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Radu T, Mar M, Tudorache V, Marginean C. The Impact of Opportunistic Salpingectomy on Ovarian Reserve: A Systematic Review. J Clin Med 2024; 13:3296. [PMID: 38893008 PMCID: PMC11173256 DOI: 10.3390/jcm13113296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 05/26/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: In the last decade, increasing evidence has suggested that high-grade serous ovarian cancers may have their origin in the fallopian tube rather than the ovary. This emerging theory presents an opportunity to prevent epithelial ovarian cancer by incorporating prophylactic bilateral salpingectomy into all surgical procedures for average-risk women. The aim of this review is to investigate the hypothesis that bilateral salpingectomy (BS) may have a negative impact on ovarian reserve, not only following hysterectomy for benign uterine pathologies but also when performed during cesarean sections as a method of sterilization or as a treatment for hydrosalpinx in Assisted Reproductive Technology interventions. Methods: PubMed, Medline, Google Scholar, and Cochrane were searched for original studies, meta-analyses, and opinion articles published between 2014 and 2024. Results: Out of 114 records from the database search, after the removal of duplicates, 102 articles were considered relevant for the current study. Conclusions: Performing opportunistic salpingectomy seems to have no adverse impact on ovarian function in the short term. However, because there is an existing risk of damaging ovarian blood supply during salpingectomy, there are concerns about potential long-term adverse effects on the ovarian reserve, which need further investigation.
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Affiliation(s)
- Teodora Radu
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
- Institution Organizing University Doctoral Studies (IOSUD) “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
| | - Matyas Mar
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
- Institution Organizing University Doctoral Studies (IOSUD) “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
| | - Vlad Tudorache
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
- Institution Organizing University Doctoral Studies (IOSUD) “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
| | - Claudiu Marginean
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
- Institution Organizing University Doctoral Studies (IOSUD) “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu-Mures, Romania
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Zangmo R, Suresh G, Sarkar A, Ramu S, Roy KK, Subramani K, Das P. The Effect of Salpingectomy on Ovarian Reserve Using Two Different Electrosurgical Instruments: Ultrasonic Shears Versus Bipolar Electrocautery. Cureus 2024; 16:e59434. [PMID: 38826994 PMCID: PMC11140537 DOI: 10.7759/cureus.59434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background Salpingectomy is a common surgical procedure in gynecology performed for various indications. Given its proximity to the ovaries and shared vascular supply, concerns have arisen regarding compromised ovarian reserve post-salpingectomy. Objective We aim to study the effect of two different energy sources (group 1: salpingectomy using bipolar electrocautery followed by division with scissors versus group 2: salpingectomy with ultrasonic shears) on residual ovarian reserve. The effect on ovarian reserve was assessed using serum levels of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian size pre- and postoperatively. Materials and methods According to the inclusion criteria, 68 women were included in the study and randomized into the bipolar electrocautery group and the ultrasonic shear group. The final analysis included 34 women in the bipolar electrocautery group and 32 in the ultrasonic shear group. Preoperatively, the ovarian reserve of all women was assessed using FSH, AMH, AFC, and ovarian size. These parameters were then reassessed at three months postoperatively, and the percentage change was analyzed. Results The mean baseline serum AMH and serum FSH values in the bipolar electrocautery group were 3.9 ± 2.9 ng/ml and 6.6 ± 2.1 IU/L, respectively, comparable with the values in the ultrasonic shear group, where serum AMH was 3.2 ± 2.9 ng/ml and serum FSH was 7.3 ± 3.9 IU/L. AFC and ovarian size were comparable between the two groups preoperatively (bipolar electrocautery group AFC was 8 ± 2.2, ovarian size on the right side was 3.3 ± 0.7 cm and on the left was 3.2 ± 0.6 cm; ultrasonic shear group AFC was 5.7 ± 2.3, ovarian size on the right side was 3.4 ± 0.8 cm and on the left was 3.2 ± 0.8 cm). After three months of postoperative analysis, AFC showed a significant fall from the preoperative value in the bipolar electrocautery group compared to the ultrasonic shear group (AFC reduced from 8 ± 2.2 to 5.5 ± 2.3 vs. 8.6 ± 0.5 to 7.9 ± 2.3; p=0.002). The other parameters showed no statistically significant change. Conclusion Our study suggests that ultrasonic shear is safer than bipolar electrocautery for preserving ovarian reserve after salpingectomy. However, further research is needed to confirm these findings.
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Affiliation(s)
- Rinchen Zangmo
- Obstetrics and Gynaecology, Luton and Dunstable Hospital United Kingdom, Bedfordshire, GBR
| | - Gayatri Suresh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Avir Sarkar
- Obstetrics and Gynaecology, Employees' State Insurance Corporation (ESIC) Medical College and Hospital, Faridabad, Faridabad, IND
| | - Sivalakshmi Ramu
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - K K Roy
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Kaloni Subramani
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Priyanka Das
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Reitz L, Balaya V, Pache B, Feki A, Le Conte G, Benammar A, Ayoubi JM. Ovarian Follicular Response Is Altered by Salpingectomy in Assisted Reproductive Technology: A Pre- and Postoperative Case-Control Study. J Clin Med 2023; 12:4942. [PMID: 37568343 PMCID: PMC10419397 DOI: 10.3390/jcm12154942] [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: 05/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case-control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13-15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results.
