No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The effect of tubal sterilization with the Pomeroy technique and bipolar electrocauterization on the ovarian reserve and serum anti-Müllerian hormone levels in a rat model
... Studies have analyzed histopathological changes during the I/R period in terms of epithelial alterations, edema, vascular congestion, follicular cell degeneration, hemorrhage, and neutrophilic infiltration. In fact, evidence has suggested that tissue histopathological alteration scores increase after I/R injury (25,26). Our results correlate with the current literature in that the salpingectomy group had the highest scores among the groups analyzed, whereas the I/R þ 30d group had the lowest scores. ...
... Considering this evidence, the detorsion procedure in adolescent girls with ischemic tubes after tubal ischemia may enhance tubal function and spontaneous conception; however, it may also increase the likelihood of ectopic pregnancy. Previous studies on factors affecting blood flow to fallopian tube tissues, such as tubal ligation or salpingectomy, have found either no significant change or a considerable decrease in the AMH levels (26,32). In those studies, the investigators stated that the tubal sterilization procedure destroys adjacent vascular structures (tubal branch or ovarian branch of the uterine artery in the mesosalpinx) besides the fallopian tube, resulting in altered blood supply to the ovaries. ...
... Ercan et al. (33) postulated that AMH is a better and early marker of microvascular perfusion change in the ovaries affected secondary to tubal electrocoagulation. Additionally, Kaya et al. (26) observed a decrease in the AMH levels after the Pomeroy method (not statistically significant) and electrocoagulation (statistically significant). Within the same context, we hypothesize that after the torsion of the tuba uterina along with the adjacent vascular structures-a wider area than that in tubal sterilization-diminished blood supply will ultimately result in microvascular ischemia in the ovaries, consequently affecting the AMH values. ...
... 9 Alternatively, particular methods of TL may cause damage to the surrounding neural tissues and ovary. 10,11 As such, it has been hypothesized that the procedure may have negative impacts on ovarian function and reserve. ...
... To control for potential confounding, we created two multivariable models: model 1, adjusted for age (squared), sample type (control from nested case-control study of early LANGTON ET AL menopause, from additional samples of premenopausal women), and blood collection factors (fasting status, season of blood collection, and luteal day); and model 2, additionally adjusted for age at menarche ( 11,12,13,14, !15 years), smoking status (current, not current), smoking pack years (continuous), alcohol intake (0, <1, 1, >1 drink/day), body mass index (<18.5, 18.5-24.9, ...
Objective:
Oral contraceptives (OCs) and tubal ligation are commonly used methods of contraception that may impact ovarian function. Few studies have examined the association of these factors with antimüllerian hormone (AMH), a marker of ovarian aging.
Methods:
We examined the association of OC use and tubal ligation with AMH in the Nurses' Health Study II prospective cohort among a subset of 1,420 premenopausal participants who provided a blood sample in 1996-1999. History of OC use and tubal ligation were reported in 1989 and updated every 2 years until blood collection. We utilized generalized linear models to assess whether mean AMH levels varied by duration of and age at first use of OCs and history, age, and type of tubal ligation.
Results:
In multivariable models adjusted for smoking, reproductive events, and other lifestyle factors, we observed a significant, inverse association between duration of OC use and mean AMH levels (P for trend = 0.036). Compared to women without a tubal ligation, AMH levels were significantly lower when the procedure included a clip, ring, or band (1.04 ng/ml vs 1.72 ng/ml, P < 0.01). AMH levels were not associated with age at first use of OCs or age at tubal ligation.
Conclusions:
Our analysis found an association between duration of OC use and certain types of tubal ligation with mean AMH levels. Further research is warranted to confirm the long-term association of these widely used contraceptive methods with AMH.
Video Summary:http://links.lww.com/MENO/A860.
... These studies have reported that tubal surgery does not adversely affect ovarian reserves [11][12][13][14][15][16][17]. However, some publications have contradicted these studies [18,19]. In most of the abovementioned studies, hormonal markers (such as FSH, LH, E2, and AMH), and ultrasonographic findings (such as ovarian or uterine artery Doppler indices and antral follicle counts) were used in the preoperative and postoperative short terms to evaluate ovarian reserves or function. ...
... Studies have also examined subjects' reporting a decrease in ovarian reserves, arguing the antithesis of the previously mentioned findings [18,19]. The factors underlying this difference may be the ligation of the dominant vessels from the uterine or ovarian arteries in the ovarian blood supply, depending on the anatomical variations of ovarian vascularization. ...
... The rates of ectopic pregnancies also vary by procedure, with the highest rates following laparoscopic sterilization using bipolar coagulation 14 . Patients should, therefore, be counseled to present early if they suspect pregnancy. ...
The objective of this study is to assess the knowledge and use of surgical contraceptive methods among women in Sialkot. The study design was “Cross Sectional Descriptive Study. 100 women patients with different ages, and characteristics who visited Gynecology OPD of Allama Iqbal Memorial Teaching Hospital, Sialkot were included. A Performa including segments related to the patients and her family was designed. Knowledge and use of different surgical contraceptives were assessed. The participants were asked to respond using recall methodology.Of 100 women, 18 have undergone tubal ligation and majority of them were belonging to low socio-economic group and their husbands were either illiterate or having maximum education till intermediate. Most of the women who had undergone tubal ligation had 4 or more than 4 children. 70 (70%) women have knowledge about tubal ligation. 69 (69%) found this procedure safe and 31 (31%) observed side effects. 32 (32%) also recommended this procedure to others. 77 (77%) were satisfied and 23 (23%) had some misconception about this procedure.There is a need to spread mass awareness about tubal ligation and its benefits.
... Therefore, patients should be advised to present early if they suspect pregnancy. 2,6,7 The most prevalent kind of sterilization procedure that is performed in conjunction with cesarean deliveries in the United States is tubal ligation; however, between the years of 2015 and 2018, there was a significant shift toward the use of bilateral salpingectomy as an alternative to tubal ligation. More research has to be done because this study found that the group who underwent bilateral salpingectomy had a greater rate of surgical morbidity than the group that underwent bilateral tubal ligation. ...
Candidates for tubal sterilisation include women who have finished having children and who are looking for a method of birth control that is both highly effective and permanent. It is possible for it to be carried out at any point during a woman's menstrual cycle, as well as right after a child is born or an abortion is performed. Hysteroscopy, laparoscopy, or even a mini-laparotomy might be performed instead. It is important to have a conversation about the danger of regret as well as the characteristics that increase the likelihood of regret, such as a young age at the time of sterilization (less than 30 years), a lower parity, sterilization administered in the immediate postpartum period, divorce or remarriage following sterilization, and being poor or of Hispanic origin. It would appear that being a young adult at the time of the sterilization is the most significant indicator of regret. It is extremely important to keep in mind that this does not provide full protection. According to the findings of the CREST study, the failure rate across all procedures was 18.5 out of every 1000 procedures over the course of a 10-year period. Even in the event that a cesarean birth is performed unexpectedly, a mother request for postpartum permanent contraception in the form of bilateral total salpingectomy during cesarean delivery may be a procedure that is both safe and practicable.
