Kadir Savan

Effect of tubal ligation on ovarian reserve and the ovarian stromal blood supply

Aim:  Our aim was to evaluate possible adverse effects of tubal ligation on ovarian reserve and ovarian stromal vascular support.

Ovarian reserve and ovarian stromal blood supply after tubal ligation by the Pomeroy technique: Comparison with controls

Objective. To determine if women who undergo tubal sterilization by the Pomeroy technique have any risk of a subsequent significant decrease in ovarian reserve and vascular support inside the ovary, by means of stromal artery Doppler ultrasonography. Methods. Between March 2000 and September 2004, 108 healthy volunteers underwent mini-laparatomic tubal ligation using the modified Pomeroy technique (study group). As a control group, 102 age-matched women were recruited. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and estradiol, ovarian volume, number of antral follicles and Doppler indices of the ovarian stromal arteries on the third day of the cycle immediately before, 1 month and 12 months after the surgical intervention. Results. In the study group and control group, results of the main outcome measurements immediately before, 1 month and 12 months after the surgical intervention did not show any significant difference except one. There was a significant elevation of FSH levels after 1 and 12 months, which was statistically significant (p < 0.05) in the study group. Conclusion. The 12-month follow-up of patients suggests that there is neither a decrease in ovarian reserve nor an adverse effect on the blood supply of ovarian stroma after tubal sterilization by the modified Pomeroy technique. A significant elevation of FSH levels was observed at 1 and 12 months after the operation.

Cornual heterotopic pregnancy after bilateral salpingectomy and uterine septum resection resulting in term delivery of a healthy infant.

Heterotopic pregnancy is the simultaneous occurrence of two or more implantation sites. A 25-year-old infertile patient with a history of bilateral salpingectomy, uterine septum resection, and left cornual resection was diagnosed with heterotopic pregnancy in her second in vitro fertilization trial. She attended our clinic when she was 7-week pregnant, complaining initially of severe abdominal pain. Findings associated with peritoneal irritation were positive during the physical examination. Transvaginal ultrasound revealed right cornual ectopic pregnancy with a live fetus in the middle of the uterine cavity. Also free fluid was noted in the pelvis. A diagnosis of heterotopic pregnancy with rupture of the cornual pregnancy was made. She underwent emergency laparoscopy with aspiration of the ruptured ectopic pregnancy, suturing to the entire visible cornual margins, and assurance of good haemostasis. Her recovery was uneventful and she continued receiving care in our obstetric unit. She delivered a healthy newborn by cesarean section at term.

A new finding for determining the incision line in the treatment of the septate uterus: “Süha-Levent’s sign”

In the initial hysteroscopic examination, we noticed that there was a blue line along the septum on the midline of the endometrial cavity traversing between the two tubal ostia after the injection of methylene blue. Then, we used this blue line as a guide to determine the line of incision and we incised the septum just along it. We presented two of these cases with a new finding, which we named the “Süha-Levent sign”. As a result, we believe that this finding might be used as a useful marker before incising the septate uterus.

A practical guide to determine the incision line in the treatment of septate uterus: “Süha–Levent’s Sign”

ObjectiveTo evaluate the significance of a new sign in the hysteroscopic incision process of the septate uterus.DesignThis is a prospective case control study.Design classificationII-2.SettingsThe study was performed in a research hospital.PatientsFourty-seven consecutive cases were operated for septate uterus.InterventionSeptum incision was performed in all cases with a hysteroscopic resectoscope under laparoscopic supervision.Measurements and main resultsMethylene blue 0.25% was injected through a Rubin canula in all cases for the assessment of tubal patency. Following the methylene blue injection, hysteroscopic septum incision was performed.ConclusionA line (blue line) on the top of the cavity has been observed in 33 of 47 (70.2%) cases. This line (blue line) can be used for determining the midline especially before hysteroscopic incision of uterine septum and can also shorten the operation time.