A total of 80 patients were studied. Reasons for having a surgery in the tubal factor group with surgery included salpingectomy following the treatment of ectopic pregnancy or hydrosalpinx, salpingectomy after ectopic pregnancy treatment, fallopian tube catheterization, and tubal ligation (TL).
Table 1. Profiles of patients
||Duration of infertility
||Serum LH (IU/L)
||Serum FSH (IU/L)
||Serum AMH (ng/ml)
There was no difference between the studied groups in terms of demographic characteristics, such as the age of patients and their husbands, body mass index, AMH, FSH, AFC, oocyte, gonadotropin time, gonadotropin count, E2, viable embryos, and good embryos. However, LH in the unexplained infertility group had a significant difference with the tubal factor group with surgery (P=0.0048) and without surgery (P=0.0674).
Table 2. Treatment-related factors of patients
||E2 on the hCG injection day (Pg/ml)
||Endometrial thickness (mm)
The study groups were not significantly different in terms of treatment-related factors, including ET, oocyte removed, gonadotropin time, gonadotropin count, E2, viable embryos, and good embryos. Results showed that 33 patients had a chemical pregnancy and 25 patients had clinical pregnancies. There were two pregnancies in the FET cycle.
According to the Spearman correlation coefficient, there was a strong negative correlation between age and AMH (P<0.001). Furthermore, significant correlations were revealed between AMH and FSH (P=0.02), AMH and AFC (P=0.0013), AMH and gonadotropin time (P=0.0016), AMH and gonadotropin count (P<0.001), AMH and E2 (P=0.0257), LH and FSH (P=0.0092), LH and oocyte (P=0.0108), AFC and oocyte (P=0.0431), AFC and gonadotropin count (P<0.001), E2 and oocyte (P<0.001), viable embryos and oocyte (P<0.001), good embryos and oocyte (P<0.001), gonadotropin time and gonadotropin count (P<0.001), gonadotropin time and E2 (P<0.001), viable embryos and good embryos (P<0.001), gonadotropin time and gonadotropin count (P<0.001), gonadotropin time and gonadotropin count (P<0.001), and viable embryos and E2 (P=0.0047). The results of Pearson correlation demonstrated that the studied groups were not significantly correlated with chemical pregnancy (P=0.9514) and clinical pregnancy (P=0.5052).
Figure 1. Correlation between AMH and the age of patients in the three groups
Figure 2. Correlation between AMH and gonadotropin time of the patients in the three groups
Figure 3. Correlation between AMH and AFC of the patients in the three groups
Figure 4 . Correlation between AMH and FSH of the patients in the three groups
Surgical trauma may alter the natural anatomical relation between ovaries and fallopian tubes. Tubal surgery is hypothesized to reduce ovarian reserve due to the anatomical relationship between the ovarian arteries and nerves and fallopian tubes. There is no consensus on whether or not salpingectomy affects ovarian reserve. Some authors believe that salpingectomy has no effects (4-7), while others suggest that it diminishes ovarian reserve (8-10).
The results of the current study showed that the fertility rate in the three groups, in terms of both chemical pregnancy and clinical pregnancy, was not statistically significant. These rates in people who had a tubal factor with surgery were similar to those of the unexplained infertility group and the group who had a tubal factor without surgery. In this study, the treatment-related factors, including gonadotropin time, gonadotropin count, E2 on the hCG injection day, endometrial thickness, the number of oocytes obtained, the number of viable embryos, and the number of good quality embryos were not significantly different between the three studied groups.
We observed a statistically significant correlation between AMH and FSH. Moreover, AMH, AFC, AMH, gonadotropin time and count, AMH, and E2 were significantly correlated. However, no significant correlation was found between AMH and some other factors, such as endometrial thickness and the number of obtained oocytes. Another study results like present study indicated that there were no significant correlation in the gonadotropin time and count and E2 on the injection day, endometrial thickness, the number of oocytes removed, viable embryos, and good quality embryos (9).
Lin et al. (6) examined 251 women in 288 cycles in the two groups of laparoscopic salpingectomy and non-salpingectomy, which included primary bilateral TL, primary tuboplasty, or proximal ovarian tube obstruction. They did not find any difference in replacement rate, clinical pregnancy, and live birth. The results of the current study were in line with the mentioned study (6). However, the present study, TL and tuboplasty were considered as tubal manipulations.
Some authors reported that salpingectomy does not affect ovarian reserve or ovarian response to gonadotropin stimulation, while some have acknowledged the effect of this parameter. Lass et al. (28) revealed that in IVF patients who underwent a salpingectomy, the follicles grew less on the operated side than on the other side resulting in significantly fewer oocytes. However, a comparison of the total number of follicles and oocytes obtained from both ovaries indicated no difference in pregnancy rates between the patients who had primary surgery and those who had unexplained or male factor infertility.
Ye et al. (9) conducted a study on 198 patients in three groups of unilateral salpingectomy, bilateral salpingectomy, and no tubal surgery. The mean AMH level was significantly higher in the patients without tubal surgery, compared to those with bilateral salpingectomy. Furthermore, FSH was significantly lower in the patients without tubal surgery than in the cases with bilateral salpingectomy. No significant differences were found in the duration of gonadotropin therapy, the amount of gonadotropin used, estradiol level on the hCG injection day, endometrial thickness, the number of oocytes retrieved, viable embryos, and good quality embryos between the three groups. The AMH concentration was not correlated with the number of oocytes.
In a study by Grynnerup et al. (10), 71 infertile and 21 fertile patients were compared. The AMH level was lower in the infertile group who underwent a salpingectomy than the infertile group with no tubal surgery. In all these groups, AMH was positively correlated with the number of oocytes removed. These controversial results in the literature may be attributed to the differences in the sample sizes, variable factors during IVF treatment, and various salpingectomy procedures.
Due to the limited number of samples, we did not separate the surgical cases based on the type of surgery and whether the surgery was unilateral or bilateral. Comparisons of AMH and AFC showed that AMH was correlated with AFC and the removed oocytes. However, in the present study, AMH was not correlated with the removed oocytes, the reason for which is unclear. In the current investigation, the evaluated AMH was not follicular-fluid AMH and different kits were used to evaluate AMH. According to the meta-analyses conducted by Qin et al. (37) and Yoon et al. (38), further studies are required for confirming these findings.
Our findings demonstrated that the AMH concentration correlates with FSH, AFC, E2, and gonadotropin time and count. Moreover, tubal surgery does not affect ovarian reserve and the outcome of assisted reproductive cycles.
The authors would like to thanks all participants.
Conflicts of Interest
Authors declared no conflict of interests.