Study On The Window Period Of Ovarian Reserve Decline After Salpingectomy

Background:Ovarian reserve usually reflects a woman's reproductive and endocrine functions.From puberty the ovaries produce female,progesterone and a small amount of androgens,which are extremely important in maintaining normal female characteristics and ovulation.Irreversible depletion of ovarian follicles is a natural trend,which is manifested by the decrease in the number and quality of follicles,which indicates the decline of fertility and the arrival of perimenopause.Fallopian tube disease has a great influence on female fertility and successful conception,and is also the most important indicator of in vitro fertilization-embryo transfer(IVF-ET).Tubal diseases such as hydrosalpinx and salpingoinflammatory diseases often lead to female infertility and affect the success rate of embryo implantation in IVF-ET cycle.Therefore,pretreatments such as IVF-ET forward salpinectomy or tubal dredging can improve the success rate of pregnancy in women.However,the uterine artery branches off into the mesosalpinx,providing blood and nutrients to the ovaries.Therefore,some studies believe that after salpingectomy,uterine artery uterine body branch is destroyed,ovarian blood supply interruption,and ultimately irreversible damage to ovarian reserve function.However,other studies have shown that it does not affect ovarian reserve function or ovarian reserve function can be gradually restored after salpingectomy.At present,there is no research showing the specific time interval of ovarian function decline after salpingectomy.Currently,anti-miillerian hormone(AMH),follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)and antral follicle count(AFC)are commonly used in clinical evaluation of ovarian reserve function.Objective:By comparing the numerical changes of AMH,FSH,LH,E2 and AFC before and after salpingectomy(unilateral or bilateral)and their characteristics,we can determine whether the ovarian reserve function decreases after salpingectomy and the time node of decline.In this way,we can evaluate whether the ovarian reserve function declines and the window period of decline,and provide theoretical reference for the ovarian reserve function assessment and fertility guidance of patients with fertility requirements.Methods:A total of 106 patients(including 69 patients with unilateral tubal resection and 37 patients with bilateral tubal resection)underwent unilateral or bilateral salpingectomy for hydrosalpinx and ectopic pregnancy in the department of obstetrics and gynecology of the second hospital of jilin university from January 2018 to March 2019.Grouping:the patients with unilateral salpingectomy were classified as group A,and the patients in group A were divided into preoperative group,postoperative group,1 month group,3 month group,6 month group,and 12 month group according to the time of preoperative and postoperative venous blood collection and ultrasound examination.Patients with bilateral salpingectomy were classified as group B,and the group was divided into group A.The inclusion criteria were:1.Age<35 years old.2.Regular menstrual cycles.3.Patients without decreased ovarian reserve.The exclusion criteria were:1.Patients with preoperative ovarian dysfunction.2.Patients with other endocrine diseases.3.Have a history of operation on fallopian tubes and ovaries.4.Patients with polycystic ovary syndrome and other primary diseases that affect ovarian function.The patient underwent salpinectomy and underwent venous blood and ultrasound examination at the first,third,sixth and twelfth month before and after the operation in the second hospital of jilin university.Results:Unilateral salpingectomy group(group A);Compared with the preoperative group,FSH,LH and E2 levels fluctuated slowly in the postoperative group 1 month,3 months,6 months and 12 months,with no statistically significant difference between the groups.The serum AMH and AFC levels of the 1 month group,3 months group and 6 months group after the operation decreased successively compared with the preoperative group,and the difference between the AMH and AFC levels was statistically significant(P<0.05).The levels of AMH and AFC in the group 12 months after surgery were higher than that in the group 6 months after surgery,and the difference was statistically significant(P<0.05).Bilateral salpingectomy group(group B);Compared with the preoperative group,serum FSH,LH and E2 fluctuated slowly in the 1 month,3 month,6 month and 12 month groups after the surgery,with no statistically significant difference.AMH and AFC gradually decreased in the 1 month,3 month,6 month and 12 month groups after the surgery,and the differences between the groups were statistically significant(P<0.05).Conclusion:Both unilateral salpingectomy and bilateral salpingectomy had an effect on ovarian reserve function.The window period for the decline of ovarian reserve function in the unilateral salpingectomy group was 6 months after the operation and gradually recovered within 12 months.The ovarian reserve function of the bilateral salpingectomy group was gradually impaired within 1 year after operation,and there was no recovery trend.