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Gupta V, Agarwal S, Chaudhari P, Saxena N, Nimonkar S. A Study to Evaluate the Effect of Opportunistic Salpingectomy on Ovarian Reserve and Function. J Obstet Gynaecol India 2023; 73:62-68. [PMID: 36879936 PMCID: PMC9984602 DOI: 10.1007/s13224-022-01709-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/24/2022] [Indexed: 03/06/2023] Open
Abstract
Background There are conflicting reports on status of ovarian function after hysterectomy and opportunistic salpingectomy in premenopausal women. The present study was undertaken to understand the effect of salpingectomy done at the time of hysterectomy on ovarian reserve and function as measured by serum AMH and FSH levels before and after the surgery. Methods This was a prospective study conducted on 60 women who underwent hysterectomy at our tertiary care centre, Shri Guru Ram Rai Institute of medical and health sciences, Dehradun, from January 2020 to September 2021. Serum AMH and FSH levels were monitored preoperatively and 3 months postoperatively in patients undergoing hysterectomy with bilateral salpingectomy and hysterectomy without salpingectomy. Results The mean age of the patients was 41.83 yrs in group 1 and 43.73 yrs in group 2 [p value = 0.078]. Most common indication of hysterectomy was AUB-L in both the groups (86% and 80%, respectively). Mean operative time was 115.50 min in group 1 and 114.40 min in group 2 [p value = 0.823]. Mean intra-operative blood loss was 214 ml in group 1 and 199.33 ml in group 2 [p value = 0.087]. Serum AMH and FSH were insignificantly decreased in both the groups post-operatively after 3 months, and the difference between both groups was also not statistically significant. Conclusion Salpingectomy done at the time of hysterectomy for benign indications with preservation of ovaries did not have any short-term adverse effects on ovarian reserve and function.
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Affiliation(s)
- Vineeta Gupta
- Department of Obstetrics and Gynaecology, SGRRIHM&S and Shri Mahant Indiresh Hospital, Patel Nagar, Dehradun, Uttarakhand 248001 India
| | - Shivangi Agarwal
- Department of Obstetrics and Gynaecology, SGRRIHM&S and Shri Mahant Indiresh Hospital, Patel Nagar, Dehradun, Uttarakhand 248001 India
| | - Priyanka Chaudhari
- Department of Obstetrics and Gynaecology, SGRRIHM&S and Shri Mahant Indiresh Hospital, Patel Nagar, Dehradun, Uttarakhand 248001 India
| | - Namrata Saxena
- Department of Obstetrics and Gynaecology, SGRRIHM&S and Shri Mahant Indiresh Hospital, Patel Nagar, Dehradun, Uttarakhand 248001 India
| | - Shweta Nimonkar
- Department of Obstetrics and Gynaecology, SGRRIHM&S and Shri Mahant Indiresh Hospital, Patel Nagar, Dehradun, Uttarakhand 248001 India
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Kobayashi M, Kitahara Y, Hasegawa Y, Tsukui Y, Hiraishi H, Iwase A. Effect of salpingectomy on ovarian reserve: A systematic review and meta-analysis. J Obstet Gynaecol Res 2022; 48:1513-1522. [PMID: 35624527 DOI: 10.1111/jog.15316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine the effect of salpingectomy on ovarian reserve. METHODS PubMed, EMBASE, Web of Science, Dynamed plus, and Cochrane Controlled Trials Register databases were searched from their inception to December 2020 to identify relevant studies, including cross-sectional studies, retrospective studies, and randomized controlled trials. Studies that compared anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC) between the control and salpingectomy groups or before and after surgery were included. RESULTS Twenty-one articles were included in the systematic review. Meta-analyses were performed on 16 studies in which data were presented as mean ± SD values. A meta-analysis comparing AMH levels before and after surgery in the same patients showed no significant decrease in all cases, irrespective of whether it was unilateral or bilateral salpingectomy. There was no significant decrease in the AFC in the meta-analysis comparing levels before and after bilateral salpingectomy, either. In contrast, in the case-controlled study the salpingectomy group had significantly lower levels of AMH in all meta-analyses of unilateral and bilateral surgery (mean difference: -0.31, 95% confidence interval [CI]: -0.55, -0.07), only unilateral cases (mean difference: -0.28, 95% CI: -0.50, -0.06), and only bilateral cases (mean difference: -0.71, 95% CI: -1.19, -0.23). The salpingectomy group that included unilateral and bilateral cases had significantly lower AFC compared with no-surgery controls (mean difference: -1.31, 95% CI: -2.13, -0.48). CONCLUSION Although not conclusive, it does appear that patients who underwent salpingectomy (either unilateral or bilateral) have a decreased ovarian reserve.
