title: Impact of tubal ligation on ovarian reserve as measured by anti-Müllerian hormone levels: a prospective cohort study.
abstract: BACKGROUND
  Tubal ligation (TL) is considered a very efficient contraceptive method. However, some patients complain of a variety of postoperative symptoms. The objective of this study was to investigate whether ovarian reserve may change after tubal ligation.
  
  
  METHODS
  This was a prospective cohort study of 80 fertile women who underwent TL. Ovarian reserve was evaluated by measuring pre- and postoperative (1 year after surgery) serum anti-Müllerian hormone (AMH) levels and transvaginal antral follicular count (AFC). Potential confounding factors were age, body mass index (BMI), smoking, surgical technique and prior contraceptive methods. The Wilcoxon test was used to compare pre- and postoperative (12 months) AMH and AFC, and simple and multiple linear regression were used to evaluate confounding factors.
  
  
  RESULTS
  Fifty-two patients completed the study protocol. The median AMH level was 1.43 ng/mL (interquartile range 0.63-2.62) preoperatively and 1.30 ng/mL (interquartile range 0.53-2.85) after 12 months (p=.23). The mean AFC was 8.0 (interquartile range 5.0-14.0) and 11.0 (interquartile range 7.0-15.0) before and after TL, respectively (p=.12). These differences were not statistically significant. Use of a hormonal contraceptive method prior to TL was significantly associated with a postoperative increase in AMH.
  
  
  CONCLUSIONS
  This study suggests that ovarian reserve is not altered by TL.
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Human Reproduction Clinic, Hospital Moinhos de Vento, Porto Alegre, Brazil. Electronic address: alberw@hotmail.com.
authors.forename: Ana Luiza Berwanger da
authors.initials: AL
authors.lastname: Silva
authors.forename: Camila da
authors.initials: Cd
authors.lastname: Ré
authors.forename: Cristine
authors.initials: C
authors.lastname: Dietrich
authors.forename: Isabela Piva
authors.initials: IP
authors.lastname: Fuhrmeister
authors.forename: Anita
authors.initials: A
authors.lastname: Pimentel
authors.forename: Helena Von Eye
authors.initials: HV
authors.lastname: Corleta
mesh_terms: D000328:Adult; D054304:Anti-Mullerian Hormone / Q000097:blood*; D002452:Cell Count; D005260:Female; D006801:Humans; D006080:Ovarian Follicle / Q000166:cytology* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013246:Sterilization, Tubal; D014463:Ultrasonography
chemical_list: D054304:Anti-Mullerian Hormone
keywords: Anti-Müllerian hormone; Hormonal contraceptives; Ovarian reserve; Tubal ligation