Surgical methods for tubal pregnancy - Effects on ovarian response to controlled stimulation during IVF

Abstract

Introduction. Tubal pregnancy is often treated by surgery: salpingotomy or salpingectomy. Concern has been raised regarding the risk of compromising the vascular and nervous supply to the ovary, following salpingectomy. The aim of this study was to investigate whether the ovarian response to controlled ovarian stimulation for in vitro fertilization (IVF) is reduced after salpingectomy in comparison with salpingotomy, among women undergoing IVF subsequent to surgical treatment of tubal pregnancy. Material and methods. This retrospective cohort study included 153 women who had undergone IVF after surgery for ectopic tubal pregnancy. Women treated by either salpingectomy or salpingotomy constituted the two groups. Potential confounders (age, body mass index, smoking, stimulation dosage of gonadotrophin and reason for IVF) were included in multivariable regression analyses. The primary outcome was number of retrieved oocytes. The secondary outcomes were clinical pregnancy and live birth rates. Results. A total of 118 women had undergone unilateral salpingectomy and 35 women had undergone unilateral salpingotomy. The mean number of oocytes at aspiration in the subsequent IVF cycle was 11.8 (salpingectomy group) and 11.7 (salpingotomy group). A linear regression analysis showed no effect of treatment type on aspirated oocytes [β = -0.11, 95% confidence interval -2.27, 2.04 (p = 0.92)]. Adjustment for potential confounders did not alter the result. Conclusion. Among women undergoing IVF after surgery for tubal pregnancy, the ovarian response was not influenced by the surgical method. Our results do not support the theory that salpingectomy, compared with salpingotomy, impairs ovarian reserve measured as number of oocytes retrieved during subsequent IVF treatment.