The Effect of Laparoscopic Tubal Disconnection or Laparoscopic Salpingectomy on Ovarian Reserve.

Abstract

Background: Fertility of a woman is the most important job in her life, thus preserving the elements of this fertility is much important. The biological age and ovarian reserve are of the most agonizing issues for women, especially in their late thirties and forties. The uterine tubal disconnection versus uterine tubal excision is usually indicated in subfertile patient suffering from tubal disease or indicated in surgical management of ectopic tubal pregnancy. Objective: To study the effect of laparoscopic tubal disconnection or laparoscopic salpingectomy on ovarian reserve. Patients and methods: This study is a prospective cohort study that was conducted at the Endoscopy Unit, Obstetrics and Gynecology Department, Al-Azhar University Hospitals, throughout the period from Oct. 2019 to Sep. 2020. It included 44 patients of the outpatient clinic with a diagnosis of tubal factor infertility or tubal ectopic pregnancy. 22 patients underwent laparoscopic proximal tubal disconnection, and 22 patients underwent laparoscopic salpingectomy. In both groups, basal antral follicle count (AFC) and mean ovarian volume (OVVOL) were evaluated by transvaginal sonography (TVS) before and 3 months after surgery. Results: The mean of the basal AFC and mean OVVOL before and after laparoscopic tubal disconnection were the same suggesting no effect on ovarian reserve, while the mean AFC and OVVOL before and after laparoscopic salpingectomy were different. Both decreased, suggesting negative effect. It was insignificant negative difference in basal AFC and hardly significant negative difference in mean OVVOL. Conclusion: Laparoscopic tubal disconnection does not affect ovarian reserve, while salpingectomy has a negative effect on ovarian reserve estimated by OVVOL three months after the surgical intervention.