Human Reproduction vol.15 no.1 pp.142–144, 2000
Ovarian function before and after salpingectomy in
artificial reproductive technology patients
P.Dar1,3, G.S.Sachs2, D.Strassburger1, I.Bukovsky1
tion technology cycle (Mukherjee et al., 1996; Shelton et al.,
1996). Furthermore, it was suggested recently that the
performance of salpingectomy before in-vitro fertilization
(IVF) in all cases of severe infertility, may improve implanta-
tion and pregnancy rates (Dechaud et al., 1998; Bredkjaer
et al., 1999). However, before embarking on such a radical
and irreversible treatment in high-risk patients without
hydrosalpinx, the short- and long-term implications of the
procedure must be considered. In view of the close anatomical
association of the blood supply and nervous system of these
organs, potential adverse effects of the physical and functional
presence or absence of the tube on ovarian function were
postulated (McComb and Delbeke, 1984; Rumeu et al., 1987;
Lass et al., 1998). However, current data are still inconclusive
and contradictory. This study was undertaken to determine and
compare ovarian response in artificial reproduction technology
patients before and after salpingectomy for ectopic pregnancy.
1Department of Obstetrics and Gynecology, Assaf Harofeh Medical
Center, Zerifin 70300, Israel, affiliated with the Sackler Faculty of
Medicine, Tel-Aviv University, Tel-Aviv, Israel and2Department of
Obstetrics and Gynecology, Albert Einstein College of Medicine/
Montefiore Medical Center, Bronx, NY 10461, USA
3To whom correspondence should be addressed
To determine the effect of the removal of the tube on
ovarian function we studied 52 artificial reproduction
technology cycles in 26 women before and after undergoing
laparoscopic salpingectomy for ectopic pregnancy. Ovarian
response was measured by the duration and quantity of
human menopausal gonadotrophins used in the cycle, the
pre-ovulatory concentrations of oestradiol, the number of
oocytes retrieved, and the quality of the embryos. All
parameters were compared between cycles carried out
before and after salpingectomy as well as between affected
and unaffected sides. Our findings show no significant
difference in any of the parameters studied. We conclude
that laparoscopic salpingectomy does not abate ovarian
response in artificial reproduction technology cycles that
follow the procedure.
Materials and methods
Records between October 1988 and July 1996 were found of 26
women who had artificial reproduction technology cycles before and
after undergoing salpingectomy for ectopic pregnancy. All these
patients met the following criteria: no previous tubal surgery; age at
post-salpingectomy cycle under 40 years; and a period of ?3 years
between cycles. The selection of a group of women with proven
fertility by previous pregnancy raised the possibility of a bias towards
a more favourable sub-group. The design of the study, using women
as the control for themselves, removed this problem.
Ovulation induction in all cases was accomplished with menstrual
long-acting gonadotrophin-releasing hormone (GnRH) analogue/
human menopausal gonadotrophin (HMG)/human chorionic gonado-
trophin (HCG) protocol described previously (Herman et al., 1990).
IVF was carried out in all but two cycles in which intracytoplasmic
sperm injection (ICSI) was utilized.
Ovarian response was measured by the duration and quantity of
HMG used in the cycle, the pre-ovulatory concentrations of oestradiol,
number of oocytes retrieved and quality of embryos (Puissant et al.,
1987). Ovarian response was compared between cycles before and
after salpingectomy as well as between affected and unaffected sides
before and after salpingectomy.
Key words: artificial reproduction technology/ovarian function/
The place of salpingectomy in the management of the patho-
logical tube in a patient who will need assisted reproduction
technology is still a dilemma.
