Salpingectomy may decrease antral follicle count but not live birth rate for IVF-ET patients aged 35–39 years: a retrospective study

Abstract

Purpose: Problems with fallopian tubes are one of the main reasons for women to undergo in vitro fertilizationembryo transfer (IVF-ET). A large proportion of women with ectopic pregnancy, fallopian tube obstruction and hydrosalpinx have had one or both fallopian tubes removed by salpingectomy. With increasing age, ovarian reserve deteriorates, the numbers of retrieved oocytes, available embryos and high-quality embryos are reduced, and the live birth rate for women treated with IVF treatment is affected. Thus, it is important to understand how salpingectomy affects live birth rates for IVF patients of different ages. This study analyzed how patients' age and salpingectomy influenced ovarian reserve, ovarian response and pregnancy outcomes for infertile women undergoing IVF-ET. Methods: A total of 1922 patients that underwent IVF-ET treatment from January 1, 2012, to December 31, 2018, were included in this retrospective study. The patients were divided into two groups according to whether or not they had a previous history of salpingectomy. The salpingectomy (group A, 534 patients) and control groups (group B, 1388 patients) were then further divided into two subgroups according to patient age (age<35 years, and age 35-39 years). Ovarian reserve, ovarian response, and IVF outcomes were investigated for each subgroup. Logistic regression model was used to estimate the relationship between clinical pregnancy and live births and patients' baseline characteristics. Results: In the salpingectomy group, antral follicle counts (AFC) were significantly lower for the subgroup aged 35 to 39 years compared with the control group. But this difference did not appear in women younger than 35 years. In addition, there were no significant differences in levels of basal follicle stimulation hormone (FSH), basal luteinizing hormone (LH), basal estradiol (E 2), total gonadotropins (Gn) dose, duration of Gn, numbers of retrieved oocytes, fertilization rates, numbers of available embryos, live birth rates, clinical pregnancy rates, miscarriage rates, ectopic pregnancy rates, or multiple pregnancy rates between the salpingectomy group and the control group (P > 0.05). Age is a risk factor for the clinical pregnancy and live birth. Conclusion: Salpingectomy may decrease antral follicle count but not live birth rate for IVF-ET patients aged 35-39 years. The increased female age was negative related with clinical pregnancy and live birth.

Prior salpingectomy impairs the retrieved oocyte number in in vitro fertilization cycles of women under 35 years old without optimal ovarian reserve

“…For women with an optimal ovarian reserve and a large follicle pool, a history of salpingectomy did not affect the number of retrieved oocytes in subsequent IVF cycles. Similar results were observed in a retrospective study [ 13 ], which revealed that in IVF patients aged 35–39 years, the AFC was lower in patients with a history of salpingectomy than in those without a history of salpingectomy; however, the study did not further stratify patients under the age of 35 with distinct baseline ovarian reserves. Moreover, in the study of Chen et al, the researchers selected patients with tubal disease as controls, which may have lessened the effect of salpingectomy, for underlying tubal disease may have been a confounding factor for reduced ovarian reserve.…”

“…In a study comparing women with infertility with and without history of salpingectomy for known tubal disease [ 13 ], history of salpingectomy was associated with a lower antral follicle count (AFC) in the women with infertility who were 35–39 years old. The study did not report a reduction of AFC related to a history of salpingectomy in women under 35 years old, implying that decline in age-related ovarian reserve may contribute to the impairment of ovarian reserve in women with a history of salpingectomy.…”

“…However, because of the profound anastomosis of the blood supply between the ovary and fallopian tubes, salpingectomy and other tubal surgeries have the potential to adversely affect fertility and ovarian reserve, causing concern for clinicians and patients [ 2 ]. Nevertheless, the data on ovarian response and ovarian reserve after salpingectomy have often been contradictory [ 2 , 12 , 13 ].…”

The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

“…Therefore, it is reasonable to consider that prophylactic bilateral salpingectomy may prevent ovarian cancer without the risk of premature menopause. However, other studies have found that bilateral salpingectomy alone or combined with hysterectomy could increase the risk of menopausal symptoms or decrease the antral follicle count (AFC) after surgery [ 10 , 11 ]. Some researchers have expressed concern about postsurgical ovarian function since fallopian tubes and their surroundings might have contributed to the ovarian blood supply.…”

The effect of prophylactic bilateral salpingectomy on ovarian reserve in patients who underwent laparoscopic hysterectomy

“…Therefore, it is reasonable to consider that prophylactic bilateral salpingectomy may prevent ovarian cancer without the risk of premature menopause. However, other studies have found that bilateral salpingectomy alone or combined with hysterectomy could increase the risk of menopausal symptoms or decrease the antral follicle count (AFC) after surgery [10,11]. Patients are understandably concerned about the effects of bilateral salpingectomy, but relatively few studies have been conducted in China to assess the risks and bene ts of the procedure.…”