?)
I'm very aware. But there are other health risks associated with not correcting PCOS. Infertility is not the only problem it causes. The surgery does correct the hormonal imbalance in the body, which not only helps with fertility but overall health of the woman.
There may be risks associated with surgery, but there are also long-term risks with not correcting the PCOS. There's a quality of life factor too. This isn't the goal of a fertility doctor. The fertility doctor isn't treating PCOS. The fertility doctor is simply trying to help them achieve pregnancy.
The cost of the surgery is the MAIN reasons insurance companies push for doctors to do surgery alternatives. These articles downplaying the benefits of the surgery are just part of that scam. I'm very aware of ovarian drilling being the 'latest' surgery treatment. But as someone who was COMPLETEY CURED by an ovarian wedge resection, I strongly support it based on experience.
And Tuck has a right to know that this surgery exists and the future health risks of only focusing on fertility and not curing her PCOS. What if they achieve pregnancy and have a baby and she later develops Insulin Resistant Diabetes and dies? It's important he knows that fertility could be the least of her health problems in her lifetime.
Here are the future health risks of PCOS:
Not every woman who has wedge resection will respond as you did.
" Unfortunately, wedge resection was associated with a very high prevalence of severe adhesive disease, thus precluding pregnancy even though the patient was again ovulating."
"Ovarian Cautery As indicated above, ovarian wedge resection was shown to enhance ovulatory function in PCOS, but at the cost of a high incidence of severe adhesive disease. In 1984, Gjonnaess reported that spot electrocautery of the ovarian capsule induced ovulation in a high proportion of 60 patients treated. The same investigator reported a much larger series in 1994, with good results. Two hundred fifty-two women were treated. Ovulation occurred in 92% and pregnancy in 84% with no further treatment. The subsequent annual rate of cessation of ovulation was 3%. Non-responding women were treated with clomiphene citrate, and 89% conceived. Several smaller series of patients so treated have been reported, with pregnancy rates of 50-70%. Endocrine changes after cautery are similar to those after wedge resection. Serum testosterone and serum LH levels fell and sex hormone binding globulin rose. These changes were maintained for up to ten years, and in a few patients followed for 15 years, the changes were maintained."
"Anovulatory patients who desire pregnancy should first be treated with clomiphene citrate in doses determined by response."
"Ovarian cautery can no longer be defined as new treatment, and in some patients may be the primary treatment for non-responders."
And with regard to the long term medical problems associated with PCO:
"It is important that the problems other than infertility and hirsutism not be forgotten after the reproductive problems are solved. All patients with PCOS should have blood lipids, including total cholesterol, LDL and HDL cholesterol and triglycerides determined. If lipids are abnormal, dietary management should be tried first, and if not effective drug therapy is clearly warranted because of the risk of heart attack or stroke. The woman should not be allowed to be exposed to uninterrupted estrogen, and should have a withdrawal bleed monthly with one of the progestational agents. At the present time, medroxyprogesterone is the most commonly used. In order to prevent long term complications of PCOS, the woman should have a lifetime relationship with her physician with special attention to the potential long term risks associated with her disease."
The metabolic problems can be managed medically, and there is no guarantee that wedge resection would prevent them.
"Fertility doctors" are also experts in reproductive endocrinology. I assure you that they are well versed in all aspects of the care of patients with PCO. The majority of generalist gynecologists can also manage these problems in patients who are not trying to get pregnant. First line treatment is medical, not surgical.
And for Mrs. Tuck, who may already have a tubal problem, the risk of surgery would outweigh the benefits if she does have one good tube. Wedging or drilling the ovaries and causing scarring which closed the good tube would place her in a situation where IVF might be the only alternative.
This study showed that medical induction of ovulation and ovarian drilling both resulted in the same pregnancy rates, though multiple pregnancies were higher with meds.
If both tubes appear to be closed, some IVF specialists would recommend removal of the tubes. At that point, consideration could be given to drilling the ovaries. Frankly, wedge resection is now a somewhat archaic procedure. It is not a "cure" for PCO, despite your personal experience, and it is not first line treatment for it. There is no "scam" involved. It's just better medicine to try the meds first.
suzy, I'm not here to have a great debate with you. I'm here to share my personal experience.
