Ep. 91: Ovarian Wedge Resection, with Dr. Christine Hemphill

Caitlin:

Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the Woven Well Podcast. So today I get to introduce you to Dr. Christine Hemphill. Dr. Hemphill is a board certified obstetrician gynecologist trained in medical and surgical NaPro technology who practices in South Carolina and is also licensed in Texas, North Carolina, and Virginia. She's married with six children and three stepchildren. Dr. Hemphill, thank you so much for being on the show. Welcome.

Dr. Hemphill:

Thank you. I appreciate the invitation to come and join you, Caitlin. It's my pleasure to give this information out to your listeners.

Caitlin:

I am excited about our topic today, ovarian wedge sections, because I think a lot of women don't know much or anything about them. But I'd love for our listeners to get to know you just a bit before we jump into learning about that topic. So, can you share a little bit about what led you to become a surgical fellow in NaPro technology?

Dr. Hemphill:

One of my online friends in a group that I was in for natural family planning had pointed out that the Pope Paul VI Institute had started this thing called a fellowship, and it kind of intrigued me at first. So I looked at the website, saw what the fellowship was, and realized it was exactly what I wanted to do. I wanted to be able to focus on correcting women's reproductive issues, helping them to conceive more naturally, and doing so within a way that didn't go against my faith beliefs. So I decided to get through my first year of obstetrics and gynecology residency, make sure I wasn't going to quit on, on the entire field, and then I would apply. So I applied during my second year and interviewed during that spring and was offered a position later that year for the year after I graduated residency. So I had secured my position quite early and I'm so thankful that I did, because there's only two--at that time, there were only two--positions per year, so I wanted to make sure that I got in. It's the only place that you can get the training.

Caitlin:

And being a certified fertility care practitioner myself, I have been privileged to see what a difference that kind of intentional restorative surgery can have in the lives of women. So I am so glad that you did pursue that. What about ovarian wedge resections? Can you tell us a little bit about what they are and what issue they address?

Dr. Hemphill:

So, an ovarian wedge resection is obviously a surgical procedure. It is primarily used to treat polycystic ovarian syndrome or polycystic ovarian disease. With PCOS, the, the background is that most patients ovulate very infrequently. And so for those who don't want to conceive, they just need to regulate their cycles so that they don't have a thickened lining to their uterus and they don't experience heavy, crazy bleeding. And when the birth control pill came out in the 1950s, that was the solution that was given to them. "Hey, take this medication. It will regulate your cycle, and you don't need to do surgery." On the flip side, those patients who wanted to conceive clomiphene citrate became available as an ovulation induction agent. So from a medical standpoint, for those trying to conceive clomiphene citrate became the go-to treatment.

Dr. Hemphill:

So there were medical therapies offered in lieu of surgery in around the 1950s, and that became the mainstay of treatment for polycystic ovarian syndrome, which neither actually fixed the underlying issue. They just were therapies that had to continue constantly. The background on this procedure actually stems back to its original discoverers, so to speak, Dr. Stein and Dr. Leventhal. So when they were trying to learn more about polycystic ovarian syndrome, one of the approaches that they took was that they wanted to do biopsies of the ovaries. They would take literally a wedge-shaped biopsy out of the ovary, in order to be able to take that biopsy and look at it under the microscope. They found that subsequent to these larger biopsies being taken from the ovaries, the women started to ovulate spontaneously more frequently. We found that ovulation rates increased and pregnancy rates increased in the 1990s, late 1990s, 2000s, there was so much advancement from laparoscopy that we began to note that we had robotic laparoscopy available.

Dr. Hemphill:

So now with robotics, you can be a lot more meticulous with your movements, and you can perform the more challenging ovarian wedge resection and still do it minimally invasive. So that decreases the recovery time. That was an original issue, and it decreases the infection risk that was an original issue. So the last issue is the scarring. Well, Dr. Hilgers and his approach with NaPro technology fixes the scarring issue because we use what he has termed pelvioplasty, which is a technique to repair the tissues after the surgery, the functional surgery, has actually been done. So now what NaPro technology and surgical fellows do is once the wedge resection is done, we actually will sew the ovary back together closed, so that those chemicals aren't being seeped into the pelvis as it repairs itself.

Caitlin:

That is amazing.

Dr. Hemphill:

That's the reason why we offer it. We're able to offer the treatment that gives you better pregnancy rates and alleviate the concerns that were the original issues with the surgery. So that's the reason why we're starting to see it a little bit more frequently noted in the literature, and there's a little bit better awareness of this procedure.

Caitlin:

So if somebody decides to have the surgery done, can they expect changes immediately, or what kind of changes would they notice from a patient's point of view?