... The literature includes only a few human studies in which the serum AMH levels and ovarian reserve were evaluated post-TL [26][27][28][29][30], and one rat model study investigated the same parameters [31]. In human studies, no differences were found between the pre-and post-TL AMH levels and serum follicle stimulating and luteinizing hormones (FSH and LH, respectively) and estrogen (E2) levels were not different in women with versus without TL [32]. ...
The aim of this study was to evaluate the effects of tubal ligation (TL) via modified Pomeroy method on ovarian reserve and to determine the role of curcumin (Curcuma longa [Indian saffron]) against ovarian reserve decrement after TL. Forty-eight albino Wistar rats were randomly divided into four groups: (1) Control group: a sham operation was performed (n = 12), (2) Tubal ligation group: TL was performed (n = 12), (3) TL+DMSO group: 1 mL/day dimethyl sulfoxide was used for 50 days after TL, (4) TL+Curc group: 100 mg/kg/day curcumin dissolved in DMSO was administrated for 50 days after TL. Pre-operatively and on post-operative day 50, blood samples were collected for AMH evaluation, and oophorectomy was performed for histological and immunohistochemical examinations of ovaries in all groups. No difference in the basal AMH levels was found among the groups (p = 0.249). Compared to the basal, AMH levels were lower in the control, TL, and TL+DMSO groups (p = 0.003, p = 0.004, and p < 0.001, respectively) but not different in the TL+Curc group (p = 0.503) on post-operative day 50. No significant differences in the number of primary, preantral, antral, atretic follicles, and corpus luteum among the groups (p > 0.05) were found. The percentage of granulosa cells stained for caspase-3 in antral follicles and the corpus luteum was higher in the TL+Curc group than in the control and TL groups ([antral follicles; p < 0.01 for both groups], [corpus leteum; p = 0.009 and 0.002 for the control and TL groups, respectively]). It seems that TL does not decrease ovarian reserve and curcumin might have a positive effect on ovarian reserve in the setting of TL.
... Technological advances have made TS in the long term a more reliable, effective, and cost-effective way [3][4][5] . However, short-and longterm risks of tubal sterilization have been reported in It may cause post-TS problems, such as menstrual irregularities, chronic pelvic pain, dysmenorrhea, increased risk of osteoporosis, intrauterine and ectopic pregnancy (16-80%), changes in sexual behavior, low pre-ovulatory estradiol (E2) or progesterone levels, and increased incidence of cumulative hysterectomy in the late period [6][7][8] . ...
... In order to understand whether or not the ovarian reserve was affected by ischemia and reperfusion damage, we Table IV. Correlation analysis of the blood samples alterations and histopatological analysis of the study groups assessed preoperative and postoperative serum AMH levels and follicle count (Kaya et al., 2015). ...
We aimed to evaluate the effects of detorsion and Allium sativum (garlic oil) treatment on the ovarian reserve in an ovarian torsion model. Ovarian torsion may lead to loss of ovarian tissue and infertility. It is an experimental rat study that was carried out on 16 sets of ovaries each, one for treatment group and a control group. In the control group, the procedure involved only the surgically opening and closing the abdomen. Bilateral adnexal torsion/detorsion was performed after a 3-hour ischemia period for the detorsion-only group. The detorsion + Allium sativum group received a 5 ml/kg dose of Allium sativum intraperitoneally, 2 hours before surgery. After the second surgery, removed ovarian samples were evaluated for follicle counts, damage scores and other parameters. Primordial, preantral, small antral and large antral follicle counts were significantly higher in the detorsion + Allium sativum group. Degeneration, congestion, hemorrhage ,inflammation and total damage scores were significantly elevated in the detorsion only group compared to those for the detorsion + Allium sativum group. Finally, there was a significant correlation between AMH alterations and postoperative, preantral follicle count (p<0.05). As a conclusion detorsion + Allium sativum treatment may be effective in protecting the ovarian reserve after torsion.
... No intervention was made on the control group. In the Pomeroy's method group, rats received bilateral tubal ligation with Pomeroy's technique; after elevating the tube, the loop was ligated with a 2/0 Vicryl suture (Johnson & Johnson, USA) 2 cm away from the ovary (6). In the bipolar electrocauterization group, the tube was cauterized by bipolar electrocoagulation 2 cm away from the ovary and interrupted via surgical scissors. ...
Objective:
To compare the degree of apoptosis in ovaries and tubal epithelium observed secondary to tubal ligation either by Pomeroy's method or bipolar electrocauterization in a rat model.
Material and methods:
A total of 24 female Sprague-Dawley rats were randomly assigned into 3 study groups: control (n=8), Pomeroy (n=8), and the electrocauterization group (n=8). Apoptotic cells were detected on the primary, secondary, tertiary follicles of the ovaries, and on the tubal epithelium using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling. The apoptotic index was calculated for each group by the percentage of the stained cells.
Results:
The apoptotic index of tubal epithelium was significantly higher in the bipolar electrocauterization group compared with the control and Pomeroy groups (3.1±0.8 vs. 1.4±1.0, p=0.018 and 2.0±1.2, p=0.03, respectively) whereas there was no significant difference between Pomeroy's method and the control group. The apoptotic index of primary follicles was higher in the bipolar electrocauterization group compared with the control and Pomeroy's method groups (3.4±0.5 vs. 1.2±0.4, p<0.001 and 1.8±0.8, p=0.005, respectively), but there was no significant difference between Pomeroy's method and the control group. The apoptotic index of secondary and tertiary follicles was similar for each group.
Conclusion:
Pomeroy's technique, as a permanent contraception method, is associated with lower apoptotic index on ovary and fallopian tube when compared with bipolar electrocauterization.
... No intervention was made on the control group. In the Pomeroy's method group, rats received bilateral tubal ligation with Pomeroy's technique; after elevating the tube, the loop was ligated with a 2/0 Vicryl suture (Johnson & Johnson, USA) 2 cm away from the ovary (6). In the bipolar electrocauterization group, the tube was cauterized by bipolar electrocoagulation 2 cm away from the ovary and interrupted via surgical scissors. ...
... In this study, we observed significantly lower primordial and preantral follicle counts after cisplatin treatment compared to those in control group. Our results were similar with other researchers' investigations [29,30]. Primordial follicle count of control group and cisplatin þ EPO group was significantly higher than that of cisplatin group. ...
The aim of this study is to investigate whether erythropoietin (EPO) can reduce the ovarian damage of cisplatin or not. Thirty, female, Wistar-Albino rats were used in the study. Control group (N = 10): Intraperitoneal saline infusion, Cisplatin group (N = 10): Intraperitoneal 7 mg/kg cisplatin, Cisplatin + EPO group (N = 10): Intraperitoneal 7 mg/kg cisplatin and subcutaneous 200 IU/kg/day EPO. Serum AMH concentrations were measured by enzyme-linked immunosorbent assay kit of AMH. Follicular counts were evaluated according to mean diameter of the follicles. Ovarian damage; including follicular cell degeneration, vascular congestion, hemorrhage, and inflammation was scored histologically using a graduated scale. Posttreatment AMH levels of cisplatin group were significantly lower than control and cisplatin + EPO groups. In cisplatin group, there was a significant decrement in posttreatment AMH level compared to pretreatment AMH level. The total damage score of cisplatin group was significantly higher than scores of control and cisplatin + EPO groups. The mean primordial follicle counts of control and cisplatin + EPO groups were significantly higher than that of cisplatin group (p = .007 and p = .003). The results of this study revealed that EPO administration to cisplatin chemotherapy could ameliorate the ovarian damage. Erythropoietin administration to chemotherapeutic agents might suggest to protect ovarian failure and infertility.
