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Geczik AM, Michels KA, Anderson GL, Falk RT, Farland LV, Manson JE, Shadyab AH, Pfeiffer RM, Xu X, Trabert B. Associations of tubal ligation and hysterectomy with serum androgen and estrogen metabolites among postmenopausal women in the Women's Health Initiative Observational Study. Cancer Causes Control 2024:10.1007/s10552-024-01882-4. [PMID: 38772931 DOI: 10.1007/s10552-024-01882-4] [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: 12/07/2023] [Accepted: 04/15/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE Hysterectomy is associated with subsequent changes in circulating hormone levels, but the evidence of an association for tubal ligation is unclear. We evaluated whether circulating concentrations of androgens and estrogens differ by tubal ligation or hysterectomy status in postmenopausal women from the Women's Health Initiative (WHI)-Observational Study (OS). METHODS Serum androgens and estrogens were measured in 920 postmenopausal women who did not use menopausal hormone therapy at the time of blood draw, of whom 139 self-reported a history of tubal ligation and 102 reported hysterectomy (with intact ovaries). Geometric mean hormone concentrations (GMs) and 95% confidence intervals (CIs) associated with a history of tubal ligation or hysterectomy (ever/never), as well as time since procedures, were estimated using adjusted linear regression with inverse probability of sampling weights to account for selection. RESULTS Circulating levels of 12 androgen/androgen metabolites and 20 estrogen/estrogen metabolites did not differ by tubal ligation status. Among women reporting prior hysterectomy compared to women without hysterectomy, we observed lower levels of several androgens (e.g., testosterone (nmol/L): GMyes 0.46 [95% CI:0.37-0.57] vs. GMno 0.62 [95% CI:0.53-0.72]) and higher levels of estrogen metabolites, for example, 2-hydroxyestrone-3-methyl ether (GMyes 11.1 [95% CI:8.95-13.9] pmol/L vs. GMno 8.70 [95% CI:7.38-10.3]) and 4-methoxyestrone (GMyes 6.50 [95% CI:5.05-8.37] vs. GMno 4.92 [95% CI:4.00-6.05]). CONCLUSION While we did not observe associations between prior tubal ligation and postmenopausal circulating hormone levels, our findings support that prior hysterectomy was associated with lower circulating testosterone levels and higher levels of some estrogen metabolites, which may have implications for future hormone-related disease risks.
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Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA.
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
| | - Kara A Michels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garnet L Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California - San Diego, La Jolla, CA, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Xia Xu
- Cancer Research Technology Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Britton Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Obstetrics and Gynecology, University of Utah, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
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Sellers TA, Peres LC, Hathaway CA, Tworoger SS. Prevention of Epithelial Ovarian Cancer. Cold Spring Harb Perspect Med 2023; 13:a038216. [PMID: 37137500 PMCID: PMC10411689 DOI: 10.1101/cshperspect.a038216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Given the challenges with achieving effective and durable treatment for epithelial ovarian cancer, primary prevention is highly desirable. Fortunately, decades of research have provided evidence for several strategies that can be deployed to optimize risk reduction. These include surgery, chemoprevention, and lifestyle factor modifications. These broad categories vary in terms of the magnitude of risk reduction possible, the possible short-term and long-term side effects, the degree of difficulty, and acceptability. Thus, the concept of a risk-based model to personalize preventive interventions is advocated to guide discussion between care providers and women at risk. For women with inherited major gene mutations that greatly increase risk of ovarian cancer, surgical approaches have favorable risk to benefit ratios. Chemoprevention and lifestyle factor modifications portend a lower degree of risk reduction but confer lower risk of undesirable side effects. Since complete prevention is not currently possible, better methods for early detection remain a high priority.
