Impact of unilateral salpingectomy on ovarian reserve and long-term reproductive outcomes in reproductive-aged women

Objective To investigate the short-term impact of unilateral salpingectomy on ovarian reserve and to evaluate its comprehensive value regarding long-term reproductive outcomes in women of reproductive age. Methods In this prospective cohort study, 96 reproductive-aged women diagnosed with ectopic pregnancy (EP) were enrolled. Base on the surgical and therapeutic regimens, participants were allocated into a study group (undergoing laparoscopic unilateral salpingectomy, n = 48) and a control group (preservation of the fallopian tube, including either laparoscopic salpingostomy or systemic methotrexate [MTX] therapy, n = 48). Biochemical markers of ovarian reserve (anti-Müllerian hormone [AMH], serum follicle-stimulating hormone [FSH], etc.) and morphological parameters (ovarian volume and antral follicle count [AFC]) were dynamically monitored and compared between the two groups at baseline and at 1, 3, and 6 months postoperatively. All participants were followed up for 24 months to compare spontaneous ovulation rates, spontaneous pregnancy rates, and the incidence of recurrent EP. Results The study group exhibited transient fluctuations in biochemical markers indicative of diminished ovarian reserve in the early postoperative period (1 month), which normalized by 6 months postoperatively. Regarding morphological compensation, the contralateral ovarian volume and AFC in the study group increased significantly at 1–3 months postoperatively compared with the control group ( P < 0.05); however, these parameters converged between the two groups by 6 months ( P >0.05). Over the 24-month follow-up, there were no statistically significant differences in spontaneous ovulation or spontaneous pregnancy rates between the groups ( P >0.05). Notably, the recurrence rate of EP in the study group was 2.08% (1/48), significantly lower than the 16.67% (8/48) observed in the control group ( P < 0.05). Conclusions Unilateral salpingectomy induces a transient early decline in ovarian reserve, counterbalanced by a distinct short-term compensatory response in the contralateral ovary. Crucially, this procedure does not compromise long-term natural conception potential while significantly mitigating the risk of recurrent EP. For patients with normal ovarian reserve and a healthy contralateral tube, unilateral salpingectomy represents a safe, effective, and optimal treatment strategy for maximizing protection against recurrent EP.