Aim
To compare postoperative pain and recovery in patients undergoing oophorectomy with single‐port laparoscopic surgery (SPLS) versus vaginal natural orifice transluminal endoscopic surgery (vNOTES).
Method
Patients who underwent salpingo‐oophorectomy with SPLS or vNOTES between 2016 and 2023 were analyzed retrospectively. Oophorectomy was performed based on the presence of an adnexal mass or breast cancer susceptibility gene mutation.
Results
Fifty‐two patients underwent oophorectomy with SPLS and 35 underwent vNOTES. Although the mean mass size was slightly larger in the SPLS group than in the vNOTES group (8.0 ± 4.1 vs. 6.8 ± 3.3 cm), the difference was not significant. There was no difference in operating times between SPLS and vNOTES. The mean visual analog scale and faces pain scale scores 2 and 6 h postoperatively were lower in the vNOTES group. The mean quality of recovery‐40 (QoR‐40) score was higher in the vNOTES group (156 ± 14 vs. 148 ± 11; p = 0.009). This analysis identified vNOTES as an independent predictor of a high QoR‐40 score.
Conclusion
The vNOTES group experienced less pain during the early postoperative period than the SPLS group. Although the operating and removal times were similar, the port setup time was longer for the vNOTES group.
Introduction:
Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic.
Evidence acquisition:
In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review.
Evidence synthesis:
In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion.
Conclusions:
Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
Background and objectives
The use of tubal ligation as a contraceptive method has started to increase because it is a safe procedure with high protection. This increase also brings to mind what the procedure-related adverse effects may be. The aim of this study was to investigate the long-term effects whether tubal ligation performed during caesarean had an effect on dysmenorrhea, dyspareunia, menstrual pattern, and hormones.
Methods
Our study was retrospectively conducted by archive scanning and phone calls of a total of 220 patients who were divided into two groups as the study group, which underwent tubal ligation during the caesarean section (n = 110), and the control group (n = 110), which had caesarean section but did not undergo tubal ligation. Patients who did not meet the inclusion criteria were not included in the study.
The patients were invited to the hospital on the second or third days of their menstrual cycles. Serum TSH, FSH, LH, E2, PRL levels of these patients were studied. Their dysmenorrhoea, dyspareunia symptoms and menstrual cycle patterns were questioned. The results of the groups were compared.
Results
There was no significant difference between the hormone levels and dysmenorrhoea-dyspareunia evaluations of both groups (p > 0.05). However, it was found that menstrual cycle irregularity was higher in the group that underwent tubal ligation and this difference was statistically significant (p < 0.05).
Conclusion
In women who underwent tubal ligation during caesarean section, it was found that there was no difference in menstrual cycle pattern, hormone levels, dysmenorrhea, and dyspareunia, except for menstrual cycle irregularity.
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 was performed; and G3 (n = 7): bilateral proximal tubal occlusion was performed. 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 aluminium foil. Serum samples were evaluated for antimullerian hormone (AMH). The right ovary was used for histological and immunoreactive examination, and the left ovary was used for tissue MDA analysis. Tissue samples were analysed 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.
Objective:
To determine the effect of tubal ligation on age at natural menopause, as a marker of long-term ovarian function.
Methods:
Three preexisting population-based cohorts were included in this cross-sectional study. Data from each cohort was analyzed separately. The cohorts were restricted to women who never smoked and had reached natural menopause, without prior hysterectomy or oophorectomy. The following variables were collected: race, age at menarche, age at menopause, history of hysterectomy or oophorectomy, gravidity and parity, tobacco use, and ever use of hormonal contraception. The type of tubal ligation and age at tubal ligation were manually abstracted in cohort 1. For cohorts 2 and 3, history of tubal ligation was obtained from an institutional form, completed by patient report. The primary outcome, age at natural menopause, was compared between the two groups (those with and without a history of tubal ligation).
Results:
Inclusion criteria was met by 555 women from cohort 1, 1,816 women from cohort 2, and 1,534 women from cohort 3. Baseline characteristics did not differ between cohorts. The percentage with tubal ligation was the same in all cohorts: 26.0%, 25.5%, and 25.0%, respectively. Women with a tubal ligation were more likely to have had at least one pregnancy and to have used hormonal contraception compared with women without a tubal ligation. There was no significant difference in age at natural menopause in women who underwent tubal ligation (50.1, 49.9, 50.0 years, respectively) compared with those who did not (50.7, 49.6, 50.0 years, respectively). The type of tubal ligation (cohort 1 only) had no effect on age at menopause.
Conclusions:
Tubal ligation did not affect age at natural menopause in the three large cohorts included in this study.
Background: This is an update of a review that was first published in 2002. Female sterilisation is the most popular contraceptive method worldwide. Several techniques exist for interrupting the patency of fallopian tubes, including cutting and tying the tubes, damaging the tube using electric current, applying clips or silicone rubber rings, and blocking the tubes with chemicals or tubal inserts. Objectives: To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties, and women's and surgeons' satisfaction. Search methods: For the original review published in 2002 we searched MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). For this 2015 update, we searched POPLINE, LILACS, PubMed and CENTRAL on 23 July 2015. We used the related articles feature of PubMed and searched reference lists of newly identified trials. Selection criteria: All randomized controlled trials (RCTs) comparing different techniques for tubal sterilisation, irrespective of the route of fallopian tube access or the method of anaesthesia. Data collection and analysis: For the original review, two review authors independently selected studies, extracted data and assessed risk of bias. For this update, data extraction was performed by one author (TL) and checked by another (RK). We grouped trials according to the type of comparison evaluated. Results are reported as odds ratios (OR) or mean differences (MD) using fixed-effect methods, unless heterogeneity was high, in which case we used random-effects methods. Main results: We included 19 RCTs involving 13,209 women. Most studies concerned interval sterilisation; three RCTs involving 1632 women, concerned postpartum sterilisation. Comparisons included tubal rings versus clips (six RCTs, 4232 women); partial salpingectomy versus electrocoagulation (three RCTs, 2019 women); tubal rings versus electrocoagulation (two RCTs, 599 women); partial salpingectomy versus clips (four RCTs, 3827 women); clips versus electrocoagulation (two RCTs, 206 women); and Hulka versus Filshie clips (two RCTs, 2326 women). RCTs of clips versus electrocoagulation contributed no data to the review. One year after sterilisation, failure rates were low (< 5/1000) for all methods. There were no deaths reported with any method, and major morbidity related to the occlusion technique was rare. Minor morbidity was statistically significantly higher with the tubal ring than the clip (Peto OR 2.15, 95% CI 1.22 to 3.78; participants = 842; studies = 2; I2 = 0%; high-quality evidence), as were technical failures (Peto OR 3.93, 95% CI 2.43 to 6.35; participants = 3476; studies = 3; I2 = 0%; high-quality evidence). Major morbidity was significantly higher with the modified Pomeroy technique than electrocoagulation (Peto OR 2.87, 95% CI 1.13 to 7.25; participants = 1905; studies = 2; I2 = 0%; low-quality evidence), as was postoperative pain (Peto OR 3.85, 95% CI 2.91 to 5.10; participants = 1905; studies = 2; I2 = 0%; moderate-quality evidence). When tubal rings were compared with electrocoagulation, postoperative pain was reported significantly more frequently for tubal rings (OR 3.40, 95% CI 1.17 to 9.84; participants = 596; studies = 2; I2 = 87%; low-quality evidence). When partial salpingectomy was compared with clips, there were no major morbidity events in either group (participants = 2198, studies = 1). The frequency of minor morbidity was low and not significantly different between groups (Peto OR 7.39, 95% CI 0.46 to 119.01; participants = 193; studies = 1, low-quality evidence). Although technical failure occurred more frequently with clips (Peto OR 0.18, 95% CI 0.08 to 0.40; participants = 2198; studies = 1; moderate-quality evidence); operative time was shorter with clips than partial salpingectomy (MD 4.26 minutes, 95% CI 3.65 to 4.86; participants = 2223; studies = 2; I2 = 0%; high-quality evidence). We found little evidence concerning women's or surgeon's satisfaction. No RCTs compared tubal microinserts (hysteroscopic sterilisation) or chemical inserts (quinacrine) to other methods. Authors' conclusions: Tubal sterilisation by partial salpingectomy, electrocoagulation, or using clips or rings, is a safe and effective method of contraception. Failure rates at 12 months post-sterilisation and major morbidity are rare outcomes with any of these techniques. Minor complications and technical failures may be more common with rings than clips. Electrocoagulation may be associated with less postoperative pain than the modified Pomeroy or tubal ring methods. Further research should include RCTs (for effectiveness) and controlled observational studies (for adverse effects) on sterilisation by minimally-invasive methods, i.e. tubal inserts and quinacrine.