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Affiliation(s)
- Thomas A Sellers
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Lauren C Peres
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
| | - Cassandra A Hathaway
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center & Research Institute, Tampa, Florida 33612, USA
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Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertil Steril 2015; 103:e37-43. [DOI: 10.1016/j.fertnstert.2015.03.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 01/03/2023]
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Examination of the ovarian reserve after generation of unilateral rudimentary uterine horns in rats. ScientificWorldJournal 2014; 2014:918496. [PMID: 24672393 PMCID: PMC3933323 DOI: 10.1155/2014/918496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 11/21/2022] Open
Abstract
Objective. The purpose of this experimental rat model study is to evaluate the changes in the ovarian environment after excision of the rudimentary horn. Methods. Ten female Wistar albino rats were used in this study. One cm of right uterine horn length was excised in the first operation. Two months after the first operation, all animals were sacrificed to obtain ovaries for histological examination. Mann-Whitney U test and Student's t-test were used for statistical analysis purposes. Statistical significance was defined as P < 0.005. Results. The number of primordial follicles (P = 0.415), primary follicles (P = 0.959), preantral follicles (P = 0.645), antral follicles (P = 0.328), and Graafian follicles (P = 0.721) was decreased and the number of atretic follicles (P = 0.374) increased in the right ovarian side. Howeve,r this difference was not found to be statistically significant. Conclusion. The results of this experimental rat model study suggest that the excision of rudimentary horn could have negative effects on ipsilateral ovarian functions.
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Impact of tubal ligation on ovarian reserve as measured by anti-Müllerian hormone levels: a prospective cohort study. Contraception 2013; 88:700-5. [PMID: 24120250 DOI: 10.1016/j.contraception.2012.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/03/2012] [Accepted: 09/18/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tubal ligation (TL) is considered a very efficient contraceptive method. However, some patients complain of a variety of postoperative symptoms. The objective of this study was to investigate whether ovarian reserve may change after tubal ligation. STUDY DESIGN This was a prospective cohort study of 80 fertile women who underwent TL. Ovarian reserve was evaluated by measuring pre- and postoperative (1 year after surgery) serum anti-Müllerian hormone (AMH) levels and transvaginal antral follicular count (AFC). Potential confounding factors were age, body mass index (BMI), smoking, surgical technique and prior contraceptive methods. The Wilcoxon test was used to compare pre- and postoperative (12 months) AMH and AFC, and simple and multiple linear regression were used to evaluate confounding factors. RESULTS Fifty-two patients completed the study protocol. The median AMH level was 1.43 ng/mL (interquartile range 0.63-2.62) preoperatively and 1.30 ng/mL (interquartile range 0.53-2.85) after 12 months (p=.23). The mean AFC was 8.0 (interquartile range 5.0-14.0) and 11.0 (interquartile range 7.0-15.0) before and after TL, respectively (p=.12). These differences were not statistically significant. Use of a hormonal contraceptive method prior to TL was significantly associated with a postoperative increase in AMH. CONCLUSIONS This study suggests that ovarian reserve is not altered by TL.
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Ni L, Sadiq S, Mao Y, Cui Y, Wang W, Liu J. Influence of various tubal surgeries to serum antimullerian hormone level and outcome of the subsequent IVF-ET treatment. Gynecol Endocrinol 2013; 29:345-9. [PMID: 23339657 DOI: 10.3109/09513590.2012.743004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the influence of various tubal surgeries to ovarian reserve via serum level of antimullerian hormone (AMH) and the subsequent in vitro fertilization and embryo transplantation (IVF-ET) outcome in patients with simple tubal infertility. STUDY DESIGN A prospective cohort study was conducted on 134 IVF cycles undegone by 26 and 34 cases with bilateral and unilateral salpingectomy, respectively, 23 cases with bilateral oviducts interrupted in the proximal and 51 cases with bilateral oviducts obstruction without intervention as controls. RESULTS Serum AMH displayed its great superiority to traditional markers of ovarian reserve in correspondence with antral follicles count and decisive effect for the number of oocytes retrieved after stimulation in each group. No significant differences on ovarian reserve and responsiveness or IVF-ET outcome existed among four groups comparable on essential characteristics, except for numerically higher clinical pregnancy rate and live birth rate after various tubal surgeries versus no intervention for bilateral oviducts obstruction. Especially, bilateral salpingectomy precursed the statistically highest implantation rate (51.0% versus 28.0%, 39.1%, 30.4%) and numerically best IVF outcome. CONCLUSION Tubal surgical procedures have some beneficial effect for improving IVF outcome without significant impact on ovarian reserve or responsiveness. Bilateral salpingectomy appears to be an appropriate procedure before IVF treatment for bilateral salpingitis, especially hydrosalpinx.
