Effect of Salpingectomy Versus Fallopian Tubes Cauterization for Management of Hydrosalpinx on the Future Females’ Ovarian Reserve

Background: Injury to the distal end of the fallopian tube (ampulla), and its fimbria, causes the end of the tube to close. Glands within the tube produce a watery fluid that collects within the tube, producing hydrosalpinx which should be blocked surgically before starting in vitro fertilization by salpingectomy, clumping or cauterization in two sites that may influence the vascularity of the adjacent ovarian tissue affecting the IVF results later on.

Aim of Study: To compare between the effect of salpingectomy and cauterization of the fallopian tubes on the ovarian reserve and ovarian vascularity in females undergoing tubal surgeries for hydrosalpix.

Subjects Materials and Method:The present study was done on 30 infertile females with history of primary or secondary infertility who were diagnosed as having bilateral or unilateral hydrosalpinx by hystrosalpingogram (HSG). These females were divided into two groups, the first group (n=15) were subjected to laparoscopic tubal ligation using cauterization in two sites for each tube, while the other group (n=15) were undergone more aggressive method which is salpingectomy (severed and sealed).

An assessment of their antral follicle count (AFC), anti-Müllerian hormone (AMH) and calculating the ovarian artery pulsatility index (PI) and Doppler index of vascular resistance in the ovarian vessels (resistant index of stromal blood flow - RI) was done for all females before and after surgery.

Results: The results of age, AFC, AMH level, RI, and PI was recorded before and after doing their surgeries in both groups. The statistical analysis recorded no significant difference (p>0.05) in all these parameters before and after subjecting to surgeries, but when these parameters were compared within each group only resistance index showed significant difference (p<0.05) in the group underwent tubal cauterization while in the other group who underwent salpingectomy a significant difference (p<0.05) was recorded in AFC and highly significant difference (p<0.01) in AMH level.

Conclusions:The negative effect of salpingectomy on ovarian reserve is more than that of tubal cauterization.