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.
Highlights
Human ovarian reserve is determined by the size of oocyte pool at birth and an age-related decline in oocyte numbers thereafter
The effect of salpingectomy, ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve was studied using serum biomarkers anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH) in a large cross-sectional study of patients referred for infertility management
Tubal and ovarian branches of uterine arteries are often excised alongside the mesosalpynx and, it is believed that disruption to blood supply to ovaries may lead to reduction of ovarian reserve
Summary
Human ovarian reserve is determined by the size of oocyte pool at birth and an age-related decline in oocyte numbers thereafter Both of these processes are largely under the influence of genetic factors, and to date, no effective interventions are available to improve physiological ovarian reserve [1]. Biomarkers that allow direct assessment of dynamics of growing follicles, anti-Müllerian hormone (AMH) and antral follicle count (AFC) may provide more accurate estimation of ovarian reserve [5]. These markers only reflect folliculogenesis of already recruited growing follicles, there appears to be a good correlation between their measurements and histologically determined total ovarian reserve [4]. The biomarkers can be utilised for the estimation of the effect of the above adverse factors on the primordial oocyte pool
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