It is well established that ectopic pregnancy is far more
technology for mechanical infertility than in the normal popula-
tion (Herman et al., 1990; Dubuisson et al., 1991; Zouves
et al., 1991). Using multivariate analysis of the risk factors
for recurrent ectopic pregnancy, a scoring system has been
proposed that allows a selection of information-based treat-
ments to decrease recurrence (Pouly et al., 1991). Even though
ectopic pregnancy may still occur following salpingectomy
a laparoscopic ipsilateral salpingectomy with contralateral
sterilization. In the presence of hydrosalpinx, in which signi-
1991; Camus et al., 1999), some investigators recommended
consideration of salpingectomy before the artificial reproduc-
Paired t-test was used to compare ovarian response parameters; χ2
test was used to assess the differences in proportions. Values are
mean ? SD; P ? 0.05 was considered statistically significant.
The average age of patients before salpingectomy was 31.7 ?
3.6 and 33.4 ? 2.7 years after salpingectomy (P ? 0.05).
© European Society of Human Reproduction and Embryology
The effect of salpingectomy on ovarian function
Table II. Embryo quality before and after laparoscopic salpingectomy
Table I. Ovarian response parameters before and after laparoscopic
salpingectomy for ectopic pregnancy
Ovarian response parameters Beforea
Days of HMG (n)
HMG ampoules (n)
Oestradiol on day 0 (pg/ml)
Oocytes retrieved from non-operated side
(n ? 25)
Oocytes retrieved from operated side
(n ? 27)c
Oocytes suitable for insemination/injection 10.81 ? 5.75
Fertilization rate (%)b
Transferred embryo (n)
10.81 ? 2.45
36.13 ? 14.45 34.81 ? 12.47
1285 ? 785
5.07 ? 3.08
10.68 ? 2.57 1st
3rd and 4th
5/54 (9.25)1151 ? 819
4.40 ? 3.68
Values in parentheses are percentages.
aAccording to Puissant et al. (1987).
χ2test for comparison of proportions; P ? 0.38 with 2 degrees of freedom.
6.06 ? 3.85 5.31 ? 4.22
9.5 ? 6.98
3.56 ? 0.81
3.37 ? 0.80
Table III. Comparison of oocyte number retrieved between operated and
non-operated sides before and after salpingectomy (n ? 25)a
Values are means ? SD.
aThere were no significant differences (paired t-test) exceptbχ2test for
comparison of proportions (0.67).
cIn one case bilateral salpingectomy was performed.
HMG ? human menopausal gonadotrophin.
Side of oocyte retrieval
6.06 ? 3.85
5.31 ? 4.22
5.07 ? 3.08
4.40 ? 3.68
Gravidity in pre-salpingectomy cycles ranged from zero to six
and parity ranged from zero to one. The main indications
before the pre-salpingectomy artificial reproduction technology
cycle was mechanical infertility (n ? 16), male factor (n ?
infertility (n ? 2). There was no significant difference in
semen analysis WHO criteria for each couple between cycles.
Salpingectomies were performed in all cases by laparoscopy.
Additional surgery was performed in three women. Contralat-
eral salpingectomy was performed in one case. A contralateral
tubal cauterization was done for two other women who
had had repeated ectopic pregnancies and on laparoscopic
examination had been found to have severe adhesions and/or
hydrosalpinx. Informed consent involved a complete explana-
tion of the procedure, the surgical options, and the uncertainty
of subsequent ovarian response to the radical and irreversible
Implantation rate and clinical pregnancy rates following the
post-salpingectomy cycle were 23.07 and 19.23 respectively.
One woman had a repeated ectopic pregnancy (3.84%) and a
laparoscopic salpingectomy was performed. In all parameters
examined to evaluate ovarian performance (Table I) no signi-
ficant differences were found before and after the salpingec-
tomy. Moreover, to determine whether the lack of difference
was due to a decrease in ovarian response on the affected side
with a compensatory increase in response on the unaffected
side, we compared the number of oocytes retrieved from the
same ovary before and after surgery. Notwithstanding that the
women were significantly older during the post-salpingectomy
cycle, no significant difference was found (Table I).
Additionally, no significant difference was found in the
distributionof embryoquality betweenpre- andpost-salpingec-
tomy cycles (Table II) or in the number of oocytes retrieved,
between the operated and non-operated side during pre- and
post-salpingectomy cycles (Table III).
