The postreproductive salpingectomy

13 12 2013

To the editor:

Findley et al. report (1) that simultaneous salpingectomy performed at the time of hysterectomy has no short-term negative effects on ovarian reserve. To add plausibility to this finding, we would like to point to the vascular connections: In the ovaries, blood supply is mainly secured via the arteria ovarica from the aorta and via the ramus ovaricus from the arteria uterina. These two arteries naturally anastomose with each other. A further branch of the arteria uterina, the ramus tubarius, connects the fallopian tube. During hysterectomy, the arteria uterina is ligated. Nevertheless, the central branch of the arteria ovarica in the infundibulopelvic ligament still guarantees sufficient blood flow from the aorta to the ovaries. A collateral connection of the remaining branch of the ramus tubarius from the anastomosis with the arteria ovarica also secures the vascular supply of the fallopian tube. However, when salpingectomy is performed concomitant to hysterectomy, the ramus tubarius will be removed. Accordingly, all the blood passing through the ligamentum infundibulo pelvicum will now become available to the ovaries. Blood circulation through the ovaries should thus remain unaffected or even increase when hysterectomy is combined with salpingectomy.

The few available studies support the hypothesis that removal of both uterus and fallopian tubes causes a redistribution of the blood flow in favor of the ovaries. Moreover, hormone production by the ovaries was also found to be unaffected even months after the intervention (2, 3). Read the rest of this entry »

Elimination of OHSS

14 03 2012

To the Editor:

I read with interest the recently published discussion on the etiology and prevention of OHSS (1-2). While the reviews comprehensively covered their aims, there are some issues that should be highlighted.

Agonist and antagonist coast

Coasting, or the complete discontinuation of exogenous gonadotropin while continuing GnRH analogues administration, is a preventive measure that is completely related on serum E2 levels at gonadotropin discontinuation and on the drop in E2 levels on day of hCG administration (1). However, while “it is well established that high E2 levels are associated with a high incidence of OHSS” (1), OHSS may occur in patients who conceived spontaneously, and in those with low or high serum E2 levels on the day of hCG administration (details in ref. 3). These versatile observations actually suggest that the previously accepted risk factors to develop OHSS, especially high serum E2 levels, are unreliable for the prediction of severe OHSS (3).

Therefore, we were not surprised at the finding of the recently published Cochrane review (4), which reported no difference in the incidence of moderate or severe OHSS after coasting. Read the rest of this entry »