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GYNECOLOGY

A retrospective analysis of the effect ofsalpingectomy on serum antiMullerian

hormone level and ovarian reserveXu-ping Ye, BS; Yue-zhou Yang, MS; Xiao-xi Sun, MD

OBJECTIVE:To determine whether previous salpingectomy is asso-

ciated with serum antiMullerian hormone (AMH) level and ovarian

reserve in women under 40 years presenting for in vitro fertilization

and embryo transfer.

STUDY DESIGN: We retrospectively compared serum AMH levels

measured on the ovulation induction initiation day in patients with

unilateral salpingectomy, bilateral salpingectomy, and no tubal sur-

gery, and examined the relationship with length of time after surgery

and in vitro fertilization and embryo transfer parameters.

RESULTS:A total of 198 women were included; 83 received unilateral

salpingectomy, 41 bilateral salpingectomy, and 74 no tubal surgery.

The baseline characteristics of the groups were similar. The mean

AMH level was significantly higher in women without tubal surgery as

compared with those with bilateral salpingectomy (183.48 vs

127.11 fmol/mL; P .037). The mean follicle stimulation hormone

level was significantly lower in women without surgery as compared

with those with bilateral salpingectomy (7.85 vs 9.13 mIU/mL;

P .048). No significant differences in duration of gonadotropin

therapy, amount of gonadotropin used, estradiol level on the human

chorionic gonadotropin injection day, thickness of the endometrium,

number of oocytes retrieved, number of 2-pronuclei, viable embryos,

and good quality embryos were found between the 3 groups. AMH

level was not correlated with the number of oocytes or age in women

that had undergone unilateral or bilateral salpingectomy.

CONCLUSION:Salpingectomy is associated with decreased AMH level

and increased follicle stimulation hormone in women seeking in vitro

fertilization, though AMH level is not correlated with the number of

oocytes retrieved in patients that have undergone unilateral or bilateral

salpingectomy. These results suggest that salpingectomy is associ-

ated with decreased ovarian reserve.

Key words:AMH, antiMullerian hormone, IVF-ET, ovarian reserve,

salpingectomy

Cite this article as: Ye X, Yang Y, Sun X. A retrospective analysis of the effect of salpingectomy on serum antiMullerian hormone level and ovarian reserve. Am J Obstet

Gynecol 2015;212:53.e1-10.

I t is generally recognized that removalof a hydrosalpinx can increase theimplantation rate of in vitro fertilization

and embryo transfer (IVF-ET).1,2 How-ever, whether salpingectomy affects

ovarian reserve is uncertain, with some

studies suggesting that salpingectomydeceases ovarian reserve,3-5 and other

studies indicating that it has no effecton ovarian reserve.6-9 Various studies,

however, have used different measures of

ovarian reserve including the duration of

gonadotropin stimulation, amount ofgonadotropin used, number of follicles,

number of oocytes retrieved, fertilizationrate, implantation rate, clinical preg-

nancy rate, live birth rate, and anti-Mllerian hormone (AMH) level.

AMH is a glycoprotein dimer secreted

primarily by granulocytes of preantralfollicles and small antral follicles.10

AMH levels are relatively constant thr-oughout the menstrual cycle,11 correlate

with the number of follicles and ovarian

reserve,12-14 and are predictive of bothover and poor response to controlled

ovarian stimulation.15,16 For these rea-

sons, AMH levels can be used to evalu-ate changes in ovarian reserve after

salpingectomy.The purpose of this study was to

determine whether previous salpingec-

tomy is associated with serum AMH leveland ovarian reserve in women under

40 years of age presenting for IVF-ET.