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Affiliation(s)
- Mio Kobayashi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshikazu Kitahara
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuko Hasegawa
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yumiko Tsukui
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hikaru Hiraishi
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Rouholamin S, Khani B, Ahmadi M. Comparison the results of hysterosalpangiography in patients with ectopic pregnancy treated by laparoscopic salpingostomy, laparotomy, and treated with methotrexate. Adv Biomed Res 2022; 11:27. [PMID: 35720217 PMCID: PMC9201226 DOI: 10.4103/abr.abr_258_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/15/2020] [Accepted: 01/03/2021] [Indexed: 11/04/2022] Open
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Capmas P, Suarthana E, Tulandi T. Management of Hydrosalpinx in the Era of Assisted Reproductive Technology: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:418-441. [PMID: 32853797 DOI: 10.1016/j.jmig.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis evaluating the effect of hydrosalpinx on pregnancy outcomes, to compare different types of management of hydrosalpinx and their impact on pregnancy rates as well as on the ovarian reserve. DATA SOURCES Electronic search using Pubmed, EMBASE, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials and including all published studies that examined tubal infertility and its management (assisted reproductive technology or surgery) as well as the effects on ovarian reserve. The following medical subject headings (Mesh) terms combinations were used: "fallopian tube disease," hydrosalpinx," "tubal or salpinx occlusion or obstruction," "in vitro fertilization," "fallopian tube surgery," "salpingectomy," "salpingostomy," "infertility," "subfertility," "sterility" and "ovarian reserve." METHODS OF STUDY SELECTION All randomized trials, cohort, and case controls studies were included. We excluded review articles, meeting abstracts, case series and case reports, and abstracts without access to full texts. The search was limited to trials in humans and published in English. TABULATION, INTEGRATION, AND RESULTS Our electronic search initially retrieved 6354 articles. Finally, 19 studies were included in the quantitative evaluation of the effects of hydrosalpinx: 23 in the qualitative evaluation and 5 in the quantitative evaluation of different types of hydrosalpinx treatments; and 17 in the quantitative evaluation of ovarian reserve. The presence of a hydrosalpinx was associated with decreased rates of implantation and clinical pregnancy, and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx with salpingectomy, tubal occlusion, or hydrosalpinx aspiration led to better in vitro fertilization pregnancy rates. We found no difference in ovarian response to stimulation after salpingectomy except a decrease in antimüllerian hormone compared to no surgery. CONCLUSIONS The presence of hydrosalpinx is associated with decreased pregnancy rate and increased rates of ectopic pregnancy and miscarriage. Management of hydrosalpinx, regardless of the type of treatment, leads to an increased chance of pregnancy.
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Affiliation(s)
- Perrine Capmas
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors); Inserm, Centre of Research in Epidemiology and Population Health, U1018, and Faculty of Medicine, University Paris Sud, Le Kremlin Bicêtre, France (Dr. Capmas)
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors)
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada (all authors).
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ATILGAN R, PALA Ş, KULOĞLU T, ŞANLI C, YAVUZKIR Ş, ÖZKAN ZS. Comparison of the efficacy between bilateral proximal tubal occlusion and total salpingectomy on ovarian reserve and the cholinergic system: an experimental study. Turk J Med Sci 2020; 50:1097-1105. [PMID: 32394684 PMCID: PMC7379445 DOI: 10.3906/sag-2002-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/10/2020] [Indexed: 01/11/2023] Open
Abstract
Background and aim To compare the effects of bilateral proximal tubal occlusion and bilateral total salpingectomy on ovarian reserve and the cholinergic system via rat experiment. Materials and methods Twenty-one adult female rats were randomly divided into the following three groups:G1 (n = 7), sham group;G2 (n = 7), bilateral total salpingectomy group; and G3 (n = 7), bilateral proximal tubal occlusion group. Four weeks later, the abdomen of the rats was opened. The right ovarian tissues were stored in 10% formaldehyde, whereas the left ovarian tissues were stored at –80 °C in aluminum foil. Serum samples were evaluated for antimullerian hormone. The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analyzed for MDA levels with spectrophotometric measurement, apoptosis with TUNEL staining, fibrosis score with Mason trichrome staining, ovarian reserve with HE staining, and cholinergic receptor muscarinic 1 (CHRM1) level with immunoreactivity method. Results Compared to G1 and G3, the number of corpus luteum with secondary follicles was significantly lower in G2, whereas the number of ovarian cysts and fibrosis and apoptosis scores increased significantly. The CHRM1 immunoreactivity was significantly lower in G2 than in G1 and G3. Conclusions Compared to the bilateral proximal tubal occlusion performed by using bipolar cautery, bilateral total salpingectomy in rats leads to a significant damage in ovarian histopathology and the cholinergic system.
