الفهرس 
Anatomy of the Ovary & Fallopian TubeOnly 14 pages are availabe for public view
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Abstract
Hydrosalpinx is one of the major tubal diseases that greatly affects in-vitro fertilization (IVF) cycle results (Johnson et al., 2014). Proper management of this condition will markedly increase the success rate of embryo implantation inside the endometrium (Ly et al., 2010; Strandell et al., 2005).
Laparoscopic salpingectomy is considered a convenient intervention for management of this condition however, in recent years the effect of this operation on ovarian reserve became a matter of debate (Grynnerup et al., 2013).
It was suggested by some studies that salpingectomy may affect blood supply and nerve supply to the ovary consequently decreases ovarian reserve due to the close anatomical relation between fallopian tubes and ovaries (Grynnerup et al., 2013; Gelbaya et al., 2006). To avoid disruption of medial tubal artery, resection by the electrocautery flush to the tube is recommended with preservation of the part of the tube that is closely related to the ovary (Standell et al., 2001). In some cases where salpingectomy is not accessible, proximal tubal disconnection with distal drilling of the tube may be done (Standell et al., 2001).
Recently, laparoscopic proximal tubal disconnection became more preferable due to fore mentioned believes (Johnson et al., 2014).Other studies suggest that ovarian reserve is not affected by salpingectomy (Kamel EM, 2012; Sezik et al., 2007; Lin et al., 2013).
Different ways were used to measure the ovarian reserve including the duration of stimulation by gonadotropin, dose of gonadotropin needed, number of follicles, number of oocytes picked up, fertilization rate, implantation rate, pregnancy rate, live birth rate, and anti-Müllerian hormone (AMH) level (van Rooij et al., 2002; La Marca et al., 2006).
The current study was conducted at Ain Shams University Maternity Hospital comparing the effect of two different techniques of laparoscopic management of hydrosalpinx (salpingectomy vs. proximal tubal disconnection) in women presenting for in vitro fertilization and embryo transfer regarding their effect on AMH level and consequently ovarian reserve.
All patients in the study were counseled regarding mode of intervention and informed consent was obtained. All women were subjected to complete history taking, routine preoperative examination and investigations including gynecological ultrasound, and then divided into 2 groups:
group 1: included 42 women underwent laparoscopic bilateral salpingectomy. Laparoscopic salpingectomy was performed using bipolar cautery. Adhesiolysis was performed. The mesosalpinx was transected just below the fallopian tube to minimize any compromise to the collateral blood supply of the ipsilateral ovary.
group 2: included 42 patients underwent bilateral tubal division. The fallopian tube was transected 1-1.5 cm from the cornual region. Proximal tubal occlusion was performed using bipolar cautery applied at two sites separated by approximately 1 cm on the isthmic portion of the affected tube, and the hydrosalpinx was not drained.
AMH levels were measured by an enzyme linked immunosorbent assay using a Bio-Rad iMark microplate absorbance reader with reagent kits from Bio-Rad.
TVUS was performed on the third day of menstruation to evaluate the ovarian size, and determine the antral follicle count (AFC). An X6 Samsung medison 2D ultrasonography machine was used at a probe frequency of 3w7 MHz. The DROP in AMH level and AFC from preoperative values to postoperative values was calculated for each patient then the values of the two groups were compared to each other collectively.
On comparing the two groups regarding age, P value was 0.289 which is not significant.
On comparing the two groups regarding value of AMH preoperative, P value was 0.982(NS), on the other hand, P value was significant (0.012) on comparing the value of AMH between the two groups one month later. There was no statistical difference between the two groups regarding value of AMH preoperative; however, it shows statistical difference between the two groups regarding values of AMH that measured one month later.
On comparing the two groups regarding AFC preoperative, P value was 0.893 (NS), on the other hand, P value was highly significant (0.000) on comparing the AFC between the two groups one month later. There is no statistical difference between the two groups regarding value of AFC preoperative; however, it shows marked statistical difference between the two groups regarding AFC one month later.
On comparing the level of AMH in group 1 preoperative and one month later, P value was 0.000 which is highly significant. Moreover, on comparing AFC in group preoperativeand one month later, P value was 0.000 which is also highly significant.
There was high statistical difference between the values of AMH and AFC measured in group 1 on the preoperativeand one month later.
On comparing the level of AMH in group 2 preoperativeand one month later, P value was 0.100which is not significant. Moreover, on comparing AFC in group preoperative and one month later, P value was 0.137 which is not significant. There is no statistical difference between the values of AMH measured in group 2 preoperative and one month later. Furthermore, there is no statistical difference between the values of AFC measured at the same times.