Impact of salpingectomy on ovarian response to hormonal stimulation in in vitro fertilization (IVF) cycles

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BACKGROUND: The coagulation-section of the mesosalpinx during the salpingectomy can lead to injuries on the ovarian vascularization, and thus to the ovarian response to hormonal stimulation. Does salpingectomy affect negatively the follicles recruitment in in vitro fertilization (IVF) cycles? We conducted a monocentric retrospective case-control study including all patients undergoing IVF cycle with a history of unilateral salpingectomy for hydrosalpinx (HSX) or ectopic pregnancy (EP) (Group S), and each of them was matched to two controls (Group C) treated in the same month, according to their: age, AMH level, and BMI. The difference in follicle recruitment the day of trigger between the two ovaries of each patient was calculated. The primary endpoint was the difference between the two groups in the total number of follicles with a diameter ≥ 13 mm. Secondary endpoints were the difference between groups regarding the number of (1) mature follicles (diameter ≥ 16 mm) and intermediate follicles [13.0-15.5 mm]; (2) cycle cancellation rate; and (3) total number of oocytes and mature oocytes retrieved. The same comparisons were also carried out on subgroups according to the indication for salpingectomy (HSX or EP). RESULTS: 114 and 228 patients were included in Groups S and C, respectively. Compared to Group C, Group S patients showed a greater difference between ovaries in the total number of follicles recruited (0.76 ± 3.95 vs. -0.18 ± 3.37, p = 0.002) and in the number of mature follicles (0.51 ± 2.91 vs. -0.14 ± 2.85, p = 0.05). No significant differences were observed for the number of intermediate follicles, or the total number of oocytes or mature oocytes retrieved. However, the cycle cancellation rate was significantly higher in Group S (13.2% vs. 3.1%, p < 0.001). Subgroup analysis revealed no significant differences between each of the Group S subgroups (HSX and EP) regarding follicular recruitment. Nevertheless, both subgroups had significantly more cancelled cycles compared with their respective controls (HSX: 12.5% vs. 4.4%, p < 0.001; EP: 8.8% vs. 1.8%, p = 0.004). CONCLUSION: Salpingectomy has a negative impact on follicles recruitement in IVF cycles. This risk must be taken into consideration when scheduling this surgery.

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