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Affiliation(s)
- Lili Ni
- Center of Clinical Reproduction, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Ercan CM, Sakinci M, Coksuer H, Keskin U, Tapan S, Ergun A. Ovarian reserve testing before and after laparoscopic tubal bipolar electrodesiccation and transection. Eur J Obstet Gynecol Reprod Biol 2012; 166:56-60. [PMID: 23036487 DOI: 10.1016/j.ejogrb.2012.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/25/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To find out whether tubal sterilization leads to loss of ovarian reserve, we assessed the hormonal and ultrasonographic parameters of ovarian reserve in women who underwent laparoscopic tubal sterilization by bipolar electrodesiccation and transection. STUDY DESIGN In this preliminary study, laparoscopic tubal sterilization was performed on 49 healthy women who had voluntarily requested elective surgical sterilization. Among the current ovarian reserve indicators, in the early proliferative phases, preoperative (baseline) and postoperative (third month) serum follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels, ovarian volume, and antral follicle counts (AFCs) were determined. Analysis of these hormonal and ultrasonographic parameters of ovarian reserve preoperatively and postoperatively was the main outcome measure. RESULTS Preoperative and third-month postoperative FSH, LH, E2, and AMH levels did not reveal statistically significant differences (p=0.101, p=0.180, p=0.254, and p=0.079; respectively). The ultrasonographic indicators of ovarian reserve did not change in terms of total ovarian volume and total AFC (p=0.793 and p=0.098, respectively). CONCLUSIONS Short-term follow-up study results revealed a slight but non-significant change in the current ovarian reserve markers, especially in the AMH levels.
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Affiliation(s)
- Cihangir Mutlu Ercan
- Gulhane Military Medical Academy, Obstetrics and Gynecology Department, 06018 Etlik, Ankara, Turkey.
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Committee opinion: role of tubal surgery in the era of assisted reproductive technology. Fertil Steril 2012; 97:539-45. [DOI: 10.1016/j.fertnstert.2011.12.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022]
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9
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Kilic S, Tasdemir N, Lortlar N, Yuksel B, Budak G, Batioglu S. Vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS) immunoreactivities in rat ovaries and uterine tubes after tubal ligation: a controlled immunohistochemical study. EUR J CONTRACEP REPR 2009; 13:431-7. [PMID: 19117260 DOI: 10.1080/13625180802267052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the effects of tubal ligation on ovarian and tubal tissues by means of immunohistochemical evaluation of two hypoxia related mediators: vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS). DESIGN Fourteen Sprague-Dawley female rats were divided into two groups: a tubal ligation (Pomeroy technique) was carried out on rats in group 1 (n = 7) whereas those in group 2 served as controls (n = 7). Salpingo-oophorectomy was performed in group 1 during the second oestrous period following tubal ligation. Rats in group 2 were submitted to a salpingo-oophorectomy, as well. VEGF and iNOS immunoreactivities in ovarian and tubal tissues were evaluated by means of immunohistochemistry. Immunohistochemical scores and number of antral follicles were compared. RESULTS In the ovary, VEGF immunoreactivity was significantly more intense in the granulosa (p = 0.002) and the theca cells (p = 0.001) of rats in group 1 but, in ovarian medulla (p = 0.259) and germinal epithelium (p = 0.209), it was not significantly different from that of rats in group 2. The iNOS immunoreactivity in ovarian granulosa cells (p = 0.073) and germinal epithelial cells (p = 0.805) did not differ between the two groups. The cytoplasmic VEGF (p = 0.001) and iNOS (p = 0.017) immunoreactivities in the uterine tube, were significantly more intense in group 1. However, VEGF immunoreactivity in the lamina propria of the uterine tube (p = 0.209) was of similar intensity in both groups. CONCLUSION Tubal ligation may lead to supraphysiological hypoxia as evidenced by increased VEGF and iNOS immunoreactivities in ovarian and tubal tissues.
