Evaluation of the effect of the salpenjectomy operation on the ovarian reserve with anti-müllerian hormone (AMH) and doppler ultrasonography for ovarian blood flow

OBJECTIVE: Ovarian cancer is the most common cause of death from gynecologic cancers in the world. 5-year survival in patients with the early-stage disease is around 89%, and recurrence is not observed in 80% of these patients. In advanced stages, the survival rate decreases up to 20%. Currently, no screening method reduces ovarian cancer mortality. High-Grade Serous Ovarian carcinomas (HGSOC) are the most common ovarian cancers and have the highest mortality. After risk-reducing bilateral salpingo-oophorectomy (BSO) performed on BRCA1/2 mutation carriers, data have been obtained showing that it is caused by Serous Tubal Intraepithelial Carcinoma (STIC) lesions detected incidentally in the pathological examination of the tuba uterine. Studies since 2010 have shown that salpingectomy and tubal ligation operation cause a 24-65% reduction in the risk of ovarian cancer. For this reason, it is recommended to offer the option of bilateral salpingectomy to patients who have completed their fertility and are planning for surgery for benign gynecological reasons. Salpingectomy is also performed due to hydrosalpinx, ectopic pregnancy, sterilization requests. The effect of salpingectomy performed before menopause and at younger ages on the ovarian reserve is not known. This study aimed to evaluate the effect of salpingectomy operation on ovarian reserve with serum AMH level and Ovarian Artery Pulsatility Index (OVA PI). MATERİALS AND METHOD: This prospective study was conducted after the ethical approval was obtained from the Non-Invasive Studies Ethics Boards of Dokuz Eylul University. 31 patients aged 37-45 years, who underwent bilateral salpingectomy at Dokuz Eylul University School of Medicine Department of Obstetrics and Gynecology between November 2020 and January 2022, were included in the study. After the review of literature, t-test statistical analysis was performed in the GPower 3.1.9.2 program by making use of the differences and averages. At least 30 patients were required with the sample size calculated at 95% power. Ovarian reserve was evaluated by measuring Anti-Müllerian Hormone (AMH) levels from the serum samples taken from the patients before the operation and 6 weeks after the operation, using the ELISA method. Changes that may occur in ovarian blood flow after salpingectomy were evaluated preoperatively, on the postoperative second day and at the 6th week, by Transvaginal Ultrasonography (TVUSG) and by measuring the Ovarian Artery Pulsatility Index (OVA PI) from color Doppler flows. RESULTS: The mean age of the patients participating in the study was 40.97±2.24 years. In 28 patients (90.4%), hysterectomy and salpingectomy were performed, 3 (9.6%) patients underwent only bilateral salpingectomy. There was a significant decrease in serum AMH levels measured at preoperative and postoperative 6th weeks. (z ꞊ -2.33, p=0.020). While the change in serum AMH levels between the preoperative and postoperative 6 weeks in the 37-39 age group was not statistically significant (p=0.314), there was a significant decrease in the serum AMH level at the postoperative 6th week in the 40-45 age group compared to the preopterative period (p=0.036) found to be. Considering the change in the mean values of Left OVA PI (p=<0.047), it was found that the Left OVA PI value measured at postoperative 6th week decreased compared to the preoperative period. (p=0.018) According to the single-factor ANOVA analysis, there was no difference between the right OVA PI values between the three measurements (p=0.067) The level of significance was determined as p<0.05 for all analyzes. CONCLUSION: It was observed that ovarian functions were negatively affected in the acute period after salpingectomy operations. According to our current study, the reason for this situation is not seen as a decrease in blood flow due to damage to the vascularity of the ovary. Further research is needed in terms of other causes that may affect ovarian function, changes that may occur in the ovary in the chronic period, and possible early menopause symptoms. KEYWORDS: Salpingectomy, Ovarian Reserve, AMH, OVA PI, Bilateral Prophylactic Salpingectomy, Doppler Ultrasonography