Biological Impact of Unilateral Oophorectomy: Does the Number of Ovaries Really Matter?

Abstract

Although unilateral oophorectomies are performed more often than bilateral ones in women of reproductive age, their clinical consequences have been less intensively investigated. Experimental models in animals have shown that compensatory mechanisms occur after a unilateral oophorectomy (UO). This review aims to summarize the available evidence on the biological effects of unilateral oophorectomy on women. Evaluated outcomes include age at onset of menopause, risk of cardiovascular and neurological disease, risk of mortality and fertility outcome after spontaneous conception or in vitro fertilization (IVF). Results were compared with findings reported after bilateral oophorectomy and/or ovarian excision and/or women with intact ovaries. An electronic database search was performed using PubMed and Scopus, followed by a manual search to identify controlled studies that compared women after UO with women with two intact ovaries. In particular, a systematic review of fertility outcomes after IVF was performed, and the data were summarized in a table. Women who underwent UO had a similar age at menopause and similar clinical pregnancy rate compared to women with two ovaries. However, decreased ovarian reserve affecting the quantity but not the quality of the ovarian pool after IVF was observed in the UO group. Furthermore, an increased risk of neurological disease and even an increased risk of mortality was observed in women with single ovary. These data need to be confirmed by further studies, and a plausible mechanism of action must be identified. At present, patients who undergo UO can be reassured with regard to their reproductive potential and their age at onset of menopause.

Zusammenfassung

Obwohl einseitige Ovarektomien häufiger als bilaterale Eierstockentfernungen bei Frauen im reproduktionsfähigen Alter durchgeführt werden, hat man den klinischen Folgen von einseitigen Ovarektomien weniger Aufmerksamkeit gewidmet. Experimentelle Tiermodelle zeigen, dass Kompensationsmechanismen nach einseitigen Ovarektomien stattfinden. Ziel dieser Übersichtsarbeit war es, die existierenden Forschungsergebnisse zu den biologischen Auswirkungen von einseitigen Ovarektomien zusammenzufassen. Zu den untersuchten Aspekten zählten Alter bei Eintritt der Wechseljahre, Risiko für Herz-Kreislauf-Erkrankungen und neurologische Erkrankungen, Mortalitätsrisiko und Fertilitätsergebnis nach spontaner Empfängnis oder In-vitro-Fertilisation (IVF). Diese Ergebnisse wurden mit den Ergebnissen nach bilateraler Ovarektomie und/oder ovarieller Exzision bzw. von Frauen mit intakten Eierstöcken verglichen. Es wurde zunächst eine elektronische Datenbanksuche mithilfe von PubMed und Scopus durchgeführt. Danach wurde eine manuelle Suche durchgeführt, um kontrollierte Studien auszumachen, die Frauen nach einseitiger Ovarektomie mit Frauen mit 2 intakten Eierstöcken verglichen. Es wurde eine systematische Überprüfung der Fertilitätsergebnisse nach IVF durchgeführt, und die Daten wurden in einer Tabelle zusammengefasst. Bei Frauen, die sich einer einseitigen Ovarektomie unterzogen hatten, waren das Alter bei Eintritt der Wechseljahre sowie die klinischen Schwangerschaftsraten ähnlich wie bei Frauen mit 2 Eierstöcken. Es wurde zwar eine verminderte ovarielle Reserve bei Frauen nach einer einseitigen Ovarektomie festgestellt; diese wirkte sich aber auf die Quantität, nicht auf die Qualität des ovariellen Pools nach IVF aus. Es wurde ferner ein erhöhtes Risiko für neurologische Erkrankungen und sogar ein erhöhtes Mortalitätsrisiko bei Frauen mit nur einem Eierstock beobachtet. Diese Daten müssen in weiteren Studien bestätigt werden, und ein plausibler Wirkungsmechanismus dafür muss noch identifiziert werden. Nach aktuellem Wissensstand können Patientinnen, die sich einer einseitigen Ovarektomie unterziehen, hinsichtlich ihres reproduktiven Potenzials und ihres Alters bei Eintritt der Wechseljahre beruhigt sein.

Key words

unilateral oophorectomy - fertility - IVF - pregnancy rate - conservative surgery - ovarian cystectomy

Schlüsselwörter

einseitige Ovarektomie - Fertilität - IVF - Schwangerschaftsrate - konservative Chirurge - ovarielle Zystektomie

^* These two authors contributed equally to this work.

^** These two authors contributed equally to this work.

Publikationsverlauf

Eingereicht: 13. Mai 2020

Angenommen nach Revision: 11. August 2020

Artikel online veröffentlicht:
01. Oktober 2020

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