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Affiliation(s)
- Sevtap Kilic
- Department of Reproductive Endocrinology, Dr Zekai Tahir Burak Women Health Research Hospital, Ankara.
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Sezik M, Ozkaya O, Demir F, Sezik HT, Kaya H. Total salpingectomy during abdominal hysterectomy: Effects on ovarian reserve and ovarian stromal blood flow. J Obstet Gynaecol Res 2007; 33:863-9. [DOI: 10.1111/j.1447-0756.2007.00669.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Belaisch-Allart J, Mayenga JM, Castaing N, Allart JP. La chirurgie tubaire et utérine a-t-elle un effet délétère sur la fonction ovarienne? ACTA ACUST UNITED AC 2006; 34:1111-7. [PMID: 17118690 DOI: 10.1016/j.gyobfe.2006.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/10/2006] [Indexed: 11/22/2022]
Abstract
Changes in menstrual pattern after tubal sterilisation have been reported for more than 50 years. Hence all tubal surgeries have been suspected of altering the ovarian reserve, by damage to the ovarian blood vessels. Recent studies showed that tubal surgery has no significant adverse effect on doppler flow indice and hormonal markers. Hysterectomy and uterine artery embolization seem to decrease ovarian reserve in perimenopausal women. Uterine artery embolization does not seem to have adverse effects on normally functioning ovaries.
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Affiliation(s)
- J Belaisch-Allart
- Service de gynécologie-obstétrique et reproduction humaine, CHI de Chaville, Saint-Cloud, Sèvres, Ville d'Avray, site de Sèvres, 141, Grande-Rue, 92318 Sèvres cedex, France.
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Dede FS, Akyuz O, Dilbaz B, Caliskan E, Haberal A. Color Doppler Flow Analysis of Uterine and Ovarian Arteries before and after Tubal Sterilization: Electrocautery versus Pomeroy. Gynecol Obstet Invest 2006; 61:45-8. [PMID: 16192732 DOI: 10.1159/000088524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 08/10/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM To compare the changes in uterine and ovarian artery blood flow following laparoscopic sterilization via bipolar cautery with Pomeroy tubal ligation via mini-laparotomy in patients who had voluntary surgical sterilization. METHODS Ninety consecutive fertile women applying for voluntary tubal ligation were recruited in this prospective study. Patients were allocated for either laparoscopic tubal ligation via bipolar electrocoagulation (group 1) or Pomeroy tubal ligation via mini-laparotomy (group 2) according to their preference. Color Doppler flow analysis of uterine and ovarian arteries were carried out on the 3rd day of the cycle prior to the procedure (D(0)), on the 3rd postoperative day (D(1)) and on the 3rd day of the cycle, 3 months (D(3)) following the surgery. The significance of difference between the three measurements was analyzed by using analysis of variance. RESULTS Prior to surgery, the mean pulsatility index of the uterine artery, left and right ovarian arteries were 1.9 +/- 0.3, 1.8 +/- 0.3, 1.8 +/- 0.2 in group 1 and 1.8 +/- 0.08, 1.8 +/- 0.08, 1.8 +/- 0.07 in group 2, respectively. There was no statistically significant difference between group 1 and group 2 in terms of D(0) values (p > 0.05). 3rd postoperative day and 3rd month measurements of both uterine and ovarian arteries in group 1 and group 2 did not show any statistically significant difference from that of preoperative values (p > 0.05). CONCLUSION No alternation in the flow of either ovarian or uterine arteries following tubal sterilization performed by bipolar electrocautery and Pomeroy's technique was determined both in the immediate postoperative period and 3 months after the surgery.
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Affiliation(s)
- F Suat Dede
- Ankara Etlik Maternity and Women's Health Teaching Hospital, Turkey.
