Clin Exp Reprod Med.  2019 Mar;46(1):30-35. 10.5653/cerm.2019.46.1.30.

Does bilateral uterine artery ligation have negative effects on ovarian reserve markers and ovarian artery blood flow in women with postpartum hemorrhage?

• Verit FF
• Çetin O
• Keskin S
• Akyol H
• Zebitay AG

• KMID: 2469604
• DOI: http://doi.org/10.5653/cerm.2019.46.1.30

Abstract

OBJECTIVE
Bilateral uterine artery ligation (UAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian function remain unclear. The aim of this study was to investigate whether bilateral UAL compromised ovarian reserve and ovarian blood supply.
METHODS
This prospective study included 49 women aged between 21 and 36 years who had undergone a cesarean section for obstetric indications. Of these, 25 underwent uterine bilateral UAL to control intractable atonic PPH. The control group consisted of 24 women who had not undergone bilateral UAL. Standard clinical parameters, the results of color Doppler screening, and ovarian reserve markers were assessed in all participants at 6 months after surgery. The clinical parameters included age, parity, cycle history, body mass index, and previous medication and/or surgery. Color Doppler screening findings included the pulsatility index (PI) and resistance index (RI) for both the uterine and ovarian arteries. The ovarian reserve markers included day 3 follicle-stimulating hormone (FSH) levels, antral follicle count, and anti-Müllerian hormone (AMH) levels.
RESULTS
There were no significant differences in the ovarian reserve markers of day 3 FSH levels, antral follicle count, and AMH levels between the study and control groups (p>0.05 for all). In addition, no significant differences were observed in the PI and RI indices of the uterine and ovarian arteries (p>0.05 for all).
CONCLUSION
In this study, we showed that bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH.

Keyword

Ovarian blood flow; Ovarian reserve; Uterine artery ligation; Uterine blood flow

MeSH Terms

Arteries*
Body Mass Index
Cesarean Section
Female
Fertility Preservation
Follicle Stimulating Hormone
Humans
Hysterectomy
Ligation*
Mass Screening
Ovarian Reserve*
Parity
Postpartum Hemorrhage*
Postpartum Period*
Pregnancy
Prospective Studies
Uterine Artery*
Follicle Stimulating Hormone