Review Article
The Effect of Salpingectomy on Ovarian Function

https://doi.org/10.1016/j.jmig.2017.02.014Get rights and content

Abstract

Tubal surgery is performed for a variety of indications in gynecology. Salpingectomy is the most aggressive form of tubal surgery and may be performed for potential risk reduction for epithelial ovarian cancer, sterilization, and ectopic pregnancy and as a method to enhance fertility in the setting of hydrosalpinx. Depending on the indication, alternatives include conservative therapy alone, tubal occlusion, and salpingostomy. However, aggressive tubal surgery may impact fertility and ovarian reserve because of its effects on adjacent ovarian tissue. Ovarian damage may manifest as alterations in serum and sonographic markers of ovarian function as well as in vitro fertilization (IVF) response and, ultimately, impair outcomes in assisted reproductive and spontaneous conception cycles. We performed a review of articles from PubMed, Cochrane, and MEDLINE from 1946 to 2016 and included 48 relevant publications. For most indications for salpingectomy, ovarian reserve is not impacted. Although there are several conflicting studies suggesting a slight impairment of the parameters of ovarian reserve, these studies were mostly in patients who underwent salpingectomy for an ectopic pregnancy. For patients attempting to conceive naturally, salpingectomy overall does not confer a substantial decrease in conception. Conservative options may increase their risk for persistent trophoblastic disease. In patients planning on IVF, salpingectomy does not appear to significantly affect ovarian stimulation parameters or clinical pregnancy rates. Furthermore, salpingectomy is recommended in cases of hydrosalpinx. Overall, salpingectomy has no significant effects on ovarian reserve. However, the impact on IVF success and spontaneous pregnancy rates must be weighed by the indication for possible salpingectomy. A review of these risks and benefits should aid in choosing between salpingectomy and less aggressive alternatives.

Section snippets

Methods

A search was performed in PubMed, the Cochrane Library, and Ovid MEDLINE. Phrases used in the search were suited for each individual database and included “salpingectomy AND ovarian reserve,” “salpingectomy AND AMH,” “salpingectomy AND FSH,” “salpingectomy AND antral follicle count,” “salpingectomy AND fertility,” “salpingectomy AND IVF,” “salpingectomy AND ovarian hyperstimulation,” “salpingectomy AND oocyte,” “salpingectomy AND tubal occlusion,” and “salpingectomy AND menopause.” Our search

Results

The systematic literature search yielded 249 articles. Only 48 of these articles met the inclusion criteria (Fig). These articles are outlined by author, study type, indications, outcomes, strengths, weaknesses, and findings (Table 1, Table 2, Table 3).

Nearly all of the salpingectomies were performed laparoscopically. Over a quarter of the articles were randomized controlled trials. The remainder were retrospective and prospective cohort studies. Two case-control studies were included with 1

Conclusions

Overall, it appears that salpingectomy is unlikely to have a substantial adverse impact on ovarian reserve. The majority of existing studies have reported reassuring findings, and no clear evidence exists to recommend against salpingectomy when tubal surgery is otherwise indicated. Still, reports of alterations in FSH, AMH, AFC, or the ovarian pulsatility index cannot be completely discounted.

Of note, the indication for salpingectomy in the majority of the studies noting a detrimental effect on

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    The authors declare that they have no conflict of interest.

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