Effect of salpingectomy on ovarian response to hyperstimulation during in vitro fertilization: a meta-analysis.
OBJECTIVE
To compare ovarian response to hyperstimulation during IVF between patients who did and did not undergo salpingectomy.


METHODS
Meta-analysis.


METHODS
University-affiliated teaching hospital.


METHODS
Patients undergoing IVF who did and did not undergo salpingectomy.


METHODS
None.


METHODS
The total dose of gonadotropin, duration of hyperstimulation, E level on the day of hCG injection, number of oocytes retrieved, and basal FSH level were evaluated because these reflect ovarian response.


RESULTS
Twenty-five studies were identified through searches conducted on PubMed, Cochrane Libraries, Ovid, Web of Science, Science Direct, China National Knowledge Infrastructure, and Wanfang Database through October 2015. The 25 studies included 1,935 patients who underwent salpingectomy and 2,893 who did not. Fixed-effects and random-effects models were used to calculate the overall combined risk estimates. The results of the meta-analysis suggest that salpingectomy impairs ovarian response to hyperstimulation. The total dose of gonadotropin was significantly increased after combined salpingectomy (inverse variance [IV] 0.10 [95% confidence interval (CI) 0.03, 0.16]; I(2) = 30%) and bilateral salpingectomy (IV [95% CI] 0.23 [0.09, 0.37]; I(2) = 36%). The number of oocytes retrieved decreased significantly after unilateral salpingectomy (IV [95% CI] -0.17 [-0.27, -0.06]; I(2) = 31%) and bilateral salpingectomy (IV [95% CI] -0.20 [-0.32, -0.08]; I(2) = 48%). In addition, a statistically significant reduction was found between the number of oocytes retrieved from the ipsilateral and contralateral ovary (IV [95% CI] 0.25 [-0.40, -0.10]; I(2) = 48%). Finally, bilateral salpingectomy may lead to an increase in the FSH level (IV [95% CI] 0.39 [0.20, 0.59]; I(2) = 0%). Heterogeneity moderators were identified by performing subgroup and sensitivity analyses. No evidence of publication bias was observed.


CONCLUSIONS
This meta-analysis indicated that salpingectomy may impair ovarian response to hyperstimulation during IVF. Further high-quality research is needed to confirm our findings and to develop therapeutic methods that are alternatives to salpingectomy for maternal well-being.
Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.
Minghui
M
Fan
Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China. Electronic address: malin8@mail.sysu.edu.cn.
Lin
L
Ma
D005260:Female; D005298:Fertility / Q000187:drug effects*; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D054315:Oocyte Retrieval; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors; D058994:Salpingectomy / Q000009:adverse effects*; D016896:Treatment Outcome
D005300:Fertility Agents, Female
In vitro fertilization; meta-analysis; ovarian response; salpingectomy