Sterilization (tubal sterilization and vasectomy) is a widely applied contraceptive method worldwide. Although most studies have described sterilization as a safe method, there are reports of tubal ligation (TL) and vasectomy complications. The aim of this study was to evaluate the effects of TL and vasectomy on the serum oxidative stress, specifically prooxidant-antioxidant balance (PAB) and malondialdehyde (MDA) levels, over time.
Male and female rats were classified into vasectomy, sham-vasectomy, TL, and sham-TL groups, respectively. The PAB and MDA levels were measured on days 15 and 45 and months 3 and 6 after the intervention. For female rats, blood sampling was performed during the diestrous phase and estradiol and progesterone were also measured.
Serum PAB and MDA increased after TL (p<0.05). Vasectomy increased serum MDA remarkably after 45 days, 3 months, and 6 months (p<0.05). After vasectomy, serum PAB also increased although not significantly. Serum estradiol and progesterone decreased remarkably in the TL group compared to the sham group (p<0.05).
Bilateral TL and vasectomy both increase the serum oxidative stress; however the imbalance after TL was very noticeable. As for the TL, the reduction of serum estrogen levels can be involved in this imbalance. Complications followed by TL or vasectomy could be due to increased levels of oxidants. Thus, prescribing antioxidants during and or after surgery may be a solution.
The current study was designed to investigate the actions of Anti-Müllerian Hormone (AMH) on primordial follicle assembly. Ovarian primordial follicles develop from the breakdown of oocyte nests during fetal development for the human and immediately after birth in rodents. AMH was found to inhibit primordial follicle assembly and decrease the initial primordial follicle pool size in a rat ovarian organ culture. The AMH expression was found to be primarily in the stromal tissue of the ovaries at this period of development, suggesting a stromal-epithelial cell interaction for primordial follicle assembly. AMH was found to promote alterations in the ovarian transcriptome during primordial follicle assembly with over 200 genes with altered expression. A gene network was identified suggesting a potential central role for the Fgf2/Nudt6 antisense transcript in the follicle assembly process. A number of signal transduction pathways are regulated by AMH actions on the ovarian transcriptome, in particular the transforming growth factor-beta (TGFß) signaling process. AMH is the first hormone/protein shown to have an inhibitory action on primordial follicle assembly. Due to the critical role of the primordial follicle pool size for female reproduction, elucidation of factors, such as AMH, that regulate the assembly process will provide insights into potential therapeutics to manipulate the pool size and female reproduction.
The antral follicle count (AFC) and anti-Müllerian hormone (AMH) both represent age-related follicular decline quite accurately, although long-term follow-up studies are still lacking. The best ovarian reserve test would need only a single, cycle-independent measurement to be representative.
To compare the inter- and intra-cycle stability of AFC and AMH, we used age-adjusted intra-class correlation coefficients (ICCs). To measure inter-cycle stability across a number of up to four menstrual cycles, we used data, prospectively collected for the purpose of an other study, from 77 regularly cycling, infertile women aged 24-40 years. AMH and AFC values were measured on cycle day 3. To study intra-cycle variability, we used data from a prospective cohort study of 44 regularly cycling volunteers, aged 25-46 years and measured AMH and assessed the AFC (2-10 mm) every 1-3 cycle days.
Between menstrual cycles, AFC and AMH varied between 0 and 25 follicles (median 10), and 0.3 and 27.1 ng/ml (median 4.64). The difference in age-adjusted ICC between AMH [ICC, 0.89 (95% CI, 0.84-0.94)] and AFC [ICC, 0.71 (95% CI, 0.63-0.77)] was 0.18 (95% CI, 0.12-0.27). For the intra-cycle variation, 0-43 antral follicles (median 7) were counted per volunteer. The difference in age-adjusted ICC between AMH [ICC, 0.87 (95% CI, 0.82-0.91)] and AFC [ICC, 0.69 (95% CI, 0.46-0.82)] was 0.18 (95% CI, 0.034-0.42).
Serum AMH demonstrated less individual intra- and inter-cycle variation than AFCs and may therefore be considered a more reliable and robust means of assessing ovarian reserve in subfertile women.
