The effect of laparoscopic salpingectomy for ectopic pregnancy on ovarian reserve.

Abstract

Salpingectomy may damage ovarian reserve by direct vascular interruption to the ovary or thermal vascular injury from electrosurgery. It is plausible that this risk may increase in the context of salpingectomy conducted for ectopic pregnancy due to the distension of the fallopian tube and vascular changes associated with pregnancy. To report anti-Müllerian hormone (AMH) concentrations before and after laparoscopic salpingectomy for ectopic pregnancy as an indicator of change in ovarian reserve. Women aged 18-44years scheduled for salpingectomy for tubal ectopic pregnancy were prospectively recruited. Serum AMH concentrations were measured immediately prior to surgery, then repeated four months post-operatively. In all cases, salpingectomy was conducted laparoscopically using bipolar electrosurgery and mechanical scissors. A group of women scheduled for uterine curettage for first trimester miscarriage was recruited to ensure any observed change in AMH concentration in the women undergoing salpingectomy was secondary to surgery, rather than an effect of pregnancy. Paired pre- and post-operative serum AMH concentrations were obtained from 32 women with tubal ectopic pregnancy. The mean age of the women was 33.6±4.6years. There was no significant difference in the median pre- and post-operative AMH concentrations (13.00pmol/L (range 5-67pmol/L) vs 15.25pmol/L (range 3-96pmol/L), P=0.575). Median AMH concentrations also remained stable in women experiencing a first trimester miscarriage (10.40pmol/L (range 3.9-37.8pmol/L) vs 13.67pmol/L (range 2.8-30.5pmol/L), P=0.185). Laparoscopic salpingectomy using electrosurgery and mechanical scissors does not damage ovarian reserve. AMH concentrations do not fluctuate from baseline in the first trimester of pregnancy.