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Affiliation(s)
- Remzi ATILGAN
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şehmus PALA
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Tuncay KULOĞLU
- Department of Histology and Embryology, School of Medicine, Fırat University, ElazığTurkey
| | - Cengiz ŞANLI
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Şeyda YAVUZKIR
- Department of Obstetrics and Gynecology, School of Medicine, Fırat University, ElazığTurkey
| | - Zehra Sema ÖZKAN
- Department of Obstetrics and Gynecology, School of Medicine, Kırıkkale University, KırıkkaleTurkey
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Rodgers R, Carter J, Reid G, Krishnan S, Ludlow J, Cooper M, Abbott J. The effect of laparoscopic salpingectomy for ectopic pregnancy on ovarian reserve. Aust N Z J Obstet Gynaecol 2020; 60:278-283. [PMID: 32065384 DOI: 10.1111/ajo.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND 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. AIM To report anti-Müllerian hormone (AMH) concentrations before and after laparoscopic salpingectomy for ectopic pregnancy as an indicator of change in ovarian reserve. MATERIALS AND METHODS Women aged 18-44 years 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. RESULTS 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 ± 4.6 years. There was no significant difference in the median pre- and post-operative AMH concentrations (13.00 pmol/L (range 5-67 pmol/L) vs 15.25 pmol/L (range 3-96 pmol/L), P = 0.575). Median AMH concentrations also remained stable in women experiencing a first trimester miscarriage (10.40 pmol/L (range 3.9-37.8 pmol/L) vs 13.67 pmol/L (range 2.8-30.5 pmol/L), P = 0.185). CONCLUSION 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.
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Affiliation(s)
- Rachael Rodgers
- Department of Reproductive Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,Genea, Sydney, New South Wales, Australia
| | - Jonathan Carter
- Department of Gynaecological Oncology, Chris O'Brian Lifehouse, Sydney, New South Wales, Australia
| | | | - Surya Krishnan
- Department of Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia.,Department of Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Joanne Ludlow
- Department of Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Cooper
- Genea, Sydney, New South Wales, Australia.,Department of Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.,GRACE Group, Royal Hospital for Women, Sydney, New South Wales, Australia
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Luo J, Shi Y, Liu D, Yang D, Wu J, Cao L, Geng L, Hou Z, Lin H, Zhang Q, Jiang X, Qian W, Yu Z, Xia X. The effect of salpingectomy on the ovarian reserve and ovarian response in ectopic pregnancy: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17901. [PMID: 31764787 PMCID: PMC6882622 DOI: 10.1097/md.0000000000017901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/28/2019] [Accepted: 10/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Salpingectomy is routinely performed in ectopic pregnancy (EP). However, the effect of the surgery on the ovarian reserve and ovarian response in EP patients is still uncertain and has not been systematically evaluated. Therefore, we conducted this meta-analysis to provide a comparison of the ovarian reserve and ovarian response between the pre-salpingectomy and post-salpingectomy in EP patients. METHODS Pubmed, Embase, and Cochrane Library were searched for all relevant articles published up to December 2018. We retrieved the basic information and data of the included studies. The data was analyzed by Review Manager 5.3 software (Cochrane Collaboration, Oxford, UK). RESULTS A total of 243 articles were extracted from the databases, and 7 studies were included in the meta-analysis. The ovarian reserve including anti-Mullerian hormone (inverse variance [IV] -0.7 [95% confidence interval [CI] -0.63, 0.49]), antral follicle count (IV 1.7 [95% CI -2.02, 5.42]) and basal follicle stimulating hormone (IV 0.02 [95% CI -0.63, 0.68]) was comparable between the pre-salpingectomy group and the post-salpingectomy group. The amount of gonadotropin was significantly higher in the post-salpingectomy group when compared with that in the pre-salpingectomy group (IV -212.65 [95% CI -383.59, -41.71]). There was no significant difference in the left parameters of the ovarian response including the duration of gonadotropin stimulation (IV -0.32 [95% CI -0.76, 0.12]), the estrogen level on the human chorionic gonadotropin triggering day (IV -4.12 [95% CI -236.27, -228.04]) and the number of retrieved oocytes (IV 0.35 [95% CI -0.76, 1.46]) between 2 groups. CONCLUSIONS The current results suggest that salpingectomy has no negative effect on the ovarian reserve and ovarian response.
