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

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]; I-2 = 30%) and bilateral salpingectomy (IV [95% CI] 0.23 [0.09, 0.37]; I-2 = 36%). The number of oocytes retrieved decreased significantly after unilateral salpingectomy (IV [95% CI] -0.17 [-0.27, -0.06]; I-2 = 31%) and bilateral salpingectomy (IV [95% CI] -0.20 [-0.32, -0.08]; I-2 = 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]; I-2 = 48%). Finally, bilateral salpingectomy may lead to an increase in the FSH level (IV [95% CI] 0.39 [0.20, 0.59]; I-2 = 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. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the American Society for Reproductive Medicine.