AMAC: Tubal sterilizasyon gunumuzde aile planlamasi yontemleri arasinda siklikla kullanilan ve uygulanan teknige gore komplikasyonlari degisen bir sterilizasyon yontemidir. Bu calismada, Pomeroy teknigi ve bipolar koterizasyonun over ve endometrium doku atrofisine etkisi ve apoptozisin bu olaydaki rolunun bu iki farkli teknigin karsilastirilarak incelenmesi amaclandi. MATERYAL-METOD: Otuz adet Wistar albino disi matur sican her biri 10 adet olmak uzere 3 gruba ayrildi. Birinci gruptaki sicanlara Pomeroy usulu ve 2. gruptaki sicanlara bilateral bipolar koterizasyonla tubal sterilizasyon yapildi. Kontrol grubundaki sicanlara ise sadece laparotomi yapildi. Iki ay sonra laparotomi ile butun sicanlarin bilateral over ve endometriyum dokulari cikartildi ve genomik DNA izolasyonu yapildi. DNA ornekleri marker esliginde agaroz jelde yurutuldu ve DNA profilleri Scion Image teknigi ile doku degredasyonlari acisindan karsilastirildi. BULGULAR: Agaroz jel elektroforezi ve Scion image teknigi ile Pomeroy, koter ve kontrol gruplarindaki over ve endometriyum dokularinin hicbirinde apoptizis saptanmadi. Pomeroy grubunda nekrozis ve intakt DNA saptanirken koter grubunda sadece nekrozis vardi. SONUC: Calismamizda disi ratlarda Pomeroy ve bipolar koterizasyon teknigi ile tubal sterilizasyon sonrasi over ve endometriyum dokularinda apoptozis gosterilemedi. Bununla birlikte bipolar koterizasyon ile karsilastirildiginda Pomeroy teknigi sonrasi dokuda daha fazla saglam doku tespit edildi. Bu calisma tubal sterilizasyon sonrasi over ve endometriyum dokusunda apoptotik degisikliklerin arastirildigi literaturdeki ilk calisma olup bu konuda daha genis, kontrollu calismalarin yapilmasi gerekmektedir.OBJECTIVE: Tubal sterilization is a common birth control method which the complication rates change according to the performed technique and methods. The aim of this study was to evaluate the effects of tubal sterilization techniques, Pomeroy and bilateral bipolar cautherization, on the apoptosis in the ovarian and endometrial tissue atrophy in rats. MATERIAL-METHOD: Thirty female Wistar Albino rats were enrolled in the study and divided into three groups (n=10). In the first group, rats underwent bilateral uterine horn ligation with Pomeroy method, in the second group, bilateral bipolar cauterization was applied, and only laparotomy was performed in the control group. Two months later, uterine horns and ovaries of the rats in all groups were excised. After genomic DNA isolation, DNA samples were run in agarose gel and the Scion images were compared with the DNA marker and control. RESULTS: There was no apoptosis in the ovarian and endometrial tissues in all groups detected by agarose gel electrophoresis and Scion image technique. In Pomeroy group, there were both necrosis and intact DNA in ovarian and endometrial tissues, while in cauterization group, there were only necrosis. CONCLUSIONS: In our study, there was no role of apoptosis in the atrophy of ovarian and endometrial tissues after tubal ligation by Pomeroy technique or bipolar cauterization in female rats. In Pomeroy technique, however, higher proportion of intact tissue was detected compared with bipolar cauterization. Further randomized controlled studies are needed to study the expression of atrophy and apoptosis.
Female sterilization by tubal ligation is a very common method of birth control. A relationship between tubal sterilization and subsequent development of menstrual disorders has been described in the literature but a biological mechanism explaining such an association has not yet been demonstrated. The aim of this study was to evaluate the influence of tubal ligation by the Pomeroy technique on ovarian and uterine artery blood flow using pre- and post-surgical Doppler assessments. We studied prospectively 20 patients undergoing laparotomy for tubal ligation. All patients had a Doppler blood flow assessment before and after surgery, conducted in the mid-follicular phase of their cycle. The pulsatility index (PI) of the right uterine artery ranged from 1.44 to 3.86 (mean 2. 23) when measured prior to surgery and from 1.36 to 2.85 (mean 2.13) when measured after surgery. In the left uterine artery, the PI ranged from 1.67 to 3.17 (mean 2.17) and from 1.69 to 2.88 (mean 2. 22) before and after surgery respectively. The difference was not statistically significant. The PI of the right ovarian artery ranged from 1.38 to 3.48 (mean 2.41) prior to surgery and from 1.48 to 3.23 (mean 2.29) after surgery. In the left ovarian artery, the PI ranged from 1.36 to 3.62 (mean 2.54) and from 1.85 to 4.00 (mean 2.61) before and after surgery respectively. Again, the difference was not statistically significant. Our results suggest that tubal sterilization performed by Pomeroy's technique does not induce immediate alterations in the vascular flow of either ovarian or uterine arteries.
We examined variations in human endometrial microvascular perfusion across one menstrual cycle in women who had undergone
tubal ligation and did not report unusual menstruation. Endometrial red blood cell flux was monitored by laser Doppler fluxmetry
via a fibreoptic probe atraumatically inserted transvaginally into the uterus of each of 13 conscious volunteers. The observations
obtained have been compared with those previously reported from a matched control group of women [B.J. Gannom et al., Hum. Reprod., 12, 132–139 (1997)]. Women who had undergone tubal occlusion for sterilization exhibited greater endometrial perfusion during
menstruation (cycle days 0–5), at the time of ovulation (cycle days 13–16) and in the late secretory phase (cycle days 23–28)
than occurred in controls. In addition, vasomotion in the study group was lower than that i.n controls in the study and late
secretory phase (cycle days 17–22 and 23–28). Tubal occlusion appeared to alter endometrial perfusion. It is possible that
the reported menstrual changes in women following tubal ligation are a consequence of altered endometrial perfusion; a possible
causative relationship is discussed.
Objective: Tubal sterilization, is a common birth control method which the complication rates change according to the performed technique and methods. The aim of this study was to evaluate the effects of tubal sterilization techniques, Pomeroy and bilateral bipolar cautherization, on the apoptosis in the ovarian and endometrial tissue atrophy in rats. Materials and Methods: Thirty female Wistar Albino rats were enrolled in the study and divided into three groups (n=10). In the first group, rats underwent bilateral uterine horn ligation with Pomeroy method, in the second group, bilateral bipolar cauterization was applied, and only laparotomy was performed in the control group. Two months later, uterine horns and ovaries of the rats in all groups were excised. After genomic DNA isolation, DNA samples were run in agarose gel and the Scion Images were compared with the DNA marker and control. Results: There was no apoptosis in the ovarian and endometrial tissues in all groups detected by agarose gel electrophoresis and Scion Image technique. In Pomeroy group, there were both necrosis and intact DNA in ovarian and endometrial tissues, while in cauterization group, there were only necrosis. Discussion: In our study, there was no role of apoptosis in the atrophy of ovarian and endometrial tissues after tubal ligation by Pomeroy technique or bipolar cauterization in female rats. In Pomeroy technique, however, higher proportion of intact tissue was detected compared with bipolar cauterization. Further randomized controlled studies are needed to study the expression of atrophy and apoptosis.
Zyklusstörungen sowie das vorzeitige Auftreten klimakterischer Symptome werden als Spätkomplikationen nach verschiedenen Eileitersterilisationstechniken diskutiert. Als Ursache für dieses als “post tubal ligation-syndrome” bezeichnete Krankheitsbild wird eine Störung der Ovarialfunktion angesehen. Die vorliegende Untersuchung soll zur Klärung der Frage beitragen, ob die Tubensterilisation mittels bipolarem Hochfrequenzstrom den Ablauf der Perimenopause beeinflussen kann. Untersucht wurden 109 Patientinnen, die im Zeitraum von 1980 bis 1984 an der Universitäts-Frauenklinik Köln mit Hilfe dieser Technik laparoskopisch sterilisiert worden waren. Als Vergleichskollektiv dienen 103 Probandinnen, bei denen zuvor weder eine Tubensterilisation noch eine Hysterektomie durchgeführt wurde. Das Alter der Frauen lag in beiden Untersuchungsgruppen zwischen 36 und 51 Jahren. In persönlichen Interviews wurden die Patientinnen beider Kollektive bezüglich des Auftretens von Zyklusstörungen, klimakterischer Symptome und Beginn der Menopause im Sinne einer Querschnittsuntersuchung befragt. Gleichzeitig erfolgten zur Beurteilung der endokrinologischen Situation Blutentnahmen zur Bestimmung von FSH, und 17-Beta-Östradiol. Die Ergebnisse der Untersuchungen waren wie folgt:
• Menstruationsstörungen, klimakterische Symptome treten nach Tubensterilisationen in der Perimenopause (bipolarer Elektrokoagulation) nicht häufiger auf als in einer gleichaltrigen Kontrollgruppe.
