| BackgroundFallopian tube disease is one of the main causes of infertility. It is generally recognized that removal of a hydrosalpinx can increase the implantation rate of in vitro fertilization arid embryo transfer (IVF-ET). The problem of whether and when to remove the fallopian tube has been plagued by clinical doctors and patients with hydrosalpinx.However, whether salpingectomy affects ovarian reserve is uncertain, with some studies indicating that it has no effect on ovarian reserve and other studies suggesting that salpingectomy deceases ovarian reserve. The fallopian tube is an essential component of the female reproductive system. The ovary is supplied by the ovarian artery, but also by the ascending branch of the uterine artery in the mesosalpinx. Some authors have reported that salpingectomy reduces the ovarian blood supply, and therefore compromises ovarian reserve.Anti-Mullerian hormone (AMH) is a glycoprotein dimer secreted primarily by granulocytes of preantral follicles and small antral follicles. AMH levels are relatively constant throughout the menstrual cycle, correlate with the number of follicles and ovarian reserve, and are predictive of both over and poor response to controlled ovarian stimulation. For these reasons, AMH levels can be used to evaluate changes in ovarian reserve after salpingectomy.ObjectiveTo determine whether previous salpingectomy is associated with serum AMH level and ovarian reserve in women under40years of age presenting for IVF-ET.DesignRetrospective analysis of data from two ART centersSettingDepartment of Reproductive Endocrinology, Women’s Hospital, School of Medicine, Zhejiang University; Shanghai Jiai Genetics and IVF Institute.MethodsSeventy-four female without surgical history of fallopian tube(Group A),83cases with previous unilateral salpingectomy (Group B) and41cases with previous bilateral salpingectomy(Group C) received in vitro fertilization-embryo transfer (IVF-ET) treatment. The level of serum AMH and the results of IVF-ET among three groups were compared. The correlation was analyzed between the level of serum AMH and the length of postoperative period in Group A and Group B.Main outcome measuresMain outcome measures of this research included Patients’ age; level of serum AMH; basal FSH; basal LH; AFC; BMI; dosage of gonadotropin; number of oocytes retrieved; number of quality embryos; number of good quality embryos; length of postoperative period.ResultsA total of198women were included;83received unilateral salpingectomy,41bilateral salpingectomy, and74no tubal surgery. The baseline characteristics of groups were similar. The mean AMH level was significantly higher in women without tubal surgery as compared with those with bilateral salpingectomy (2.57vs1.78ng/mL; P<0.037). The mean follicle stimulation hormone level was significantly lower in women without surgery as compared with those with bilateral salpingectomy (7.85vs9.13mIU/mL; P=0.048). No significant differences in duration of gonadotropin therapy, amount of gonadotropin used, estradiol level on the human chorionic gonadotropin injection day, thickness of the endometrium, number of oocytes retrieved, number of2-pronuclei, viable embryos, and good quality embryos were found between the3groups. No significant linear correlation was found between AMH level and age in all women. For women with a unilateral salpingectomy, a significant linear correlation was found between AMH level and time after surgery. For women with a bilateral salpingectomy, no significant linear correlations was found between AMH level and time after surgery ConclusionSalpingectomy is associated with decreased AMH level and increased follicle stimulation hormone in women seeking in vitro fertilization. These results suggest that salpingectomy is associated with decreased ovarian reserve. Ovary function is restored after unilateral salpingectomy through compensation. However, the damage of bilateral salpingectomy to ovarian function was permanent. |
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