PATIENTS ANDMETHODSPatients

IVF-ET patients who visited Shanghai

Ji Ai Genetics and IVF Institute andthe Obstetrics and Gynecology Hospital

of Fudan University between October

2012 and May 2013 were eligible for in-clusion in this study. Inclusion criteria

were age

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centrifuged for 5 minutes, and the su-pernatant serum was collected and

stored at 20 C. Before testing, the

sample was thawed and vortexed.Estradiol (E2), progesterone, luteinizing

hormone, and follicle stimulating hor-

mone (FSH) levels were measured with aBeckman Acoulter Access automated

chemiluminescence immunoassayanalyzer with reagent kits from Beckman

(BeckmaneCoulter Inc., Brea, CA).Testing was performed according to the

manufacturers instructions. AMH levels

were measured by an enzyme linkedimmunosorbent assay using a Bio-Rad

iMark microplate absorbance readerwith reagent kits from Bio-Rad (Bio-Rad

Laboratories Inc, Hercules, CA). Per the

manufacturer, the interassay coef

cientof variability is 10%, and the intraassay

coefcient of variability is 15%.

Determination of antral follicle count

On the third day of menstruation (IVF-ET initiation day), transvaginal sonog-

raphy was performed to evaluate the

status of the uterus and ovaries, measurethe ovarian size, and determine the

antral follicle count (AFC). A PhilipsHDII ultrasonography machine (Philips,

Amsterdam, the Netherlands) was usedat a probe frequency of 3w7 MHz.

Ovulation induction and IVF protocols

Short controlled ovarian

hyperstimulation protocolDaily subcutaneous triptorelin 0.1 mg

was given from the third day of men-

struation to the day of human chorionicgonadotropin (hCG) injection. Gonad-

otropin 75-300 IU/day by injection was

started on the fourth day, and adjusted

according to ultrasonography resultsand serum E2level.

Minimal ovarian stimulation protocol

Oral clomiphene 50-100 mg was given

from the third day of menstruation tothe day of hCG injection. Daily humanmenopausal gonadotropin 75-150 IU

by injection was given starting on the

fth day of clomiphene. When 1 domi-nant follicle reached 18 mm in diameter,

or 2 follicles reached 16 mm in diameter,

intramuscular injection of hCG 3000-10000 IU was given. Oocytes were

retrieved under transvaginal ultraso-nography guidance within 34-36 hours

of hCG injection.

IVFQuality sperm was selected for IVF/

intracytoplasmic sperm injection. Eigh-teen hours after fertilization, the oocyte

was observed to conrm the formation

of a pronucleus. After 3 days of culture,the embryo was observed and scored

under a microscope.

Evaluation of embryo qualityEmbryos of class I-III were considered

viable. Goodquality embryos were denedas having a normal cleavage rate, even-

sized blastomeres, and fragments .05). The mean AMH level was signi-

cantly higher in women without tubalsurgery as compared with those with

bilateral salpingectomy (183.48 vs

127.11 fmol/mL, P .037). The meanFSH level was signicantly lower in

women without surgery as comparedwith those with bilateral salpingectomy

(7.85 vs 9.13 mIU/mL, P .048). Themean duration of primary infertility was

signicantly higher in women without

surgery as compared with those withunilateral and bilateral salpingectomy

(3.6 vs 0.31 and 0.82 years, P < .001).The reasons for having surgery were

signicantly different between the uni-

lateral and bilateral salpingectomygroups. The percentage of patients with

an ectopic pregnancy was greater in the

unilateral salpingectomy group, and thepercentage of patients with a hydro-

salpinx was greater in the bilateral sal-pingectomy group (Table 1).

The comparisons of treatment-related

factors between the three groups areshown inTable 2. No signicant differ-

ences in duration of gonadotropin ther-

apy, amount of gonadotropin used,

E2 level on the hCG injection day,thickness of the endometrium, numberof oocytes retrieved, number of 2-pro-

nuclear zygote (2PN), viable embryos,and good quality embryos were found

between the 3 groups (all,P> .05).

Correlation between AMH level

and time after surgery and numberof oocytes

The correlations between AMH level and

time after surgery, number of oocytes,

and age for women with a unilateralsalpingectomy are shown in Figure 1,

and the correlations for women with abilateral salpingectomy are shown in

Figure 2. For women with a unilateral

salpingectomy, a signicant linear cor-relation was found between AMH leveland time after surgery (r 0.399, P