Abstract
PurposeProblems with fallopian tubes are one of the main reasons for women to undergo in vitro fertilization-embryo 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.MethodsA 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.ResultsIn 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 (E2), 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.ConclusionSalpingectomy 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.
Highlights
Infertility is estimated to affect 8–12% of couples of child-bearing age worldwide [1]
There were no significant differences in levels of basal follicle stimulation hormone (FSH), basal luteinizing hormone (LH), basal estradiol (E2), 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)
We found that basal follicle-stimulating hormone (bFSH) levels, basal luteinizing hormone levels, basal estradiol levels, antral follicle counts (AFC), total Gn dose, and duration of relatively the same for both groups
Summary
Infertility is estimated to affect 8–12% of couples of child-bearing age worldwide [1]. Infertility may be caused by ovulation disorders, fallopian tube issues, endometriosis, male disorders, and other factors [2]. Tubal infertility caused by fallopian tube obstruction, hydrosalpinx, tubal ligation, or salpingectomy accounts for 25–35% of female infertility [3]. According to the guideline issued by The American College of Obstetricians and Gynecologists (ACOG), salpingectomy is a routine therapy for ectopic pregnancy (EP) cases when the patient is exhibiting signs of intraperitoneal bleeding or ongoing pelvic pain, or when patients have contraindications to more conservative medical treatments [4]. The American Society for Reproductive Medicine (ASRM) recommends salpingectomy as a therapy for patients with extensive dense peritubal adhesions, a surgically irreparable hydrosalpinx, or a fallopian tube that is damaged beyond repair by infection or endometriosis [5]. IVF was first used to treat cases of tubal factor infertility, and tubal infertility is one of the chief indications for IVF
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