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Affiliation(s)
- Laurianne Reitz
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Gynecology and Obstetrics Unit, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, France
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Basile Pache
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Anis Feki
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Le Conte
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Achraf Benammar
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Jean-Marc Ayoubi
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Medical School, University of Versailles Saint-Quentin, 78000 Versailles, France
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Li P, Tan X, Chen Y, Ge Q, Zhou H, Zhang R, Wang Y, Xue M, Wu R, Sun D. Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review. J Pers Med 2023; 13:jpm13020332. [PMID: 36836566 PMCID: PMC9960516 DOI: 10.3390/jpm13020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
PURPOSE This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. METHODS The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. RESULTS The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. CONCLUSIONS The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.
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Affiliation(s)
- Ping Li
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Department of Ultrasonography, Weifang People’s Hospital, Weifang 261044, China
| | - Xiao Tan
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Department of Zhuhai Campus, Zunyi Medical University, Zunyi 563006, China
| | - Yi Chen
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Qiaoli Ge
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Haiying Zhou
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Renrong Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Department of Zhuhai Campus, Zunyi Medical University, Zunyi 563006, China
| | - Yue Wang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Min Xue
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Ruifang Wu
- Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen 518036, China
- Correspondence: (R.W.); (D.S.); Tel.: +86-0755-8392333 (D.S.)
| | - Desheng Sun
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Correspondence: (R.W.); (D.S.); Tel.: +86-0755-8392333 (D.S.)
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Sakko Y, Aimagambetova G, Terzic M, Ukybassova T, Bapayeva G, Gusmanov A, Zhakhina G, Zhantuyakova A, Gaipov A. The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14679. [PMID: 36429398 PMCID: PMC9690357 DOI: 10.3390/ijerph192214679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice. METHODS A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014-2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). RESULTS In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014-2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy-29.4%, with 72.6% patients aged between 18-34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low-11.59%. CONCLUSIONS The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.
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Affiliation(s)
- Yesbolat Sakko
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Gulnur Zhakhina
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Almira Zhantuyakova
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center”, Astana 010000, Kazakhstan
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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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Ho CY, Chang YY, Lin YH, Chen MJ. Prior salpingectomy impairs the retrieved oocyte number in in vitro fertilization cycles of women under 35 years old without optimal ovarian reserve. PLoS One 2022; 17:e0268021. [PMID: 35507603 PMCID: PMC9067640 DOI: 10.1371/journal.pone.0268021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
STUDY OBJECTIVE The impairment of the ovarian response in in vitro fertilization (IVF) cycles after salpingectomy remains contentious. Therefore, we investigated whether a history of salpingectomy affects the number of oocytes retrieved in women undergoing IVF in comparison with the number in women without underlying tubal disease. DESIGN Case-control study (Canadian Task Force Classification II-2). SETTING A tertiary hospital-affiliated fertility center. PATIENTS Fifty-four women aged <35 years with a history of salpingectomy and 59 age-matched women without tubal disease. INTERVENTIONS Gonadotropin-releasing hormone antagonist protocol for controlled ovarian stimulation and transvaginal oocyte retrieval. MEASUREMENTS AND MAIN RESULTS The antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, and the number of retrieved oocytes were significantly lower in women with prior salpingectomy than in women without tubal disease. Day-3 follicle-stimulating hormone (FSH) levels, total gonadotropin dosage, and stimulation days did not significantly differ between the groups. The indications of salpingectomy (i.e., hydrosalpinx and ectopic pregnancy) did not differ significantly in terms of ovarian response or reserve among women with salpingectomy history. A history of salpingectomy and other factors related to ovarian response in IVF, such as age, AMH, AFC, day-3 FSH, and total gonadotropin dose, were significantly correlated with the number of oocytes retrieved by univariate regression analysis. In the multivariate-adjusted model after controlling all the above-mentioned variables, only AFC and AMH levels continued to exhibit significant associations with the number of retrieved oocytes. In a subgroup analysis, the negative impact of prior salpingectomy on the number of retrieved oocytes was especially significant in women with suboptimal ovarian reserves (defined as AMH < 4 ng/mL), regardless of the indication of salpingectomy or whether salpingectomy was bilateral or unilateral. CONCLUSION A negative effect on the number of retrieved oocytes in the subsequent IVF cycle after salpingectomy is more likely in women aged <35 years with suboptimal ovarian reserve. Nevertheless, postsurgical AMH and AFC levels still possess a more direct predictive value on ovarian response than the history of salpingectomy.