Afterall, the OP asked for personal experiences when he asked if "anyone has been through this." (I don't see anything about personal experience in your responses.)
Until my post, nobody mentioned any surgical options and nobody mentioned the other health risks associated with PCOS that can't be ignored even if she does have children.
As a result, I'm very pleased with the outcome of my posts in this thread resulted in attracting passionate responses from you.
If I were the OP, I'd be seeing multiple specialists, not putting all of my faith in one doctor/practice.
I'm sorry that you fail to understand that the insurance industry dictates the order in which treatment options are done.
Hopefully, the OP will understand that and ask specialists hard questions because patients need to advocate for themselves to get the best possible treatments available.
suzy, I'm not here to have a great debate with you. I'm here to share my personal experience.
After all, the OP asked for personal experiences when he asked if "anyone has been through this." (I don't see anything about personal experience in your responses.)
The problem is that your personal experience is atypical, and it is unwise to base a medical decision on the basis of a "series of one". Also, you are promoting a surgical procedure that is seldom done any more, because a lot of women develop pelvic scar tissue from the procedure. They may ovulate, but with the tubes closed by scar tissue, they still cannot get pregnant.
And no, I do not have PCO personally.
Quote:
Until my post, nobody mentioned any surgical options and nobody mentioned the other health risks associated with PCOS that can't be ignored even if she does have children.
I did not mention surgical options because I feel they are inappropriate first line options for Mrs. T. Mr. T.'s original post was about the concern with the possibility of a tubal problem. Surgery could potentially worsen a tubal problem, leaving IVF the only viable option.
Quote:
As a result, I'm very pleased with the outcome of my posts in this thread resulted in attracting passionate responses from you.
Quote:
If I were the OP, I'd be seeing multiple specialists, not putting all of my faith in one doctor/practice.
I'm sorry that you fail to understand that the insurance industry dictates the order in which treatment options are done.
Hopefully, the OP will understand that and ask specialists hard questions because patients need to advocate for themselves to get the best possible treatments available.
You are misinformed. As I said before, currently trained reproductive endocrinologists are well versed in the metabolic features of PCO. In fact, the majority of the research that has worked out the metabolic processes was done by reproductive endocrinologists. Right now Mrs. T.'s goal is a baby. I feel confident that her fertility specialist will also educate her concerning the long term goals of managing the other features of PCO, which her primary gynecologist and primary care doctor can easily handle.
There is really no need to scampering off to see "multiple specialists" --- and which would you be thinking of anyway?
As far as insurance is concerned, you do know that most companies do not cover services for fertility treatment, don't you? Mr. and Mrs T. may be paying totally out of pocket
Perhaps that's her only goal because she wasn't aware of the other health risks associated with PCOS.
Quote:
Originally Posted by suzy_q2010
As far as insurance is concerned, you do know that most companies do not cover services for fertility treatment, don't you? Mr. and Mrs T. may be paying totally out of pocket
They wouldn't be paying totally out of pocket if they sought treatment for PCOS via a gynecologist and a regular endocrinologist.
Start focusing on the positives of not having a child...working on a PhD, planning a wonderful trip to Europe, doing things that are childfree, and focusing on those things. It is so easy to get caught up in the cycles of doctors, and medication, and stress...why not take a deep breath, and think about some positives of being childfree for a while longer? Then, consider adopting a child, why not investigate adoption overseas, it is an option, that might be better in the long run, than the health risks of medication, and surgery, or think about being a foster parent.
Plan a trip to China, or whatever...and investigate adoption overseas. This might be a better option. And then, just see what happens later on down the road, without any birth control, you never know...once you start relaxing, and not focusing on this, it just might work...
Last edited by jasper12; 01-26-2011 at 03:26 PM..
Reason: edit
No, I do not have PCO, but I have had ovarian surgery. And I am very familiar with the treatment of PCO. I do not think it is necessary to have a medical condition in order to share information about it on this forum. Do you? Have you had a problem with damaged Fallopian tubes? I do not think so, because you are completely ignoring the title of the thread and the concern that Mrs. T. has at least one damaged tube and possibly both are compromised.
