Abstract
Objective: To compare the effect of laparoscopic salpingectomy and proximal fallopian tubes division on ovarian function after controlled ovarian hyperstimulation. Methods: Seventy six patients undergoing their first IVF-ET cycle were divided into (group 1) 20 patients undergoing laparoscopic salpingectomy, (group 2) 19 patients undergoing proximal tubal division and (group 3) 37 tubal-factor patients without hydrosalpinx as control group. Main outcome measure (s): Ovarian artery pulsatility index (PI), basal follicle-stimulating hormone (FSH) levels before and after surgery, operative time, total dose and duration of IVF stimulation, number of retrieved and fertilized oocyte, and number of embryo transferred. Result (s): No significant differences in mean ovarian artery pulsatility indices among any of the groups before or after surgery. The mean FSH value was similar before and after laparoscopic proximal tubal division. The FSH value significantly increased after laparoscopic salpingectomy. The operative time in the PTD group was significantly shorter than in the salpingectomy group, total dose and duration of stimulation, number of retrived and fertilized oocyte, were not significantly different between group 1, group 2 or control group. Conclusion (s): Laparoscopic salpingectomy or proximal tubal division gives similar responses to IVF-ET cycles. However, proximal tubal division preserved ovarian function.
Highlights
Tubal disease, hydrosalpinx, has a detrimental effect on in vitro fertilization (IVF) cycle outcome [1]
The baseline clinical data and outcome of the first treatment cycle for group A, B and group C were shown in table 1, the three groups were comparable for age, ovarian artery pulsatilty index and basal follicle-stimulating hormone (FSH) levels
We found that management of hydrosalpinges by laparoscopic salpingectomy or proximal tubal division gives similar response to controlled ovarian hyperstimulation but when comparing baseline presurgery with postsurgery serum FSH levels, the latter were significantly raised in the salpingectomy group
Summary
Hydrosalpinx, has a detrimental effect on in vitro fertilization (IVF) cycle outcome [1]. Prophylactic salpingectomy for large hydrosalpinges could improve pregnancy and live birth rate in women undergoing IVF [2], the effect of salpingectomy on ovarian function remains a matter of debate. Due to the close anatomical association of vascular and nervous supply of tubes and ovaries, partial disruption of ovarian blood supply is possible after unilateral or bilateral salpingectomy [5]. In cases where it would be difficult to perform the salpingectomy close to the fallopian tube, Lass recommended clamping the proximal part of the hydrosalpinx in combination with distal fenestration [6]. This study compare the effect of laparoscopic salpingectomy with proximal tubal division on ovarian function assessed as ovarian response to IVF treatment for infertility patient with hydrosalpinx
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