Does laparoscopic hysterectomy + bilateral salpingectomy decrease the ovarian reserve more than total abdominal hysterectomy? A cohort study, measuring anti-Müllerian hormone before and after surgery

Abstract

Background Decreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH). Methods In this prospective cohort study, serum levels of AMH were compared between the groups undergoing TAH + bilateral salpingectiomy and TLH, in 66 patients (33 in each group) who referred to the hospitals of Shiraz University of Medical Sciences for hysterectomy during one years of work. The collected information included age, weight, gravidity, parity, regularity of menstrual cycle, uterine weight, blood loss during surgery, and serum levels of AMH before and 6 months after surgery, compared between groups. Results Most patients (88% in TAH and 73% in TLH group) aged 40–50 years. Mean age, weight, parity of patients was similar in both groups, while blood loss was significantly less in TLH group (P < 0.01). Median (IQR) of pre-surgical AMH values were 0.40 (0.55) ng/ml in the TLH group and 0.92 (1.23) ng/ml in the TAH group (P = 0.12) that decreased to 0.29 (0.44) ng/ml in the TLH group and 0.15 (0.31) ng/ml in the TAH group (P = 0.02). Also Median (IQR) of the difference between pre and post-surgical AMH values were 0.12 (0.31) and 0.58 (1.17) in TLH and TAH group, respectively (P = 0.003). Conclusion The serum levels of AMH decreased significantly after both methods of hysterectomy (laparoscopy and laparotomy), while this decrease was greater in TAH group that shows.

Anti-Müllerian Hormone Level Decline in Patients Undergoing Hysterectomy With and Without Oophorectomy Compared With Natural Menopause

“…16 On the other hand, Tavana et al recently reported opposite findings of increased postoperative decline in AMH levels among women undergoing abdominal hysterectomy in a smaller sample (33 women per group). 17 Notably, in the latter report, women were aged 40–50 years, baseline AMH levels were overall low (400 pg/mL or less), and salpingectomies were performed in these patients. The conflicting data suggest that the precise surgical approach and possibly an independent role of salpingectomy may influence postoperative ovarian reserve, but effects may be transient and are incompletely understood.…”

Association of Myomectomy With Anti-Müllerian Hormone Levels and Ovarian Reserve

“…Other invasive and minimally invasive treatments for leiomyomas, including uterine artery embolization and hysterectomy, may decrease ovarian reserve, and it is possible that myomectomy may affect ovarian reserve through similar mechanisms, such as interrupting the collateral vasculature that supplies the ovaries through cautery, sutures, or temporary occlusion. [13][14][15][16][17][18] The use of a tourniquet to minimize blood loss during myomectomy transiently decreases blood supply to the ovaries and could potentially harm ovarian reserve. [19][20][21][22] The few studies that have assessed a possible effect of myomectomy on ovarian reserve are limited by small sample sizes, short-term follow-up, or unspecified surgical route and details.…”

The Impact of Opportunistic Salpingectomy on Ovarian Reserve: A Systematic Review

“…Comparing AMH levels between total abdominal hysterectomy and total laparoscopic hysterectomy, Tavana et al found a significant decrease in this hormone level after both methods of hysterectomy. However, a lower level of AMH was noted in the total abdominal hysterectomy group [ 22 ].…”