• Die hier untersuchten sterilisierten Patientinnen zeigen im Vergleich zu einem Kollektiv nicht operierter Frauen weder ein frühes Auftreten von Zyklusstörungen und ovariellen Ausfallerscheinungen im Sinne von klimakterischen Beschwerden noch ein vorzeitiges Eintreten der Menopause.
• Durch Hormonanalysen konnte festgestellt werden, daß bezüglich der endokrinologischen Parameter in der Perimenopause keine signifikanten Unterschiede zwischen beiden Kollektiven bestehen. Insbesondere konnte gezeigt werden, daß weder ein vorzeitiges Ansteigen von FSH noch ein frühes Abfallen der 17-Beta- Östradiolspiegel bei sterilisierten Patientinnen in der Perimenopause auftritt. Der Kreuzungspunkt zwi schen FSH und E2 (Kreuz des Klimakteriums) liegt in beiden Kollektiven bei 47 Jahren.
Objective:
The aim of the present study was to determine to what extent ovarian reserves are affected by ischemia-reperfusion injury, evaluating the number of growing follicles and the serum levels of the ovarian hormones.
Study design:
Thirty female fertile adult Wistar albino rats, weighing 200 to 220 g, were previously numbered to randomization, and then randomly divided into 3 equal groups (n = 10): sham, torsion, and detorsion groups. In torsion and detorsion groups, bilateral adnexal torsion (3-hour ischemia) was carried out. Bilateral adnexal detorsion (3-hour reperfusion) was performed in the detorsion group.
Results:
The mean number of preantral and small antral follicles in detorsion group were lower than those of the sham group (P < .01). After torsion, anti-Müllerian hormone (AMH), estradiol, and inhibin B levels decreased significantly compared to the preoperative and postoperative periods (P = .003, P = .032, and P = .014, respectively). In detorsion group, only AMH levels were found to decrease significantly following the 3-hour ischemia and 3-hour reperfusion (P < .05).
Conclusion:
After adnexal torsion, a significant decrease in ovarian reserve has been detected for the first time in this study. Additionally, the results of this study suggest that conservative surgery alone is insufficient to protect ovarian reserve.
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.
Background. To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.
Methods. Twenty-four female Wistar albino rats weighing 220–260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.
Results. We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).
Conclusion. Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.
To examine the effects of melatonin use in the unilateral Pomeroy method of tubal ligation on ovarian histology in rats.
Firat University Medical School, Obstetrics and Gynecology Department, Elaziğ.
Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase: G1 (n: 10): The abdomen was opened and closed. G2 (n: 10): The group where the abdomen was opened, and the Pomeroy method of tubal ligation was performed. G3 (n: 10): The group where the abdomen was opened, and Pomeroy method of tubal ligation was performed 15 min after 10 mg/kg/ip melatonin administration. Abdomens of all rats were opened six months later and left oophorectomy was performed. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylin eosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. An atretic follicle count was made. The corpus luteum and corpus albicans were counted, and the number of total corpuses were calculated. Regression of angiogenesis within the corpus luteum was examined. Presence of fibrosis on ovarian stroma was examined. An ordinal scale was formed for the regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 were considered significant.
The comparison between G1 and G3 showed that all values were similar (p > 0.05, Kruskal Wallis variance analysis). When G2 was compared with G1 and G3, regression of angiogenesis in the corpus luteum was found to be significantly lower (p < 0.05, Mann Whitney U test), while atretic follicle count and fibrosis were significantly higher in G2 (p < 0.05, Mann Whitney U test).
The Pomeroy method of tubal ligation reduces regression of angiogenesis in the corpus luteum, and increases atretic follicles and fibrosis development. Melatonin use restores these harmful effects. Melatonin can be used to refrain from this negative effect of the Pomeroy method of tubal ligation on the ovary.
The purpose of this study is to compare the effects of tubal sterilization on the ovarian reserve by means of hormonal and ultrasonographic evaluation during a cesarean section or when performed as a planned interval procedure.
Fifty women who had undergone tubal sterilization during a cesarean section (n=24) and by minilaparotomy as an elective procedure (n=26) were included in the study. Tubes were ligated with the Pomeroy technique in both groups. The women who had chosen to use barrier method or intrauterine device for contraception (n=30) constituted the control group. Among the women in the control group, two separate control groups were constituted (control 1 and control 2) who were age matched with the women in each study group. Hormone levels including antimüllerian hormone (AMH) and inhibin B and ultrasonographic evaluations were performed on the third day of the menstrual cycle 1 year after the tubal sterilization procedure.
Mean blood estradiol, follicle stimulating hormone and luteinizing hormone levels on the third day of the cycle postoperative 12 months after the surgical intervention did not show any significant differences in the groups with respect to their age-matched controls. There was no significant difference in terms of mean serum AMH and inhibin B levels between the groups and their age-matched controls. However, significantly higher postoperative levels of mean AMH levels were detected in the tubal sterilization during cesarean section group when compared with the minilaparotomy group, and significantly lower postoperative levels of mean inhibin B were detected in the elective tubal sterilization via minilaparotomy group when compared with the cesarean section group. Statistically significant differences were observed in terms of number of antral follicles and mean ovarian volumes being less in the elective tubal sterilization via minilaparotomy group when compared with age-matched controls.
Intraoperative cesarean section tubal sterilization seems to be a practical and safe method, and has less effect on the ovarian reserve when compared with planned tubal sterilization by minilaparotomy.
To examine the changes caused by tubal sterilization (TS) in ovarian hormone secretion and uterine and ovarian circulation.
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.
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.
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.
Female sterilisation is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated.
To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties, and women's and surgeons' views.
Originally MEDLINE and The Cochrane Controlled Trials Register were searched. For the 2010 update, searches of Popline, Lilacs, Pubmed and The Cochrane Controlled Trials Register were performed. Reference lists of identified trials were searched.
All randomised controlled trials comparing different techniques for tubal sterilisation, regardless of the route of Fallopian tube access or the method of anaesthesia.
Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes.
Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76). Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than those with the electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10). Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported. Pomeroy versus Filshie clip: In the only trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months. No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices.
Electrocoagulation was associated with less morbidity including post-operative pain when compared with the modified Pomeroy and tubal ring methods, despite the risk of burns to the small bowel. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.
The study was conducted to compare the effects of tubal sterilization through electrocoagulation and the application of mechanical clips on the ovarian reserve.
