Effects Of Trans-laparoscopic Management Of Hydrosalpinx On Ovarian Reserve

Objective: Previous studies had proved that hydrosalpinx significantly has negative effects on the outcome of IVF and ovarian function. Therefore, it is nessessary to treat hydrosalpinx before IVF/ICSI.. Trans-laparoscopy treatment of hydrosalpinx is the most commonly used clinical method .Due to the different operations of various laparoscopy methods, until now, whether the operation itself has negative influence on ovarian function is controversial. So in this study, we investigated the effects of different kinds of laparoscopic managements of hydrosalpinx on ovarian reservation and analyze the possible mechanisms.Methods: According to the selecting criterion, we choose 111 hydrosalpinx patients who were treated by laparoscopy in Tongji hospital from March 2009 to November 2009. This is a prospective study, including 48 cases with pure salpingostomy (group A), 33 cases with proximal tubal division and distal salpingostomy (group B) and 30 cases with salpingectomy (group C). Other 20 women undergoing Laparoscopic with unexplained infertility were defined as control group (group D). First of all, we compared the ovarian reserve between hydrosalpinx group(including group A,B,C)and control group before operation, and then, we compared the preoperative ovarian reserve and postoperarive ovarian reserveof each group. The basal level of serum FSH,LH,E2 was detected by immunochemiluminometric assays ; the ovary volume, the number of all antral follicles and small antral follicles (between 2 and 6 millimeters),the resistant index(RI)of ovarian artery were measured by color doppler ultrasonography(Aloka SSD-3500)on the third day of menstrual cycle.Results:①T here were significant differences between hydrosalpinx group and control group before operation in basic FSH,E2,AFC,small antral follicles and RI.②Three months after operation, the number of small antral follicles (between 2 and 6 millimeters) in the group A, B and C were more than preoperation(P<0.05); RI of ovary artery was higher than preoperation in group B(P<0.05). There was no significant difference between preoperation and postoperation in the group D.③Before operation, the pationts of group A, B and C had similar ovarian reserve (P > 0.05). Postoperative RI of group A,B and C was significant difference compared with each other (P < 0.05).Conclusion: Hydrosalpinx can impair ovarian reserve function; three kinds of clinical laparoscopic managements mentioned above can improve ovarian reserves. The proximal tubal division and distal salpingostomy of hydrosalpinx may be the most conducive to improve the function of ovarian reserves.