"Bilateral ovarian wedge resection (BOWR) of the ovaries was then introduced as a procedure that could assist patients with polycystic ovary syndrome to ovulate. It was the only method available until the introduction of the oral medicine clomiphene citrate in the mid 1960's. The problems with BOWR were that it required a major abdominal incision and that almost all patients developed scar tissue (adhesions) around the tubes and ovaries that further exacerbated their infertility." (Emphasis mine - Suzy Q)
Concerning ovarian drilling:
"Despite these efforts, adhesions around the tubes and ovaries can occur, but tend to be milder than with the classic BOWR, and do not appear to affect pregnancy rates.. Rarely the ovaries can undergo irreparable damage and cease to function (atrophy)." ( Emphasis mine - Suzy Q)
These days, wedge resection can be done through the laparoscope, but ovarian drilling is the preferred procedure. Even ovarian drilling would be avoided in a patient with already compromised tubes.
What I cannot fathom is why you refuse to believe that wedge resection is no longer a preferred procedure used to treat PCO. It may be offered to patients who do not respond to medication, however:
"Frequently, the surgical approach is chosen when a patient has already failed to ovulate on clomiphene citrate at maximal doses and has not responded to insulin sensitizing agents. The use of this procedure for other aspects of testosterone excess such as acne or hirstuism has yielded very poor results and is not recommended.
Therefore, surgical treatment is not a cure for PCO.
I stand by my opinion that wedge resection of the ovary is an outdated procedure and that Mrs. T probably should avoid surgery if she has one functioning tube until medical treatment is tried first to help her get pregnant. If both tubes are damaged and surgery becomes indicated for removal of the tubes prior to IVF or if laparoscopy is recommended for fiurther diagnosis, such as to look for and treat endometriosis (which is what caused me to lose an ovary ), then her fertility specialist might recommend ovarian drilling. Surgery is no longer the first line treatment for PCO and has not been for many years.
Quote:
Perhaps that's her only goal because she wasn't aware of the other health risks associated with PCOS.
I did not say it was her only goal. That appears to be an assumption that you are making. You seem to feel she should just forget trying to get pregnant and worry only about the other features of PCO.
Quote:
They wouldn't be paying totally out of pocket if they sought treatment for PCOS via a gynecologist and a regular endocrinologist.
Again, you continue to ignore the tubal problem. You also do not understand the scope of practice of the reproductive endocrinology and infertility specialist. And, yes, insurance may refuse to pay for treatment from a general gynecologist that is designed to treat infertility.
See here about the qualifications for a reproductive endocrinologist and infertility specialist:
Perhaps you should read some previous posts in the thread:
Quote:
Originally Posted by suzy_q2010
I do not think it is necessary to have a medical condition in order to share information about it on this forum. Do you?
The OP asked:
Quote:
Originally Posted by Tuck91NYG
Has anyone went through a situation like this?
Quote:
Originally Posted by suzy_q2010
Have you had a problem with damaged Fallopian tubes? I do not think so, because you are completely ignoring the title of the thread and the concern that Mrs. T. has at least one damaged tube and possibly both are compromised.
I stated:
Quote:
Originally Posted by Hopes
When I was 23, I had an etopic pregancy in my right fallopian tube, which was removed.
Quote:
Originally Posted by suzy_q2010
You seem to feel she should just forget trying to get pregnant and worry only about the other features of PCO.
It doesn't take a rocket scientist to realize that treating her PCOS could help her achieve her pregnancy goals. His wife isn't ovulating because of her PCOS.
Quote:
Originally Posted by Tuck91NYG
My wife after several months of not ovulating and getting her period was sent to get an ultrasound which revealed cysts. They put her on medication to induce her period in hopes that it would jump start her cycle again. Well it didn;t happen. She was then blood tested and it came back with a little higher than normal testosterone and low DHEA, also no progesterone which means no ovulation has been occuring.
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), then her fertility specialist might recommend ovarian drilling. Surgery is no longer the first line treatment for PCO and has not been for many years. 