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Kutlar I, Ozkur A, Balat O, Ugur MG, Genco Y, Aksoy F. Effects of three different sterilization methods on utero-ovarian Doppler blood flow and serum levels of ovarian hormones. Eur J Obstet Gynecol Reprod Biol 2005; 122:112-7. [PMID: 16154047 DOI: 10.1016/j.ejogrb.2004.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Revised: 08/24/2004] [Accepted: 12/22/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the study was to assess pre-operative and post-operative serum levels of ovarian hormones and changes in utero-ovarian arterial blood flow by Doppler ultrasonography in women in whom one of three different sterilization methods was applied. STUDY DESIGN The Pomeroy method of tubal ligation, fimbriectomy, or laparoscopic bipolar coagulation were applied in 42 patients. Serum levels of sex hormones were checked, and utero-ovarian arterial Doppler measurements were performed pre-operatively and post-operatively. The presence or absence of dysmenorrhea was noted before and after the operations. RESULTS We detected a significant increase in the average uterine arterial resistivity index (RI) and both ovarian arterial pulsatility index (PI) values in the Pomeroy method group (p<0.05). There was a significant increase in dysmenorrhea complaints in the total number of patients (p<0.05), particularly in the fimbriectomy group. CONCLUSION The significant increase in uterine arterial Doppler measurements with the Pomeroy method may be due to the removal of a larger tubal segment. Even though the increase is not statistically significant, fimbriectomy should not be applied in young women, because it may increase dysmenorrhea and the procedure is not reversible.
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Affiliation(s)
- Irfan Kutlar
- Departments of Obstetrics and Gynecology, Gaziantep University, Faculty of Medicine, Milli Egemenlik Bulvari 32/6, 27060 Gaziantep, Turkey.
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Nelson DB, Sammel MD, Freeman EW, Gracia CR, Liu L, Langan E. Tubal ligation does not affect hormonal changes during the early menopausal transition. Contraception 2005; 71:104-10. [PMID: 15707559 DOI: 10.1016/j.contraception.2004.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 09/28/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine if women with a bilateral tubal ligation (BTL) were more likely to experience hormonal changes indicative of the transition to menopause or an increase in menopausal symptoms compared to women without a BTL. METHODS Menopausal symptoms and hormone profiles of 134 women reporting a BTL were compared throughout the course of a 4-year follow-up study to 172 women without a BTL. Generalized linear regression models for repeated measures were used to estimate the independent effect of BTL on menopausal symptoms and hormonal levels adjusted for covariates. RESULTS Forty-four percent of women reported a BTL and over one-half of women with a BTL experienced hot flashes. Women with a BTL had similar hormonal levels over the study period compared to women without a BTL. In addition, no relationship was found between BTL and any of the menopausal symptoms, including hot flashes, decreased libido or increased anxiety adjusting for age, race, body mass index (BMI), education, menopausal status and parity. CONCLUSION These findings document that women with a BTL have similar changes in sex hormone levels over the perimenopausal period compared to women without a BTL independent of other covariates. In addition, the reporting of menopausal symptoms was similar between the groups.
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Affiliation(s)
- Deborah B Nelson
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
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Kelekci S, Yorgancioglu Z, Yilmaz B, Yasar L, Savan K, Sonmez S, Kart C. Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply. Aust N Z J Obstet Gynaecol 2005; 44:449-51. [PMID: 15387868 DOI: 10.1111/j.1479-828x.2004.00269.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Our aim was to evaluate possible adverse effects of tubal ligation on ovarian reserve and ovarian stromal vascular support. METHODS Ninety-one women who underwent tubal ligation, using a modified Pomeroy technique, were studied. The main outcome measurements were serum follicle stimulating hormone, luteinising hormone and oestradiol levels, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery on the third day of the menstrual cycle immediately before, 1 month and 12 months after the surgical intervention. RESULTS Statistically significant elevation of follicle stimulating hormone levels was observed at 1 and 12 months after tubal ligation (P < 0.05). CONCLUSION Doppler flow studies of the ovarian stromal arteries showed that there were no significant differences before and after tubal ligation.
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Affiliation(s)
- Sefa Kelekci
- Suleymaniye Maternity Hospital, Family Planning Unit, Istanbul, Turkey.