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Affiliation(s)
- Jiaqi Luo
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Yu Shi
- Department of Ultrasound, Peking University Shenzhen Hospital
| | - Dan Liu
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Danni Yang
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Jiahui Wu
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Lijuan Cao
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
- Department of Gynecology & Obstetrics, Nanshan People's Hospital
| | - Lan Geng
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Zhenhui Hou
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Hongbo Lin
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Qiuju Zhang
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Xuefeng Jiang
- Department of Gynecology & Obstetrics, Nanshan People's Hospital
| | - Weiping Qian
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
| | - Zhiying Yu
- Department of Gynecology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China
| | - Xi Xia
- Center for Reproductive Medicine, Peking University Shenzhen Hospital (The Affiliated Hospital of Shantou University Medical College)
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Grynnerup AGA, Lindhard A, Sørensen S, Ørskov M, Petersen KR, Madsen LB, Pilsgaard F, Løssl K, Pinborg A. Serum anti-Müllerian hormone concentration before and after salpingectomy for ectopic pregnancy. Reprod Biomed Online 2018; 37:624-630. [PMID: 30287173 DOI: 10.1016/j.rbmo.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022]
Abstract
RESEARCH QUESTION Does salpingectomy for ectopic pregnancy affect the ovarian reserve measured by changes in pre- and post-operative levels of anti-Müllerian hormone (AMH)? DESIGN This is a prospective observational multicentre study of 64 women treated with salpingectomy for an ectopic pregnancy. AMH was measured in serum samples collected at admission before salpingectomy and at follow-up (median time to follow-up [interquartile range] was 3 [3-4] months). Changes in serum AMH levels were investigated using Wilcoxon signed-rank test and the relationship between changes in AMH and age, time to follow-up, and pre-operative serum AMH level was investigated using linear regression analysis. The biological variation of AMH was also calculated. RESULTS Serum AMH levels did not differ significantly before and after salpingectomy (median ∆AMH [follow-up value minus admission value] 0.40 pmol/l, interquartile range -2.0 to 4.0 pmol/l). ΔAMH was independent of age, time to follow-up and pre-operative serum AMH level. The intra-individual biological variation for AMH ranged from 12.1% to 26.3%, depending on time between the two samples. CONCLUSIONS This is the first paired study to investigate serum AMH values before and after salpingectomy in an unselected population of women presenting with an ectopic pregnancy, including both patients who conceived naturally and following fertility treatment. It was found that salpingectomy for ectopic pregnancy had no short-term effect on serum AMH levels, and changes in AMH levels were independent of age, time to follow-up, and pre-operative serum AMH level. Furthermore, the study demonstrated a 6-month biological variation of AMH of less than 30%.
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Affiliation(s)
- Anna Garcia-Alix Grynnerup
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark.
