Post-partum tubal ligation at time of cesarean delivery or via laparoscopy as an interval sterilization has similar effects on ovarian reserve

Abstract

Objective: To observe and compare the effect of postpartum tubal ligation (TL) procedures on ovarian reserve at women desiring TL as a contraceptive method at the end of pregnancy.

Material and methods: Eighty-one women were included in the prospective study. TL was performed at the time of cesarean delivery (CD) (n=49) and as an interval procedure by laparoscopy (LS) in the postpartum period (n=32). Anti-müllerian hormone (AMH) was used to determine ovarian reserve. Blood samples were taken twice from each subject; the first sample was taken before delivery from all subjects and the second sample was taken 4 months after sterilization. AMH level differences were compared in each group and between groups.

Results: The preoperative AMH values of CD and LS groups were similar 2.30 (maximum: 5.20, minimum: 0.42) ng/mL and 1.80 (maximum: 3.50, minimum: 0.40) ng/mL, respectively (p=0.262). The postoperative AMH values of the CD and LS groups were 1.30 (maximum: 2.60, minimum: 0.30) ng/mL and 0.90 (maximum: 2.50, minimum: 0.20) ng/mL, respectively (p=0.284). When the preoperative and postoperative values of each group were compared the change was statistically significant for both groups p<0.001. The decrease in mean AMH values in the CD and LS groups were 37.83% and 44.15%, respectively. The percentage changes of AMH values were not statistically significant (p=0.286).

Conclusion: TL at the time of CD and interval sterilization with LS have similar effects on ovarian reserve.

Keywords: Tubal ligation; ovarian reserve; cesarean section; laparoscopy; anti-müllerian hormone.

Figure 1

Flow-chart of patients *Four of the excluded patients had polycystic ovaries and two had previous ovarian surgery because of endometrioma