Eighty-eight patients in the reproductive period with the desire of tubal sterilization were included in the prospective, randomized study. The patients were divided into two groups by simple randomization as tubal sterilization through electrocoagulation group and the application of mechanical clips group. Day-3 serum follicle stimulating hormone, luteinizing hormone, estradiol, inhibin-B and antimüllerian hormone and Day-3 total ovarian volume measurements and anthral follicle counts of all patients in the preoperative and 10th postoperative months were compared both within and between the two groups.
A significant difference between the postoperative 10th-month Day-3 total ovarian volumes and anthral follicle counts was detected between the electrocoagulation and mechanical clips application groups.
Tubal sterilization by electrocoagulation is very likely to have an adverse effect on the ovarian reserve in the postoperative period.
To determine the effect of CO(2) pneumoperitoneum on the ovaries in an experimental pneumoperitoneum model.
Experimental controlled study.
University hospital.
Sixteen adult female conventional rabbits.
Group I (8 rabbits) was not subjected to intra-abdominal pressure (IAP). In group II (8 rabbits), IAP insufflation was performed at 12 mm Hg. In total, 60 minutes of pneumoperitoneum and 10 minutes of reperfusion were maintained. Ovarian blood flow (OBF) was studied using laser Doppler flowmetry. The time points of OBF measurements were as follows: OBFbaseline, 10 minutes before insufflation; OBF30min, 30 minutes after pneumoperitoneum; OBF60min, 60 minutes after pneumoperitoneum; and OBFreperfusion, 10 minutes after pneumoperitoneum desufflation. Mean OBF changes during CO(2) pneumoperitoneum (OBFmean) were also assessed.
Blood perfusion units, tissue malondialdehyde values, and histopathologic damage scores.
In group II, mean OBF values were significantly lower than in group I, especially for OBF30min, OBF60min, OBFreperfusion, and OBFmean. The mean tissue malondialdehyde value for group II was significantly higher than in the control group (104.48 +/- 20.07 nmol/g vs. 64.12 +/- 8.77 nmol/g, respectively). Compared with group I, in group II histologic specimens of the ovaries had higher scores for follicular cell degeneration, vascular congestion, hemorrhage, and inflammatory cell infiltration.
Pneumoperitoneum, even at normal IAP levels, leads to significant oxidative stress-induced biochemical and histologic damage to the ovaries.
It is estimated that 10% of women experience a rapid decline in their ovarian reserve from the early 30s. This is called 'early ovarian ageing'. With the development of the so-called 'ovarian reserve tests', it was hoped that it would be possible to assess each woman's ovarian biological age and screen for 'early ovarian ageing' in the general population. This review examines the progress that has been made in this area.
Almost the entire literature on ovarian reserve tests refers to women having IVF, rather than women in the general population. Recent systematic reviews have shown that the currently known 'ovarian reserve' tests are reasonably good at predicting the number of eggs that are collected following ovarian stimulation with gonadotrophins in the context of an IVF cycle. They show very poor correlation with live-birth rates. The reason is that they cannot directly assess oocyte quality.
Screening for 'early ovarian ageing' in the general population is desirable but still not possible. Therefore, postponing childbearing to the late 30s remains a risky gamble. Advice to individual women should be given by specialist reproductive endocrinologists, though home-testing is not advisable.
To evaluate the influence of laparoscopic sterilization by Falope-rings (Cabot Medical Corp., Langhorne, PA) or Filshie-clips (Femcare, Nottingham, United Kingdom) on menstrual pattern and ovulatory function.
A prospective, nonrandomized study of women sterilized by Falope-rings (n = 6) or Filshie-clips (n = 5). Menstrual charts were kept. Serum follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) were measured by means of radioimmunoassay in one cycle before and 3, 6, and 12 months after the sterilization. Blood samples were drawn on day -6, -2, 0, +6, +10 of the menstrual cycle, ovulation corresponding to day 0. The women sterilized by Filshie-clips had abdominal ultrasonography of the ovaries measuring the leading follicle on day -6, -2, 0, +6 of the menstrual cycle.
Twelve women, 25 to 38 years old, with regular menstrual cycles and no use of oral contraceptives or intrauterine contraceptive device at least 6 months before sterilization. One woman was excluded.
After the sterilization, all women reported unchanged menstrual pattern. The follicular rise in E2 unchanged, and FSH levels fell accordingly. Progesterone levels were ovulatory, but the midluteal P peak 3 months poststerilization was significantly decreased. Serial abdominal ultrasonography in women sterilized by Filshie-clips confirmed ovulation in all cycles except in one woman, who had an unruptured follicle in one cycle before and in the sixth cycle after sterilization.
Laparoscopic sterilization by Falope-rings or Filshie-clips does not seem to interfere with menstrual pattern or ovulatory function.
Surgical sterilization has become one of the most widely used methods of fertility regulation in the world. A common concern is the not yet clarified possible disturbance of the ovarian function resulting from the surgical procedure. A prospective study was carried out to contribute toward answering this question. Twenty subjects were enrolled in a longitudinal study of ovarian endocrine function before, and 2 and 6 months after, tubal ligation. The Pomeroy technique, which may compromise ovarian circulation, and the Uchida technique, which is free of this risk, were used randomly. Eight women who underwent to the Pomeroy technique and 9 who underwent the Uchida technique completed the protocol. Luteinizing hormone, follicle-stimulating hormone, estradiol, and progesterone were measured daily from days 10 through 18 of the cycle and every other day until the onset of the next menses. No change in any of the hormones studied was observed, with the exception of a significant increase in progesterone 2 months after tubal ligation by the Uchida technique.
Ovarian follicles (greater than or equal to 100 X 10(5) microns 3 or a mean diameter of greater than or equal to 275 microns) in adult rats were classified as non-atretic and atretic during the oestrous cycle and recorded in 5 volume classes. The atretic follicles were also categorized in several stages according to the progress of atresia. The degeneration of the entire granulosa wall until the induced changes in the oocyte took at least 24 h. Another 24 h elapsed before the oocyte became denuded. Therefore the % of atretic follicles, i.e. follicles in all stages of atresia, could not be used as indicator for the rate of atresia. The atretic portion in the follicle population greater than or equal to 100 X 10(5) microns 3 increased from early dioestrus 1 to early dioestrus 3, reached a plateau during dioestrus 3 and pro-oestrus, and declined at late oestrus to the level of early dioestrus 1. The sudden decrease in number of atretic follicles after late pro-oestrus was caused by the discard of many atretic follicles in the advanced stages due to various deformities as revealed by histological observation. By using the % of atretic follicles in the earliest stage as indicator of atretic rate, two waves of atresia were found affecting the population of antral follicles during their growth, the first at dioestrus 1 amounting to 15-20% and then at dioestrus 3, affecting 35% of the population. The present study also shows the extension of atresia in the various volume classes of follicles during the oestrous cycle. A pool of approximately 7 follicles in the smallest volume class was maintained after ovulation, grew further in the next cycle with a new cohort of 20 follicles, and seemed to provide the required number of follicles destined to ovulate. This suggests that the follicles that ovulate were already present at an antral stage in the preceding cycle and needed two cycles for their growth to ovulation.