| | - Anette Lindhard
- Department of Obstetrics and Gynaecology, Zealand University Hospital Roskilde, Sygehusvej 10, DK-4000 Roskilde, Denmark
| | - Steen Sørensen
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark; Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Hvidovre DK-2650, Denmark
| | - Mette Ørskov
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Kresten Rubeck Petersen
- Department of Obstetrics and Gynaecology, Odense University Hospital, J. B. Winsløwsvej 4, Odense C Denmark, C DK-5000
| | - Lisbeth Buss Madsen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Fie Pilsgaard
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Kristine Løssl
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Anja Pinborg
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
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Gao J, Li X, Chen J, Gong W, Yue K, Wu Z. Uterine artery embolization combined with local infusion of methotrexate and 5- fluorouracil in treating ectopic pregnancy: A CONSORT-compliant article. Medicine (Baltimore) 2018; 97:e9722. [PMID: 29384854 PMCID: PMC5805426 DOI: 10.1097/md.0000000000009722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To compare the efficiency and safety of uterine artery embolization (UAE) combined with local infusion of methotrexate (MTX) or MTX and 5-fluorouracil (5-FU) in the treatment of ectopic pregnancy (EP). METHODS One hundred women with EP were prospectively enrolled from December 2012 to February 2015 and randomly allocated into 2 groups. One group was treated with UAE combined MTX, and the other with UAE combined with MTX and 5-FU. Local MTX was administrated at a dose of 80 to 120 mg, based on the initial β-human chorionic gonadotropin (β-HCG) levels, and 5-FU was given intra-arterially at a uniform dose of 0.5 g. RESULTS Bilateral UAE was successfully performed in all 100 patients, 88 of whom were clinically successfully treated, 45 (91.8%) in the MTX group, and 43 (87.8%) in the MTX + 5-FU group; 89% of the patients achieved normalization of β-HCG below 70,000 mIU/mL within 14 to 21 days postoperatively. The time to successful β-HCG resolution was 26.74 ± 5.57 days for patients receiving MTX + UAE treatment, and 27.57 ± 5.08 days for those treated with additional 5-FU. Six patients had subsequent intramuscular injections of MTX and 6 had a unilateral salpingectomy after the treatment failure. Mild immediate side effects accounted for 24.5% in the sole MTX and 58.3% in MTX + 5-FU group. CONCLUSION A combination of UAE and intrauterine infusion of MTX showed comparable efficiency to UAE combined with a local infusion of MTX and 5-FU in treating EP patients with the intention to preserve fertility.
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Taylan E, Oktay KH. Current state and controversies in fertility preservation in women with breast cancer. World J Clin Oncol 2017; 8:241-248. [PMID: 28638793 PMCID: PMC5465013 DOI: 10.5306/wjco.v8.i3.241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
On average, over 25000 women are diagnosed with breast cancer under the age of 45 annually in the United States. Because an increasing number of young women delay childbearing to later life for various reasons, a growing population of women experience breast cancer before completing childbearing. In this context, preservation of fertility potential of breast cancer survivors has become an essential concept in modern cancer care. In this review, we will outline the currently available fertility preservation options for women with breast cancer of reproductive age, discuss the controversy behind hormonal suppression for gonadal protection against chemotherapy and highlight the importance of timely referral by cancer care providers.
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Chiu NC, Ho CH, Shen SH, Tsuei YC, Lee KL, Huang CY, Li HY, Chen TJ. Impact of hysterosalpingography after operative treatment for ectopic pregnancy in Taiwan: A 16-year Nationwide Population-Based Analysis. Medicine (Baltimore) 2017; 96:e7263. [PMID: 28640130 PMCID: PMC5484238 DOI: 10.1097/md.0000000000007263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
By retrieving records from Taiwan's National Health Insurance (NHI) system's database, the current study aimed to investigate the impacts of hysterosalpingography (HSG) to patients after ectopic pregnancy (EP) operations in Taiwan.In this retrospective cohort study, insurance claims data from 1997 to 2013, derived from a cohort of 1 million people randomly sampled to represent all NHI beneficiaries, were analyzed. Patients after ectopic pregnancy (EP) operations were identified via the inclusion of the corresponding NHI procedure codes. We further divided the patients into 2 groups by whether received subsequent HSG, EP-HSG, and EP-no-HSG. Patients with history of previous pregnancies (PP) and subsequent HSG were grouped as PP-HSG. We sought to evaluate the following pregnancies (FP) rate, interval to FP in EP-HSG compared with that in EP-no-HSG, and PP-HSG.EP-HSG had significantly higher FP rate odds ratio than EP-no-HSG (OR, 1.64; 95% CI, 1.24-2.16, P < .001). EP-HSG had lower FP rate odds ratio than that in PP-HSG, but no significant difference (33.1% vs 34.6%, P = .654). The INTERVAL(HSG-FP) in EP-HSG was no significantly different from that in PP-HSG (843.34 ± 82 days vs 644.72 ± 24.30 days, P = .077). There was significant positive correlation between FP after EP and number of HSG (r = 0.070, P < .001). There were significant negative correlation between FP and EP age (r = -0.270, P < .001), FP and INTERVAL(EP-HSG) (r = -0.212, P = .001). The multivariate analysis showed that INTERVAL(EP-HSG) less than 1 year is the predictor factor of INTERVAL(EP-FP) (hazard ratio: 1.422; 95% CI: 1.130-1.788; P = .003). It was evident that the longer the INTERVAL(EP-HSG), the lower the FP rate odds ratio; and the older the EP age, the lower the FP rate odds ratio. (OR, 95% CI; >1 year: 0.59, 0.41-0.86; >2 year: 0.42, 0.32-0.55; >25 years old: 0.47, 0.38-0.57; >30 years old: 0.29, 0.24-0.35; >35 years old: 0.12, 0.08-0.18, all P < .001).Receiving HSG after EP, short INTERVAL(EP-HSG), EP age less than 30 years old, had significant positive impacts on the FP. We encourage shortening the INTERVAL(EP-HSG), and the counseling of women on the most appropriate way to conceive thereafter.