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Kelekci S, Yilmaz B, Yakut Y, Yasar L, Savan K, Sonmez S. Hormonal and ovarian stromal blood supply changes after laparoscopic tubal sterilization: a prospective controlled study. Contraception 2005; 73:279-83. [PMID: 16472571 DOI: 10.1016/j.contraception.2005.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 07/27/2005] [Accepted: 08/02/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study is to determine if the effects of tubal sterilization (TS) by laparoscopy have any risk of a subsequent significant decrease in ovarian reserve and vascular support within the ovary by means of stromal artery Doppler study, and to compare the results with matched paired controls. DESIGN Between February 2002 and January 2005, 148 healthy volunteers were enrolled sequentially, 74 undergoing laparoscopic TS (study group) and 74 age-, parity-, body mass index-matched women were recruited as a control group. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and E2, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery pulsatile index (PI) and maximum velocity (Vmax) on the third day of the cycle immediately before, and 1 and 12 months after the surgical intervention. RESULTS There were significant elevations in both serum FSH levels and PI values observed 1 month after TS, compared to the preoperative levels (p < .05), and also when compared to controls. However, there were no significant elevations at 12 months postoperation in both study and control groups. The other outcome measurements did not show any significant differences between the two groups. CONCLUSIONS Tubal sterilization by laparoscopic electrocoagulation does not cause any decrease in ovarian reserve or ovarian stromal blood supply, except an early postoperative increase in FSH and PI.
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Affiliation(s)
- Sefa Kelekci
- Family Planning Unit, Suleymaniye Maternity Hospital, 34340 Istanbul, Turkey.
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Dede FS, Dilbaz B, Akyuz O, Caliskan E, Kurtaran V, Dilbaz S. Changes in menstrual pattern and ovarian function following bipolar electrocauterization of the fallopian tubes for voluntary surgical contraception. Contraception 2005; 73:88-91. [PMID: 16371302 DOI: 10.1016/j.contraception.2005.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 07/10/2005] [Accepted: 07/13/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to investigate the changes in menstrual pattern, ovarian reserve and presence of dysmenorrhea and ovulation after tubal ligation via bipolar electrocautery. METHODS Sixty patients requesting voluntary tubal ligation were recruited in the study. Laparoscopic tubal sterilization via bipolar electrocoagulation was performed in all patients in the early follicular phase. Blood samples were collected on day 3, one cycle before the procedure, in the same cycle when the procedure was carried out and on the third cycle following the procedure for determination of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E(2)), and on day 21 for progesterone (P) levels. All patients were followed for 3 months, and changes in menstrual pattern, presence or absence of dysmenorrhea and ovulation were noted. RESULTS Menstrual changes occurred in six patients (10%), although only one patient had mild dysmenorrhea (1.6%) after the procedure. The incidence of ovulation was 33% preoperatively, rising to 40% in the cycle when surgery was performed and maintained a constant level at 40% 3 months after tubal ligation. There was no statistically significant difference in the serum FSH, LH and estradiol levels in preoperative and postoperative assessments (p > .05). CONCLUSION Tubal ligation has been blamed for causing luteal phase defect as a result of an effect on ovarian circulation. In our study, the rate of ovulation was slightly improved after the procedure, and ovarian reserve was not negatively affected. Bipolar electrocoagulation of the fallopian tubes did not alter the ovarian reserve and function.
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Affiliation(s)
- F Suat Dede
- Ankara Etlik Maternity and Women's Health Teaching Hospital, Ankara 06010, Turkey.
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Kelekci S, Yilmaz B, Yasar L, Savan K, Sonmez S, Kart C. Ovarian reserve and ovarian stromal blood supply after tubal ligation by the Pomeroy technique: comparison with controls. Gynecol Endocrinol 2005; 20:279-83. [PMID: 16019374 DOI: 10.1080/09513590500097192] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To determine if women who undergo tubal sterilization by the Pomeroy technique have any risk of a subsequent significant decrease in ovarian reserve and vascular support inside the ovary, by means of stromal artery Doppler ultrasonography. METHODS Between March 2000 and September 2004, 108 healthy volunteers underwent mini-laparatomic tubal ligation using the modified Pomeroy technique (study group). As a control group, 102 age-matched women were recruited. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and estradiol, ovarian volume, number of antral follicles and Doppler indices of the ovarian stromal arteries on the third day of the cycle immediately before, 1 month and 12 months after the surgical intervention. RESULTS In the study group and control group, results of the main outcome measurements immediately before, 1 month and 12 months after the surgical intervention did not show any significant difference except one. There was a significant elevation of FSH levels after 1 and 12 months, which was statistically significant (p < 0.05) in the study group. CONCLUSION The 12-month follow-up of patients suggests that there is neither a decrease in ovarian reserve nor an adverse effect on the blood supply of ovarian stroma after tubal sterilization by the modified Pomeroy technique. A significant elevation of FSH levels was observed at 1 and 12 months after the operation.