Dr. Hemphill:

The biggest thing that they notice is a better regulation of their menstrual cycles. So polycystic ovarian syndrome with the irregularity that they experience can vary from patient to patient. Some patients are just slightly longer cycles where they're maybe 40 days instead of 28 days. And then you have other patients who never ovulate on their own or so infrequently that it's years between ovulation. So we do see that if they're going to respond to this procedure, they tend to become more frequent. And even for those patients who don't see the regulation of their cycle, those patients tend to be patients that when you are using Clomid or Clomiphene citrate, Tamoxifen or Letrozole, that they didn't respond very well to those medications, or if they did respond, you had to use really high doses to get them to respond. So after having the surgery, they tend to respond better, and you can lower the doses of exposure and still get ovulatory cycles. So that's kind of the main thing that we can see from this procedure. There is some evidence in the literature that says it will decrease some of the androgens, which are the male hormones that we frequently will see elevated in polycystic ovarian syndrome, as well as decreasing some of the insulin resistance that may be seen associated with polycystic ovarian syndrome. So there's a threefold benefit, potential benefit, from this surgery.

Caitlin:

And I love that you addressed how it helps women who are wanting to conceive a pregnancy and women who value their health and just want to have that regular cycle for the health of their overall body and their reproductive system. We absolutely agree with you. We are all about health and the ability to grow your family. So, we're right on board agreeing with you a hundred percent with that. So you're talking a lot about PCOS and especially women with PCOS who have a longer time in between ovulation. Would you say that that's kind of the ideal candidate for this procedure?

Dr. Hemphill:

Well, definitely this procedure is indicated for someone with PCOS. So if you don't have polycystic ovarian syndrome, I don't personally recommend this surgery for those type of patients. So even if you have long and irregular cycles, but you don't have PCOS, I would not say this is the surgery for you. You need to have polycystic ovarian syndrome. But even with polycystic ovarian syndrome, a couple of other criteria probably need to be present. Some patients with polycystic ovarian syndrome do not have enlarged ovaries, and you don't want to take the chance that you're taking too much ovary and decreasing the functional amount of ovary that a patient has. So the ideal candidate would be someone with polycystic ovarian syndrome confirmed. So all of the evaluation has been done, they meet the criteria--the inclusion criteria, as well as the exclusion criteria.

Dr. Hemphill:

And I will, just my little personal side note here, I see so many patients who come to me who say that they have polycystic ovarian syndrome and their workup is incomplete. Now, most of the time they end up having PCOS, but the last thing I want to do is do a surgery that's irreversible on someone who had an incorrect diagnosis. So I definitely make sure that the workup is completely finished before we talk about surgery. But I generally want to see that the patient has an enlarged ovary. So a normal-sized ovary is approximately two centimeters by two centimeters by two centimeters. If I've got a patient whose ovary is measuring five centimeters, and they don't have a big singular cyst on it, so, you know, it is that polycystic appearance that would be a patient that probably would benefit from a wedge resection. Because what we're trying to do is estimate the amount of ovary to be removed so that what's residual when it brings back together is the size of a normal ovary. So if you don't have a lot of tissue to remove, then the risk of the surgery may not be beneficial to you.

Caitlin:

I so appreciate you bringing up that point, because I know that there are a lot of women who are concerned about what this could do for their chances to conceive. We know that we're born with all the reproductive eggs will ever have, and they're all stored in the ovaries. So the thought of removing a large section of that ovary, I can understand where there would be some women who would be very concerned about that actually reducing the chances of their pregnancy. But as you're saying, you are very discerning as to who needs this surgery. It is not just every woman, it's not just every woman with diagnosed PCOS, but certain, very certain, conditions make you an ideal candidate for that. And I appreciate that you are so discerning in that, and I'm sure your clients are too.

Dr. Hemphill:

And that's part of the reason why we have to be very, very careful in discerning who's an appropriate candidate. Now, the idea that they could go into menopause early is a theoretical risk that has been circulated out there. But there's been no proven association between the ovarian wedge resection and premature ovarian failure or premature menopause. As a matter of fact, most polycystic ovarian syndrome patients, if you were to look at their AMH, which is one of those markers, Anti-Müllerian Hormone, one of the markers for ovarian reserve, most polycystic ovarian syndrome patients have an AMH that is higher than normal. So really once you do the wedge resection, if you were to recheck their AMH, their AMH comes down to normal levels, not suboptimal regions. So, I really do think that it's a theoretic that yes, there is a possibility that someone who doesn't know what they're doing could take too much ovary and yes, result in, you know, a dysfunctional ovary. But if you really know that your surgeon understands the procedure and is cautious about how much ovary they're taking, you shouldn't go into premature ovarian failure or premature menopause. And instead it should help to reset the hormones and actually make your ovulation, make your ovary, functional so that you're ovulating regularly and being able to take what premature eggs that you have and mature them so that they can ovulate and result in a pregnancy later.