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Affiliation(s)
| | - Chi-Hong Ho
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | | | - Yu-Chuan Tsuei
- School of Medicine, National Yang-Ming University; School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan, R.O.C; and Department of Orthopaedics, Cheng Hsin General Hospital, Taipei City, Taiwan R.O.C
| | | | - Chen-Yu Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Hsin-Yang Li
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Beitou District, Taipei City, Taiwan, R.O.C; and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, R.O.C; and Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Mohamed AA, Yosef AH, James C, Al-Hussaini TK, Bedaiwy MA, Amer SAKS. Ovarian reserve after salpingectomy: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96:795-803. [PMID: 28471535 DOI: 10.1111/aogs.13133] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/11/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Although there has been a growing concern over the possible damaging effect of salpingectomy on ovarian reserve, this issue remains uncertain. The purpose of this meta-analysis was to test the hypothesis that salpingectomy may compromise ovarian reserve. MATERIAL AND METHODS A detailed search was conducted using MEDLINE, Embase, Dynamed Plus, ScienceDirect, TRIP database and the Cochrane Library from January 2000 to November 2016. All cohort, cross-sectional and randomized controlled studies investigating changes in circulating anti-Müllerian hormone (AMH) after salpingectomy were considered. Thirty-seven studies were identified, of which eight were eligible. Data were extracted and entered into RevMan software for calculation of the weighted mean difference (WMD) and 95% CI. Two groups of studies were analyzed separately: group 1 (six studies, n = 464) comparing data before and after salpingectomy and group 2 (two studies) comparing data in women who have undergone salpingectomy (n = 169) vs. healthy controls (n = 154). RESULTS Pooled results of group 1 studies showed no statistically significant change in serum AMH concentration after salpingectomy (WMD, -0.10 ng/mL; 95% CI -0.19 to 0.00, I2 = 0%). Similarly, meta-analysis of group 2 showed no statistically significant difference in serum AMH concentration between salpingectomy group and controls (WMD, -0.11 ng/mL; 95% CI -0.37 to 0.14, I2 = 77%). Subgroup analyses based on laterality of surgery, type of AMH kit and participants' age (<40 years) still showed no statistically significant changes in circulating AMH. CONCLUSION Salpingectomy does not seem to compromise ovarian reserve in the short-term. However, the long-term effect of salpingectomy on ovarian reserve remains uncertain.
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Affiliation(s)
- Ahmed Aboelfadle Mohamed
- Department of Obstetrics and Gynecology, University of Nottingham, Royal Derby Hospital, Derby, UK.,Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - Ali Haroun Yosef
- Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt.,Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Cathryn James
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | | | - Mohamed Ali Bedaiwy
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada
| | - Saad Ali K S Amer
- Department of Obstetrics and Gynecology, University of Nottingham, Royal Derby Hospital, Derby, UK
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The Effect of Salpingectomy on Ovarian Function. J Minim Invasive Gynecol 2017; 24:563-578. [DOI: 10.1016/j.jmig.2017.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
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The Role of Opportunistic Bilateral Salpingectomy vs Tubal Occlusion or Ligation for Ovarian Cancer Prophylaxis. J Minim Invasive Gynecol 2017; 24:371-378. [DOI: 10.1016/j.jmig.2017.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/31/2016] [Accepted: 01/04/2017] [Indexed: 01/11/2023]
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