Influences Of Different Treatments On Tubal Ectopic Pregnancy On Ovarian Function During Controlled Ovarian Stimulation

ObjectiveTo investigate the ovarian reserve and ovarian responsiveness during controlled ovarian stimulation（COS）after different treatments on tubal ectopic pregnancy.MethodsThis was a retrospective study conducted at the Department of Assisted Reproductive Center in Tianjin Central Hospital of Obstetrics and Gynecology.From January 1,2014 to August 31,2017,822 fresh cycles of in vitro fertilization（IVF）/intracytoplasmic sperm injection（ICSI）were selected according to the registration system.These cycles were divided into bilateral salpingectomy（Group 1）,one side salpingectomy and another side partial salpingectomy（Group 2）,one side salpingectomy and another side salpingostomy（Group 3）,one side salpingectomy and another side without surgical intervention（Group 4）,bilateral partial salpingectomy（Group 5）,one side partial salpingectomy and another side salpingostomy（Group 6）,one side partial salpingectomy and another side without surgical intervention（Group 7）,bilateral salpingostomy（Group 8）,one side salpingostomy and another side without surgical intervention（Group 9）,both sides without surgical intervention（Group 10）and patients without history of tubal ectopic pregnancy but with tubal factor infertility or male factor infertility（Group 11/control group）.The following clinical data and parameters were recorded and assessed:（1）Basic clinical characteristics such as age,body mass index（BMI）,basal luteinizing hormone（bLH）,prolactin（PRL）,testosterone（T）and progesterone（P）;（2）Ovarian reserve parameters such as basal follicle stimulating hormone（bFSH）,bFSH/bLH and basal estradiol（bE₂）;（3）Ovarian responsiveness during COS such as the number of total,≥14mm,≥11mm follicles on the day of human chorionic gonadotrophin（hCG）administration,the number of oocytes retrieved,initial dose of gonadotropins（Gn）,days of Gn administration,total dose of Gn,level of E₂ on day of hCG,number of mature oocytes,fertilized oocytes,normal fertilized oocytes,normal cleavage,high quality embryos,fertilization rates,normal fertilization rates,normal cleavage rates and high quality embryo rates.Results1.No significant difference was observed in age,BMI,bLH,PRL,T and P between the 11 groups.2.Significant differences in ovarian reserve were observed between the 11 groups:bFSH was significantly higher in Group 1 and Group 4 compared with Group 11;bFSH/bLH was significantly higher in Group 1 compared with Group 9 and Group 11,and was significantly higher in Group 4 compared with Group 11.3.Significant differences in ovarian responsiveness during COS were observed between the 11 groups:Initial dose of Gn was significantly higher in Group 1,Group2 and Group 4 compared with Group 11.Total dose of Gn was significantly higher in Group 1 and Group 4 compared with Group 11.E₂ level on the day of hCG administration was significantly lower in Group 1 compared with Group 10 and Group 11.The total number of follicles on the day of hCG administration was significantly lower in Group 1 compared with Group 11.The number of follicles≥11mm and≥14mm was significantly lower in Group 1,Group 3 and Group 4compared with Group 11.Uniformity of follicles was significantly lower in Group 4compared with Group 11.The number of oocytes retrieved was significantly lower in Group 1 and Group 4 compared with Group 11.Self-paired analysis revealed that the number of follicles on the day of hCG administration and oocytes retrieved in the same patient was higher in the salpingostomy side than the salpingectomy side,and was higher in the non-surgical intervention side than the side of surgical intervention such as salpingectomy,partial salpingectomy and salpingostomy.But none of the differences reached a statistical significance.Summary analysis revealed a general linear trend of decline in the number of follicles on the day of hCG administration and the number of oocytes retrieved from the side of control,without surgical intervention,salpingostomy,partial salpingectomy to salpingectomy.Embryonic condition revealed that the number of mature oocytes was significantly lower in Group 1 and Group 4 compared with Group 11.The number of normal fertilized oocytes was significantly lower in Group 1 compared with Group 11.The number of normal cleavage was significantly lower in Group 1 and Group 4 compared with Group 11.The number of high quality embryos was significantly lower in Group 4compared with Group 11.Conclusions1.Unilateral or bilateral salpingectomy for tubal ectopic pregnancy increased bFSH and bFSH/bLH,indicating that salpingectomy had an adverse effect on ovarian reserve.Furthermore,salpingectomy increased initial and total dose of Gn,and decreased E₂ level and follicle number on the day of hCG administration,and decreased the number of oocytes retrieved,mature oocytes,normal fertilized oocytes,normal cleavage and high quality embryos,indicating that salpingectomy had a detrimental effect on ovarian response during COS.2.Unilateral or bilateral salpingostomy for tubal ectopic pregnancy did not impair the ovarian reserve,but decreased the number of follicles on the day of hCG administration and oocytes retrieved,indicating that salpingostomy had a detrimental effect on ovarian response during COS.3.Medical management or expectant management for tubal ectopic pregnancy did not impair the ovarian reserve,but decreased the number of follicles on the day of hCG administration and oocytes retrieved,indicating that conservative treatment for tubal ectopic pregnancy may had a detrimental effect on ovarian response during COS.4.Different methods of treating tubal ectopic pregnancy compromised ovarian function in women during COS and the impact was related to the extent and degree of the injury.