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Affiliation(s)
- Cheng-Yu Ho
- Department of Obstetrics and Gynecology, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Yuan Chang
- Department of Obstetrics and Gynecology, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hung Lin
- Department of Obstetrics and Gynecology, Shin Kong Wu Huo-Shih Memorial Hospital, Taipei, Taiwan
| | - Mei-Jou Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
- Livia Shang-Yu Wan Chair Professor of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
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Riccio A, Lisi G, Miscia ME, Di Paolo G, Lauriti G, Lelli Chiesa P. Secondary hydrosalpinx in adolescents: a challenging decision-making process for surgical choice and future fertility preservation. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 42. [PMID: 33601874 DOI: 10.4081/pmc.2020.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Hydrosalpinx in pre-pubertal children and non-sexually active adolescents is a rare finding with several etiology and negative impact on future female fertility. The therapeutic approach in these specific populations is debated and it must consider its etiology and adult guidelines focused on fertility issues, which suggest laparoscopic salpingectomy. We described two adolescent cases (15 years asymptomatic and 13 years with abdominal pain) presenting a monolateral hydrosalpinx secondary to surgery for Hirschsprung's disease and complicated appendicitis, respectively. Both patients underwent to uncomplicated robotic-assisted salpingectomy, with uneventful follow-up and preserved ovarian function. Robotic-assisted salpingectomy for hydrosalpinx secondary to previous surgical conditions is a safe and careful approach for adolescents in order to preserve ovarian vascularization, function and future fertility.
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Affiliation(s)
- Angela Riccio
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Maria Enrica Miscia
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gilda Di Paolo
- Service of Pediatric and Adolescent Gynecology, Department of Medicine and Aging Science, University "G. d'Annunzio" of Chieti-Pescara.
| | - Giuseppe Lauriti
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
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Ozcan MCH, Wilson JR, Frishman GN. A Systematic Review and Meta-analysis of Surgical Treatment of Ectopic Pregnancy with Salpingectomy versus Salpingostomy. J Minim Invasive Gynecol 2020; 28:656-667. [PMID: 33198948 DOI: 10.1016/j.jmig.2020.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the fertility outcomes of salpingectomy compared with those of salpingostomy among patients treated for tubal ectopic pregnancies, including a separate analysis of women with risk factors along with a review of the surgical technique. DATA SOURCES Systematic review and meta-analysis from 1990 to the present through PubMed, Embase, CINAHL, and Ovid MEDLINE. The search string included "tubal pregnancy" or "ectopic" as well as "salpingectomy" and various terms describing salpingotomy. METHODS OF STUDY SELECTION Articles studying women who underwent surgical management of an ectopic pregnancy and the contrasted outcomes of salpingectomy vs salpingostomy were reviewed. The primary outcomes included subsequent intrauterine pregnancy (IUP) and repeat ectopic pregnancy (REP). TABULATION, INTEGRATION, AND RESULTS Two randomized controlled trials (RCTs), which consisted mostly of patients classified as low risk, and patients from 16 cohort studies were included. In the RCTs, there was no significant difference in the odds of subsequent IUP in patients who underwent a salpingectomy compared with those who were treated with salpingotomy (odds ratio [OR] 0.97; 95% confidence interval [CI], 0.71-1.33). However, a significant and clinically meaningful difference was noted in the cohort studies, with the patients having a lower chance of IUP after salpingectomy (OR 0.45; 95% CI, 0.39-0.52). No significant difference was noted in the OR for a REP in the randomized trials (OR 0.77; 95% CI, 0.41-1.47), but the patients followed in the cohort studies had a cumulatively higher risk of REP after a salpingostomy (OR 0.73; 95% CI, 0.60-0.90). The subgroup analysis examining women within the studies with risk factors for tubal pathology found an even more impressive lowering in the odds of a subsequent IUP in patients classified as at-risk who were treated with salpingectomy (OR 0.30; 95% CI, 0.17-0.54), with a change in the direction of the odds for an REP rate favoring those who were treated with salpingostomy (OR 1.96; 95% CI, 0.88-4.35). CONCLUSION Salpingectomy has clear advantages over salpingostomy, and RCTs consisting mainly of patients classified as low risk show no difference in outcomes between salpingectomy and salpingostomy. However, in cohort studies inclusive of all patients, the likelihood of a subsequent spontaneous IUP is decreased in patients treated with salpingectomy, and salpingostomies may be especially underused in women with risk factors for tubal disease.
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Affiliation(s)
- Meghan C H Ozcan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island (Drs. Ozcan and Frishman).
| | - Jeffrey R Wilson
- W.P. Carey School of Business, Arizona State University, Tempe, Arizona (Dr. Wilson)
| | - Gary N Frishman
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, Rhode Island (Drs. Ozcan and Frishman)
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Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of a new National Academy of Medicine report on planned place of birth and implications during the SARS-CoV-2 pandemic and commentaries on reviews focused on anorectal sexually transmitted infections and feeding methods following cleft lip repair in infants.
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