Short-Term Impact of Prophylactic Salpingectomy on Ovarian Reserve in Perimenopausal Women Undergoing Hysterectomy: A Prospective Observational Study

Abstract

Background: Prophylactic salpingectomy is increasingly performed during hysterectomy to reduce epithelial ovarian cancer risk, based on evidence that high-grade serous carcinomas may originate from fallopian tube epithelium. However, concerns exist about potential impacts on ovarian function due to shared vasculature between the fallopian tubes and ovaries. Objective: To evaluate the impact of prophylactic salpingectomy on ovarian reserve and function in perimenopausal women undergoing hysterectomy for benign conditions. Methods: A prospective observational study was conducted at SMS Medical College, Jaipur, from January to December 2024. Fifty-five perimenopausal women (aged 35-49 years) undergoing hysterectomy with bilateral prophylactic salpingectomy and ovarian preservation were enrolled. Serum Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH) levels were measured preoperatively and at three months postoperatively using ELISA and chemiluminescent immunoassay, respectively. Results: The mean age of participants was 42.2 ± 2.69 years. Preoperative mean FSH was 7.36 ± 0.56 IU/mL and AMH was 1.30 ± 0.29 ng/mL. At three months follow-up, FSH increased slightly to 7.51 ± 0.59 IU/mL (p = 0.166) and AMH decreased marginally to 1.24 ± 0.28 ng/mL (p = 0.178). All participants maintained FSH levels within normal range (3.0-10.0 IU/mL) both pre- and postoperatively. The proportion with normal AMH levels (1.0-4.0 ng/mL) decreased from 81.8% to 76.4%, while below-normal AMH increased from 18.2% to 23.6%. Conclusions: Prophylactic salpingectomy performed during hysterectomy does not significantly compromise short-term ovarian reserve in perimenopausal women. The minimal, non-significant changes in AMH and FSH levels support the safety of this cancer risk-reduction strategy when performed with proper surgical technique and ovarian preservation.  These findings support the safety of prophylactic salpingectomy in terms of short-term ovarian endocrine function when the ovaries are preserved. Thus, salpingectomy may be considered a viable cancer risk-reduction strategy without adversely impacting ovarian reserve in the immediate postoperative period.