Wide excision of soft tissues adjacent to the ovary and fallopian tube does not impair the ovarian reserve in women undergoing prophylactic bilateral salpingectomy: results from a randomized, controlled trial
“…Out of 147 only 29 met the inclusion criteria (Fig. 1) [1–13, 16–31]. A full report regarding authors, study design, sample size, type of surgical procedure (unilateral/bilateral salpingectomy), epidemiological features, surgical indications and years from surgery is illustrated in detail in Table 1.Fig.…”
Section: Resultsmentioning
confidence: 99%
“…A total of twelve manuscripts reported evidence regarding possible variations in FSH serum values following uni/bilateral salpingectomy [8, 10, 16, 17, 20–23, 27–29, 31]. We analyzed data from 1,569 patients.…”
Section: Resultsmentioning
confidence: 99%
“…In particular, seven papers [10, 16, 17, 20, 27, 29, 31] reported evidence from observational prospective studies evaluating FSH serum value before and after uni/bilateral salpingectomy. Six of these studies, including a total of 376 patients, did not report statistically significant differences in terms of serum FSH changes before and after surgical intervention [16, 17, 20, 27, 29, 31].…”
Salpingectomy is largely used in case of hydrosalpinx in infertile women scheduled for assisted reproductive technologies (ART), whereas there is no consensus on its role in absence of hydrosalpinx. The current is a systematic literature review to collate all available evidence regarding salpingectomy as fertility enhancement procedure before ART in infertile patients. Our primary endpoint was to assess the impact of the surgical procedure on ovarian reserve, and secondary outcomes were to evaluate its benefits and harms on ART outcomes. We identified 29 papers of which 16 reporting data on the impact of tubal surgery on ovarian reserve and 24 (11 previously included) on ART outcomes. Available data suggested an absence of variation in ovarian reserve markers after unilateral salpingectomy while contradictory results were reported for bilateral surgery. Considering ART outcomes, data reported a significant improvement in ongoing pregnancy/live-birth rate in treated subjects without significant reduction in ovarian response to gonadotropin stimulation. In case of tubal disease, a surgical approach based on unilateral salpingectomy may be considered safe, without negative effects on ovarian reserve and ovarian response to controlled ovarian stimulation whilst having a positive effect on pregnancy rate. Data regarding bilateral salpingectomy and ovarian reserve are conflicting. Further trials are needed to confirm both the benefits of salpingectomy before ART and the safety of bilateral salpingectomy on ovarian reserve, and to clarify the role of uni- or bilateral surgery in case of tubal blockage without hydrosalpinx.
“…Out of 147 only 29 met the inclusion criteria (Fig. 1) [1–13, 16–31]. A full report regarding authors, study design, sample size, type of surgical procedure (unilateral/bilateral salpingectomy), epidemiological features, surgical indications and years from surgery is illustrated in detail in Table 1.Fig.…”
Section: Resultsmentioning
confidence: 99%
“…A total of twelve manuscripts reported evidence regarding possible variations in FSH serum values following uni/bilateral salpingectomy [8, 10, 16, 17, 20–23, 27–29, 31]. We analyzed data from 1,569 patients.…”
Section: Resultsmentioning
confidence: 99%
“…In particular, seven papers [10, 16, 17, 20, 27, 29, 31] reported evidence from observational prospective studies evaluating FSH serum value before and after uni/bilateral salpingectomy. Six of these studies, including a total of 376 patients, did not report statistically significant differences in terms of serum FSH changes before and after surgical intervention [16, 17, 20, 27, 29, 31].…”
Salpingectomy is largely used in case of hydrosalpinx in infertile women scheduled for assisted reproductive technologies (ART), whereas there is no consensus on its role in absence of hydrosalpinx. The current is a systematic literature review to collate all available evidence regarding salpingectomy as fertility enhancement procedure before ART in infertile patients. Our primary endpoint was to assess the impact of the surgical procedure on ovarian reserve, and secondary outcomes were to evaluate its benefits and harms on ART outcomes. We identified 29 papers of which 16 reporting data on the impact of tubal surgery on ovarian reserve and 24 (11 previously included) on ART outcomes. Available data suggested an absence of variation in ovarian reserve markers after unilateral salpingectomy while contradictory results were reported for bilateral surgery. Considering ART outcomes, data reported a significant improvement in ongoing pregnancy/live-birth rate in treated subjects without significant reduction in ovarian response to gonadotropin stimulation. In case of tubal disease, a surgical approach based on unilateral salpingectomy may be considered safe, without negative effects on ovarian reserve and ovarian response to controlled ovarian stimulation whilst having a positive effect on pregnancy rate. Data regarding bilateral salpingectomy and ovarian reserve are conflicting. Further trials are needed to confirm both the benefits of salpingectomy before ART and the safety of bilateral salpingectomy on ovarian reserve, and to clarify the role of uni- or bilateral surgery in case of tubal blockage without hydrosalpinx.
“…tension-free vaginal tape procedures (7)(8)(9)(10)(11)(12)(13)(14)(15). These treatments significantly improve the overall sex life of women with SUI: orgasm incontinence, penetration incontinence, post-coital infections, anxiety and avoidance of sex are all reduced (16)(17)(18)(19)(20). A complete evaluation of the psychosomatic impact of such a disease by means of SPM is the right key not only for correcting the single symptom, but also for improving the well-being of the individual's social and intimate life (21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”
“…Studies on tubal ligation or tubal dissection did not find a significant decrease in AMH levels [30, 31]. Venturella et al reported a decline in AMH levels after salpingectomy, although they noted that the decrease of AMH levels between the usual salpingectomy and “wide salpingectomy” with removal of mesosalpinx groups were not significantly different [32]. However, the average age of the study participants exceeded 40 years, and the average preoperative AMH levels were less than 1.0 ng/mL.…”
BackgroundSerum anti-Müllerian hormone (AMH) concentration has been used to assess ovarian reserve in patients with endometriosis, especially when endometrioma surgery is involved. Previously, we reported that decreased serum AMH levels after cystectomy for endometriomas can recover to preoperative levels in some cases. In this present study, we assessed the sequential changes in serum AMH levels before and after cystectomy in terms of the state of the mesosalpinx prior to surgery.MethodsThe retrospective cohort study recruited 53 patients from a series of prospective studies conducted from 2009 to 2015. All patients underwent laparoscopic cystectomy for endometriomas. If either mesosalpinx was involved in the endometrioma or adnexal adhesion before cystectomy, the case was defined as ‘involved mesosalpinx’ (n = 14). If both mesosalpinx remained anatomically correct, the case was classified as ‘intact mesosalpinx’ (n = 39). Blood samples were obtained from the patients 2 weeks before surgery, and at 1 month and 1 year after surgery to assess serum AMH levels.ResultsThe serum AMH levels (the involved group vs. the intact group) were 1.92 vs. 0.98 (P = 0.552) preoperatively, 0.59 vs. 1.99 (P = 0.049) at 1 month postoperatively, and 0.48 vs. 2.37 ng/mL (P = 0.007) at 1 year postoperatively. The involved mesosalpinx group showed a further decrease in serum AMH levels at 1 year postoperatively, while serum AMH levels in the intact mesosalpinx group tended to recover.ConclusionThese results suggest that pre-existing mesosalpinx disturbance, in combination with adhesiolysis, may be involved in the medium- and long-term decrease in ovarian reserve after endometrioma surgery. A disturbance in ovarian blood supply via the mesosalpinx may underlie this.Trial registrationUMIN-CTR UMIN000019369. Retrospectively registered October 15, 2015.
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