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Affiliation(s)
- Sefa Kelekci
- Family Planning Unit, Suleymaniye Maternity Hospital, Istanbul, Turkey.
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Fagundes ML, Mendes MC, Patta MC, Rodrigues R, Berezowski AT, de Moura MD, Yazlle MEHD. Hormonal assessment of women submitted to tubal ligation. Contraception 2005; 71:309-14. [PMID: 15792652 DOI: 10.1016/j.contraception.2004.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Revised: 07/06/2004] [Accepted: 08/09/2004] [Indexed: 11/16/2022]
Abstract
Sixteen fertile women aged 30-35 years with regular menstruations were studied before and 6 months after tubal ligation (TL). The diagnosis of ovulation was based on clinical ultrasonographic and hormonal parameters [follicle-stimulating hormone (FSH), luteinizing hormone (LH), E2 and P4]. The menstrual pattern did not vary before and after surgery. Follicular or luteal phase FSH and E2 levels did not differ between the pre- and post-TL period. Luteinizing hormone levels on days -2 and 0 of the follicular phase were significantly higher during the post-TL period, while no difference was observed for the luteal phase. P4 levels during the follicular phase did not differ between the two periods, except for day -4, while they were lower during the post-TL luteal phase. The results of the study suggest that in the present patient group, no modifications in the menstrual pattern could be observed 6 months after TL, and TL appears not to interfere with ovulation. Luteinizing hormone levels showed an increase during the ovulatory period after TL, and progesterone secretion decreased during the post-TL luteal phase.
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Affiliation(s)
- Maria Letícia Fagundes
- Sector of Contraception, Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14049-900, Brazil
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Cevrioglu AS, Degirmenci B, Acar M, Yilmazer M, Erol D, Kahraman A, Demirel R, Coksuer H. Examination of changes caused by tubal sterilization in ovarian hormone secretion and uterine and ovarian artery blood flow rates. Contraception 2004; 70:467-73. [PMID: 15541408 DOI: 10.1016/j.contraception.2004.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Revised: 07/22/2004] [Accepted: 08/12/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation. DESIGN Tubal sterilization was performed by minilaparotomy and laparoscopy methods in 36 women. Blood samples were taken for hormonal tests on Preoperative Day 3 (D3) of the menstrual cycle, on Postoperative Days 13-15 (periovulatory period) of the same cycle and on D3 in the 1st and 6th months post-TS. Uterine and ovarian artery blood flow rates of the women were measured on the same days as hormonal tests by transvaginal color Doppler ultrasonography (TVCDUSG). The control group was composed of 15 volunteers in the same age group who preferred the barrier method and who had the same TVCDUSG and hormonal analyses in the same periods. RESULTS There was a decrease in the uterine and ovarian artery pulsatility index (PI) measurements and an increase in serum luteinizing hormone (LH) and estradiol (E2) values during the periovulatory period as compared with preoperative and postoperative menstrual measurements in all groups. There was no difference between baseline uterine and ovarian artery PI and serum follicle-stimulating hormone, LH and E2 values and those measured on D3 of the menstrual cycle in the 1st and 6th months post-TS. CONCLUSIONS The 6-month postoperative follow-up of groups that had undergone different TS methods showed no difference in uterine or ovarian artery blood flow rates or ovarian hormone secretion in comparison with baseline values.
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Affiliation(s)
- Arif Serhan Cevrioglu
- Department of Obstetrics and Gynecology, School of Medicine, Kocatepe University, 03200 Afyon, Turkey.
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