Values are means ? SD.
aIn one case bilateral salpingectomy was performed.
There were no significant differences (paired t-test).
performance in subsequent artificial reproduction technology
cycles. Some studies from the 1980s, before the routine use
of operative laparoscopy, reported adverse effects on ovarian
function following salpingectomy. Significantly fewer follicles
appeared in rat ovaries following the division of anastomotic
blood vessels between the ovary and the fimbria (McComb
and Delbeke, 1984), and a significantly lower number of pre-
ovulatory oocytes in patients after bilateral salpingectomy was
also noted (Rumeu et al., 1987). Likewise, fewer corpora lutea
were seen in the ipsilateral ovary after unilateral fimbriectomy
as compared with the number found in the contralateral intact
ovary (McComb et al., 1981). It was reported that four of
seven women who had undergone tubal ligation had oestrogen
excretion concentrations at ovulation below the tenth percentile
(Cattanach, 1985). Nevertheless, studying 2456 women for 2
years after tubal sterilization (DeStefano et al., 1983) it was
shown that except for menstrual pain among patients who had
undergone unipolar electrocoagulation procedures, there was
no increase in the prevalence of adverse menstrual function
after the procedure. The existence of periadnexal adhesions
was also found by some investigators to be associated with
poor ovarian function (Mahadevan et al., 1985; Molloy et al.,
1987), but others could not confirm this finding (Halme et al.,
1982; Imoedemhe et al., 1988).
Some recent studies of ovarian performance following
salpingectomy resulted in different findings and conclusions.
Lass et al. compared ovarian response in artificial reproduction
technology cycles between 29 patients who had undergone
unilateral salpingectomy because of ectopic pregnancy and 73
patients with no preceding tubal surgery (Lass et al., 1998).
They found fewer follicles and retrieved oocytes on the
operated side, but no difference in overall number of follicles
and oocytes as compared to the control group. These findings
introduce the possibility of a compensatory mechanism in the
unaffected tube. Our study does not support such a possibility.
The current study demonstrates that laparoscopic salpingec-
tomy apparently has no deleterious impact on ovarian
P.Dar et al. Download full-text
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Moreover, no difference in ovarian function was reported in
five women before and after bilateral salpingectomy. This
series as well as our own supports the hypothesis that tubal
removal does not compromise ovarian function. A third study
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were also confirmed by others (Bredkjaer et al., 1999).
The most important blood supply for the tube is the medial
tubal artery, which originates at the same level as the median
ovarian artery. Laparoscopic surgery, the predominant method
for treatment of ectopic pregnancy today, in combination with
early detection of ectopic pregnancy, permits resection of the
unruptured tube as close as possible to its surface in the
isthmical region. This minimizes the damage to the ovarian
blood supply and thus may decrease the occurrence of adverse
effects as reflected in our results.
Although not addressed in our study, the long-term impact
of salpingectomy on ovarian function, such as timing of
menopause, is an important concern. It has been shown (Siddle
et al., 1987) that the mean age of ovarian failure was
lower in women who had undergone hysterectomy. However,
salpingectomy and hysterectomy are scarcely comparable since
the latter is far more devastating to the ovarian nerve and
blood supply than the laparoscopic procedure. Furthermore,
the local hypertension that results from the occlusion of the
ovarian ligament may have a role in deterioration of ovarian
function. Clearly, more studies are needed to elucidate the
long-term effects of salpingectomy on the ovary.
In conclusion, our data suggest that laparoscopic salpingec-
tomy is a safe procedure in regard to conservation of ovarian
response in subsequent artificial reproduction technology
cycles. In view of the high risk of ectopic pregnancy in patients
with pathological tubes who will need assisted reproduction,
salpingectomy, when indicated, should not be avoided because
of concern for deterioration of ovarian function.
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Received on June 14, 1999; accepted on October 8, 1999