Disturbances of menstrual cycle, as well as premature onset of climacterial symptoms, are discussed as late complications of diverse techniques of tubal sterilisation. A disturbance of the ovarian function is regarded as cause for the disorder known as "post-tubal ligation syndrome". This study should help to clarify if tubal sterilisation via bipolar high-frequency current influences the course of perimenopause. 109 patients were examined, who had been sterilised by this technique at the Department of Gynaecology and Obstetrics of the University of Cologne during the period 1980 to 1984. 103 patients formed the comparison group, all of whom had neither undergone tubal sterilisation nor hysterectomy. The age of these women of both groups ranged between 36 and 51. Patients of both groups were interviewed personally with regard to cycle irregularities, climacteric symptoms, and onset of menopause in the form of transverse examination. Simultaneously, blood tests were performed to establish the endocrinological status, and to examine FSH and 17-beta-oestradiol levels. Summing up, this study led to the following conclusions: 1. Menstrual disturbances, climacteric symptoms after tubal sterilisation during perimenopause do not occur more frequently than in a comparative group of the same age. 2. In comparison with a group of women with no surgical history, neither did cycle anomalies and ovarian deficiency symptoms in terms of climacteric complaints occur earlier, nor did early onset of menopause take place more often in this examined group of sterilised women. 3. Hormone analysis could not establish any significant differences between both groups in respect of endocrinological parameters in the perimenopause.(ABSTRACT TRUNCATED AT 250 WORDS)
To review the literature on menstrual and hormonal changes in women who under go tubal sterilization.
A systematic review through MEDLINE and a literature search identified more than 200 articles in the English literature from which the most relevant were selected for this review.
Many authors have investigated the sequelae of female sterilization. Increased premenstrual distress, heavier and more prolonged menstrual bleeding, and increased dysmenorrhea have been reported. However, failure to control for age, parity, obesity, previous contraceptive use, interval since sterilization, or type of sterilization may have affected study results. Most studies that have controlled for these important variables have not reported significant changes, except in women who undergo sterilization between 20 and 29 years of age.
Tubal sterilization is not associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women who undergo the procedure after age 30 years. There may be some increased risk for younger women, although they do not appear to undergo significant hormonal changes.
Recent studies suggest that ovarian volume and antral follicle numbers may be sensitive, specific, and early indicators of menopausal status. The accuracy of these markers, however, has not been compared directly to more traditional markers [age and follicle-stimulating hormone (FSH) levels]. Thus, the purpose of this study was to test whether ovarian volume and antral follicle counts are more sensitive and specific markers of menopausal status than age or FSH levels.
Premenopausal (n = 34) and postmenopausal (n = 25) women between 40 and 54 years old received a transvaginal ultrasound for determination of ovarian volume and antral follicle numbers, provided blood for measurement of FSH levels, and completed a questionnaire. FSH levels, age, ovarian volume, and antral follicle numbers were compared using t tests. Receiver operating characteristic curves were generated to evaluate the sensitivity and specificity of each marker.
Postmenopausal women had significantly higher FSH levels (p < or = 0.0001), smaller ovarian volumes (p < or = 0.002), and fewer antral follicles (p < or = 0.002) than premenopausal women. Ovarian volume and antral follicle numbers had similar sensitivity (27.3-100%) and specificity (3.4-92.9%) in indicating postmenopausal status as FSH levels and age.
These data suggest that ovarian volume and antral follicle numbers may be useful indicators of menopausal status.
To assess the effects of laparoscopic tubal sterilization with Hulka or Filshie clip on ovarian function and regulation of the hypothalamic-pituitary-ovarian axis.
Hormonal changes were evaluated in 33 women undergoing sterilization with Hulka (n = 16) or Filshie clips (n = 17). All participants were healthy, with regular menstrual cycles. The levels of estradiol, follicle-stimulating hormone, luteinizing hormone, sex hormone binding globulin, prolactin, testosterone and androstenedione were measured in one cycle immediately before and 3 and 12 months after sterilization on cycle days 3-7 and 20-24. Repeated measures analysis of variance, paired t test and nonparametric Friedman two-way analysis of variance were used for statistical analysis.
The follicular phase estradiol values increased after sterilization. The highest values were observed three months after the procedure (204.8 +/- 119.1 pmol/L vs. 170.3 +/- 111.7 pmol/L) (P = .0407). The values declined to the presterilization level by 12 months (150.3 +/- 71.3 pmol/L). The luteal phase estradiol values did not change significantly. No change in any of the other hormones studied took place, with the exception of a slight increase in follicular phase luteinizing hormone levels (4.4 +/- 1.4 U/L in the first cycle, 5.1 +/- 1.3 U/L in the second cycle and 5.2 +/- 1.8 U/L in the third cycle) (P = .0553).
Laparoscopic tubal sterilization increases follicular phase estradiol levels, but the change seems to be only temporary.
This study was conducted to study poststerilization menstrual changes. For this purpose, 60 rats were divided into 2 groups. In the first group, rats underwent bilateral uterine horn ligation with Pomeroy method, and one ovary of each rat was excised and weighed. The other ligated ovary was left intact. In the second group, only unilateral oophorectomy was performed. Histopathological studies revealed the presence of primary, secondary, and tertiary follicles in the ovaries of all the rats at the beginning of the study. Such follicles were found in 20 of the 22 rats in the first group and 23 of the 26 rats in the second group at the end of the study. Poststerilization ovarian weight remained unchanged in both groups. There was no difference in terms of histologic examination between pre- and post-ligation. These findings suggest that tubal ligation in the rats performed using surgical method does not cause any alteration in the ovarian morphology.
To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.
Twenty-four female Wistar albino rats weighing 220-260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.
We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).
Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.
Tubal ligation may reduce the ovarian blood flow and lead to tissue damage to the ovary. If so, this may also result in a significant decrease of the total follicular pool. We performed a long-term evaluation of ovarian reserve and function after tubal sterilization in a longitudinal prospective comparison cohort.
In an university tertiary-care center, 26 women undergoing laparoscopic tubal sterilization with the use of bipolar coagulation, and 26 matched control subjects underwent measurement of follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, and inhibin on menstrual cycle day 3 before (baseline) and at 6, 12, 18, 24, and 60 months after the sterilization for ovarian reserve evaluation. At baseline and 12 and 24 months after tubal ligation, women who underwent sterilization were sampled every other day across an entire menstrual cycle for follicle-stimulating hormone, luteinizing hormone, 17beta-estradiol, inhibin, and progesterone determination to evaluate ovarian function.
No significant changes were observed either within or between groups for any parameter, despite the fact that a 45% and 30% increase in follicle-stimulating hormone concentration from baseline to the 60-month control was detected in tubal sterilization and control groups of women, respectively. No significant changes were observed in the mean area under the curve of follicle-stimulating hormone, luteinizing hormone, estradiol, inhibin, and progesterone per menstrual cycle at baseline and 12 and 24 months after sterilization.
This 5-year follow-up study suggests that there is neither an accelerated decline of ovarian follicular reserve nor ovarian dysfunction after tubal sterilization by electrocoagulation.
Our aim was to investigate the changes in menstrual pattern, ovarian reserve and presence of dysmenorrhea and ovulation after tubal ligation via bipolar electrocautery.
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.
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).
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.
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.
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.
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.
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.
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.
Doppler colour flow analysis of uterine and ovarian arteries prior to and after surgery for tubal sterilization: a prospective study.
- Geber S.
- Cactono J.P.J.