Study On The Effects Of Tubal Surgery On IVF-ET Ovarian Response And Clinical Outcomes

Objective: To discuss the effects of tubal surgery on the ovarian response and outcome during the process of in vitro fertilization and IVF-ET, and provide certain theoretical basis for clinical practice.Methods:The data of 650 cycles from the Second Affiliated Hospital of Kunming Medical University from October 2013 to January 2015 were retrospectively analyzed(Sample 1). All of the patients in the menstrual period determinate basal FSH, LH, E2 and AFC,then calculate the FSH/LH ratio.There are 115 cycles of them both analyze basal AMH and down-regulated AMH (Sample 2). They are divided into three groups according to the operation methods:group A:salpingectomy group; group B:tubal prosthesis and anaplasty group, group C:control group.We define the ovarian response according to the number of retrieved oocytes and poor ovarian response as the number of retrieved oocytes<4 and high ovarian response as the number of retrieved oocytes>15. They were divided into two groups in accordance with tubal excision of the lateral:unilateral Salpingectomy group, bilateral salpingectomy group.Result:1、A total of 650 subjects were divided into three groups in accordance with surgical methods:group A:salpingectomy group (155 cases), group B:tubal prosthesis and anaplasty group (149 cases), and group C:control group (346 cases). The incidence rates of poor ovarian response in group A, B and C decreased in a sequential manner, and the comparison between group A and C presented statistical difference with P< 0.05; the comparison of basal FSH, E2, FSH/LH and days of Gn in group A and C presented statistical difference, P<0.01; basal E2 and days of Gn in group B and C were compared; all the comparisons of total Gn among the three groups were statistically different; AFC, number of retrieved oocytes, high-quality embryo rate, clinical pregnancy rate and embryo implantation rate presented a tendency of progressive increase in group A, B and C, the abortion rate in group A, B and C decreased in a sequential manner, but the comparisons among the three groups were not statistically different, P> 0.05.2、The basal FSH in the unilateral salpingectomy group and the basal FSH and days of Gn in the bilateral salpingectomy group were statistically different in comparison with those in the control group; the comparison of days of Gn between two surgical groups, P<0.01 and the comparisons of total Gn among three groups were all statistically different, P<0.01. The comparisons of other indexes among three groups presented no statistical significance.3、Both AFC and number of retrieved oocytes in the ovary on the excision side of patients receiving unilateral salpingectomy are much fewer than those in the contralateral ovary, P<0.01.4、A total of 115 subjects were divided into two groups:tubal surgery group (55 cases), and control group (60 cases)., the comparison of basal AMH and down-regulated AMH in tubal surgery group and control group presented statistical difference,P< correlated with basal AMH or the AMH after down-regulation, P>0.05.Conclusions:1、Tubal surgery dose have an impact on ovarian response and the impact extent is related to surgical scope and the degree of surgical injury.2、The ovarian response on the excision side is poorer than that on the contralateral side in patients receiving unilateral salpingectomy.3、Tubal surgery does not have a significant effect on the pregnancy outcome of IVF-ET.4、AFC, basal AMH and down-regulated AMH are all significantly positively correlated with the number of retrieved oocytes, and the down-regulated AMH presented the most substantial correlation.5、The impact of unilateral salpingectomy on ovarian reserve function presents no significant correlation with postoperative duration.