Abstract
Objective:To observe and compare the effect of postpartum tubal ligation (TL) procedures on ovarian reserve at women desiring TL as a contraceptive method at the end of pregnancy.Material and Methods:Eighty-one women were included in the prospective study. TL was performed at the time of cesarean delivery (CD) (n=49) and as an interval procedure by laparoscopy (LS) in the postpartum period (n=32). Anti-müllerian hormone (AMH) was used to determine ovarian reserve. Blood samples were taken twice from each subject; the first sample was taken before delivery from all subjects and the second sample was taken 4 months after sterilization. AMH level differences were compared in each group and between groups.Results:The preoperative AMH values of CD and LS groups were similar 2.30 (maximum: 5.20, minimum: 0.42) ng/mL and 1.80 (maximum: 3.50, minimum: 0.40) ng/mL, respectively (p=0.262). The postoperative AMH values of the CD and LS groups were 1.30 (maximum: 2.60, minimum: 0.30) ng/mL and 0.90 (maximum: 2.50, minimum: 0.20) ng/mL, respectively (p=0.284). When the preoperative and postoperative values of each group were compared the change was statistically significant for both groups p<0.001. The decrease in mean AMH values in the CD and LS groups were 37.83% and 44.15%, respectively. The percentage changes of AMH values were not statistically significant (p=0.286).Conclusion:TL at the time of CD and interval sterilization with LS have similar effects on ovarian reserve.
Highlights
Tubal ligation (TL) is a permanent contraceptive method preferred mostly by women with more than one child [1]
The median postoperative antimüllerian hormone (AMH) values of both groups were lower than the preoperative median AMH values; this difference was statistically significant for both groups (p
Surgical sterilization can result in subtle changes in ovarian function, even though ovulation itself is not affected [16,17]
Summary
Tubal ligation (TL) is a permanent contraceptive method preferred mostly by women with more than one child [1]. It is known to be safe procedure but utero-ovarian blood flow disruption has been considered as an adverse effect of the procedure [2,3,4,5,6]. The debate on this issue has continued since the 1950s [2]. More objective parameters were used to measure ovarian reserve and function; namely, folliclestimulating hormone, luteinizing hormone, estradiol (E2), antimüllerian hormone (AMH), and ultrasound (Doppler blood flow and antral follicle count) for determining the effect of TL [9,11,12,13,14,15,16,17,18,19,20,21,22]. Venturella et al [8] reported that
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