Effect of salpingectomy on ovarian response to hyperstimulation during in vitro fertilization: a meta-analysis

Meta-analysis involving 25 studies demonstrated that salpingectomy impairs ovarian response to hyperstimulation during in vitro fertilization, thereby increasing the total dose of gonadotropins and reducing the number of oocytes retrieved.

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Volume 106, Issue 2, Pages 322-329

Authors:

Minghui Fan, M.D., Lin Ma, M.D., Ph.D.

Abstract:

Objective

To compare ovarian response to hyperstimulation during IVF between patients who did and did not undergo salpingectomy.

Design

Meta-analysis.

Setting

University-affiliated teaching hospital.

Patient(s)

Patients undergoing IVF who did and did not undergo salpingectomy.

Intervention(s)

None.

Main Outcome Measure(s)

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.

Result(s)

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]; I2 = 30%) and bilateral salpingectomy (IV [95% CI] 0.23 [0.09, 0.37]; I2 = 36%). The number of oocytes retrieved decreased significantly after unilateral salpingectomy (IV [95% CI] −0.17 [−0.27, −0.06]; I2 = 31%) and bilateral salpingectomy (IV [95% CI] −0.20 [−0.32, −0.08]; I2 = 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]; I2 = 48%). Finally, bilateral salpingectomy may lead to an increase in the FSH level (IV [95% CI] 0.39 [0.20, 0.59]; I2 = 0%). Heterogeneity moderators were identified by performing subgroup and sensitivity analyses. No evidence of publication bias was observed.

Conclusion(s)

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.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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