Effect of salpingectomy, ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve

Abstract

Pelvic surgery can affect ovarian reserve, but estimates of the potential effect of different surgical procedures are lacking. This study examines the markers of ovarian reserve after different procedures in order to help the provision of informed consent before surgery. Anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH) of women with a history of salpingectomy, ovarian cystectomy or unilateral salpingo-oophorectomy were compared to those without history of surgery using cross-sectional data adjusting for patient and clinical factors in multivariable regression model. There were 138 women who had had salpingectomy, 36 unilateral salpingo-oopherectomy, 41 cystectomy for ovarian cysts that are other than endometrioma and 40 women had had excision of endometrioma. There was no significant difference in AMH (9 %; p = 0.33), AFC (−2 %; p = 0.59) or FSH (−14 %; p = 0.21) in women with a history of salpingectomy compared to women without surgery. Women with a history of unilateral salpingo-oophorectomy were found to have significantly lower AMH (−54 %; p = 0.001). These women also had lower AFC (−28 %; p = 0.34) and higher FSH (14 %; p = 0.06), the effect of which did not reach statistical significance. The study did not find any significant associations between a history of cystectomy, for disease other than endometrioma and AMH (7 %; p = 0.62), AFC (13 %; p = 0.18) or FSH. (11 %; p = 0.16). Women with a history of cystectomy for ovarian endometrioma had 66 % lower AMH (p = 0.002). Surgery for endometrioma did not significantly affect AFC (14 %; p = 0.22) or FSH (10 %; p = 0.28). Salpingo-oopherectomy and cystectomy for endometrioma cause a significant reduction in AMH levels. Neither salpingectomy nor cystectomy for cysts other than endometrioma has appreciable effects on ovarian reserve.Electronic supplementary materialThe online version of this article (doi:10.1007/s10397-016-0940-x) contains supplementary material, which is available to authorized users.

One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

“…The majority of studies have focused on short‐term ovarian reserve follow‐up after laparoscopic cystectomy; the scarcity of studies examining the issue of long‐term laparoscopic cystectomy impacts on ovarian reserve has been particularly striking. Moreover, many results in those studies were inconclusive, originating from different ovarian reserve tests . Vignali et al.…”

Practical Recommendations for the Management of Benign Adnexal Masses

“…This drop was also more significant in the group with endometriosis of stages III to IV (4.26 ng/mL versus 2.62 ng/mL; p < 0.001) when compared with the group with endometriosis of stages I to II (4.38 ng/mL versus 3.34 ng/mL; p ¼ 0.66). 32 Another retrospective study 33 with 138 women submitted to salpingectomy, 36 submitted to unilateral salpingo-oophorectomy, 40 who underwent excision of an endometrioma, and 41 who underwent cystectomy due to other causes showed no difference in the levels of AMH (p ¼ 0.33), AFC (p ¼ 0.59) and FSH (p ¼ 0.21) between the salpingectomy group and the group who did not undergo surgery. The group submitted to unilateral salpingo-oophorectomy had lower levels of AMH (-54%; p ¼ 0.001).…”

“…Women with endometrioma also had lower levels of AMH (-66%; p ¼ 0.002), but this did not affect the AFC (p ¼ 0.22) and FSH (p ¼ 0.28). 33 Recently, a study performed in patients 34 with endometriomas (n ¼ 34) and other benign masses (n ¼ 18) showed that, 6 months after surgery, the levels of AMH were reduced by 59.3% (p < 0.12) when compared with baseline values in the group with endometriomas, and it was reduced by 29.5% (p < 0.2) in the group with other benign masses. This reduction was not related to the number of follicles inadvertently removed during the procedure (p < 0.669).…”

Antenatal management of singleton pregnancies conceived using assisted reproductive technology

“…Concerns have been raised about a potential reduction in ovarian reserve following tubal surgery, but several studies have suggested these to be unfounded. 33 Surgeons must, however, strive to avoid inadvertent damage to the gonadal artery during salpingectomy so as not to unnecessarily disrupt blood supply to the ovary.…”