Caitlin:

I know that that is a great relief to many women who are listening and wondering about that very thing. What about other concerns? Are there other things that we should consider when deciding whether or not to have this procedure? You know, if you fit all the criteria that you just mentioned, are there any other things that we should consider?

Dr. Hemphill:

Well, it is surgery, so everybody should be very discerning at the idea of surgery. Yes, we the NaPro technology fellows who've done the surgical training are quite proficient in doing ovarian wedge resections. There are other gynecologists who are familiar with the wedge resection and could probably do it very safely. But anytime you're considering surgery, you need to be discerning about the risks that are present. Like I said, with this particular surgery, nowadays, we're able to do it minimally invasive. I tell them approximately two weeks for a recovery period. But most of them are actually doing well before that two-week mark. Usually it's somewhere between & and 10 days. With it being abdominal surgery, you know, your movements are going to be a little bit less. So there's risks of things like developing a blood clot, but with young healthy women, that's usually a pretty low risk. But for the most part, this is a pretty safe procedure overall, when done in the right hands.

Caitlin:

And even though this isn't taught as a commonplace procedure in medical schools, I'm so thrilled that there are medical professionals like yourself out there doing it, who are trained in it. Because I know even in my client base, I have had many ladies who have had an ovarian wedge resection and have had success from it. I mean, directly, I'm talking conceiving within three months after having this surgery. And, of course, everyone has it done for different reasons, but I've seen the fruits of it. And so having someone who knows what they're doing, I think I completely agree with you that it is worth it.

Dr. Hemphill:

Absolutely.

Caitlin:

If someone were interested in working with you specifically, maybe they live in or around South Carolina, what would be the best way for them to get connected with you?

Dr. Hemphill:

So to connect with me, ideally they would call my office. If they're looking specifically for NaPro technology, I have a separate nurse specifically for NaPro technology and for my surgery. So I do general OBGYN as well. So I get, you know, the, the general patient population who comes in who just needs an annual or, you know, maybe developed an ovarian cyst and is being referred by their primary care doctor. But I have a separate side that's just for my NaPro technology. So they would probably need to mention that they're interested in an ovarian wedge resection, if it's for this specifically, or if it's for NaPro technology or other surgical that they want NaPro technology, because then my front office staff will get them connected with my NaPro nurse, and my NaPro nurse will do an intake interview with them, get some background information.

Dr. Hemphill:

With NaPro technology, it is based off of the Creighton model fertility care charting system. So, if you're not charting already, many times we'll be recommending that you learn how to chart before you actually walk through my doors, especially if you're coming in from a fertility standpoint. Sometimes if it's not for fertility, limited numbers of patients, I'll say, well, in this particular situation, the charting's not absolutely necessary because we're looking, because we know we have an endometrium or something like that. And I do have some areas where there's exceptions to the rule, but the majority of the time we want you charting. And so if we recommend that you chart, it's 60 days of charting before you can get an appointment. So if you're thinking about it, start charting. If you've reached out to us and you're already charting and you have that 60 days, we'll get you in with the very next available new NaPro patient appointment. Otherwise, once you've gone that 60 days, you reach back out to us and then we'll get you the next available after that timeframe.

Caitlin:

That's great. And we will make sure to have either a link to your website or maybe even the telephone number in our show notes, so if anyone's interested in doing that. So Dr. Hemphill, thank you so much for being on the show and sharing so much great information. It has really been helpful.

Dr. Hemphill:

Thank you. I appreciate the invitation and the opportunity to share with your listeners.

Caitlin:

I'm so glad to be able to introduce doctors like Dr. Hemphill. As a certified fertility care practitioner, I know that we could not serve women and couples the way that we do without the education, compassion, and care of restorative medical professionals. Here at Woven Well Podcast, we bring you resources like this on a regular basis. We provide education and a sense of community that empowers women to make informed fertility decisions, while honoring the deep connection between fertility and faith. We invite you to check out our other episodes of Woven Well to get to know us a little bit, and we'll have a few episodes linked in the show notes to help you do that. If you'd like access to more of our free resources, we email them out each month through our email list, which you can sign up for at wovenfertility.com or through the link in the show notes. As always, thanks for listening as we continue to explore together what it means to be woven well.