COMMENTARY

Could Salpingectomy Affect Response to Ovarian Stimulation?

Peter Kovacs, MD, PhD

Disclosures

September 29, 2016

Effect of Salpingectomy on Ovarian Response to Hyperstimulation During In Vitro Fertilization: A Meta-analysis

Fan M, Ma L
Fertil Steril. 2016;106:322-329

Background

Intact tubal function is required for pregnancy as fertilization and early embryonic development take place in the fallopian tube. Problems with tubal function may result in infertility and increase the risk for extrauterine pregnancy, yet there are conditions when salpingectomy has to be considered. Tubal ectopic pregnancy, especially if ruptured, is best treated by surgery. The presence of a hydrosalpinx is another indication for tubal removal. Following bilateral salpingectomy, in vitro fertilization (IVF) remains the only option to achieve pregnancy. Ovarian hyperstimulation is an essential part of IVF treatment.

In this meta-analysis, the authors reviewed the evidence on how salpingectomy may affect ovarian response to stimulation.

Summary

The analysis is based on 25 studies (4 prospective, 21 retrospective) and involves 1935 patients who underwent salpingectomy and 2893 who did not. The main outcome measure was response to stimulation. Gonadotropin dose for stimulation, duration of stimulation, peak estradiol level, number of oocytes collected, and basal follicle-stimulating hormone (FSH) levels were compared as markers of response to stimulation.

When the outcomes were compared between women with salpingectomy (bilateral and unilateral combined) and women who did not undergo salpingectomy, the following findings were obtained:

  • Basal FSH levels were significantly increased, and the amount of gonadotropins used for stimulation was higher in the salpingectomy group.

  • Duration of stimulation, peak estradiol level, and the number of oocytes collected were similar.

When bilateral salpingectomy was compared with no salpingectomy, the following findings were obtained:

  • Gonadotropin dose, duration of stimulation, and basal FSH level were significantly increased.

  • The number of oocytes collected was lower.

  • Peak estradiol level was not affected.

When unilateral salpingectomy was compared with no salpingectomy, the following findings were obtained:

  • None of the studied parameters differed significantly.

  • Fewer eggs were collected from the operated side when compared with the contralateral side.

The authors concluded that salpingectomy has a negative effect on ovarian function.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....