title: Effect of salpingectomy, ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve.
abstract: Pelvic surgery can affect ovarian reserve, but estimates of the potential effect of different surgical procedures are lacking. This study examines the markers of ovarian reserve after different procedures in order to help the provision of informed consent before surgery. Anti-Müllerian hormone (AMH), antral follicle count (AFC) and follicle-stimulating hormone (FSH) of women with a history of salpingectomy, ovarian cystectomy or unilateral salpingo-oophorectomy were compared to those without history of surgery using cross-sectional data adjusting for patient and clinical factors in multivariable regression model. There were 138 women who had had salpingectomy, 36 unilateral salpingo-oopherectomy, 41 cystectomy for ovarian cysts that are other than endometrioma and 40 women had had excision of endometrioma. There was no significant difference in AMH (9 %;p= 0.33), AFC (-2 %;p= 0.59) or FSH (-14 %;p= 0.21) in women with a history of salpingectomy compared to women without surgery. Women with a history of unilateral salpingo-oophorectomy were found to have significantly lower AMH (-54 %;p= 0.001). These women also had lower AFC (-28 %;p= 0.34) and higher FSH (14 %;p= 0.06), the effect of which did not reach statistical significance. The study did not find any significant associations between a history of cystectomy, for disease other than endometrioma and AMH (7 %;p= 0.62), AFC (13 %;p= 0.18) or FSH. (11 %;p= 0.16). Women with a history of cystectomy for ovarian endometrioma had 66 % lower AMH (p= 0.002). Surgery for endometrioma did not significantly affect AFC (14 %;p= 0.22) or FSH (10 %;p= 0.28). Salpingo-oopherectomy and cystectomy for endometrioma cause a significant reduction in AMH levels. Neither salpingectomy nor cystectomy for cysts other than endometrioma has appreciable effects on ovarian reserve.
authors.affiliation: Department of Reproductive Medicine, St Mary's Hospital, Manchester Academic Health Science Centre (MAHSC), Central Manchester University Hospital NHS Foundation Trust, Manchester, M13 0JH UK ; Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, AB25 2ZN UK.
authors.forename: Oybek
authors.initials: O
authors.lastname: Rustamov
authors.affiliation: Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, S10 2JF UK ; Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Krishnan
authors.affiliation: Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: Department of Reproductive Medicine, St Mary's Hospital, Manchester Academic Health Science Centre (MAHSC), Central Manchester University Hospital NHS Foundation Trust, Manchester, M13 0JH UK.
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Fitzgerald
keywords: AFC; AMH; FSH; Ovarian cystectomy; Ovarian reserve; Salpingectomy; Salpingo-oopherectomy