The impact of internal iliac artery ligation on hormonal and functional ovarian reserve parameters: A case-control study in patients with postpartum hemorrhage in sub-Saharan Africa

Int J Gynaecol Obstet. 2024 Oct;167(1):306-312. doi: 10.1002/ijgo.15551. Epub 2024 Apr 22.

Abstract

Objective: The study aims to evaluate the long-term impact of internal iliac artery ligation (IIAL) on ovarian hormonal and functional changes in women. The procedure is often used for postpartum hemorrhage and is considered uterus-sparing. However, its effects on ovarian reserve and fertility preservation remain controversial.

Methods: This is a retrospective, case-control study involving consecutive female patients aged 17-47 years. These patients underwent successful bilateral IIAL due to severe postpartum hemorrhage between January 2022 and December 2022. The control group included women of matching age, parity, and body mass index (BMI) who did not undergo IIAL. Both groups were followed for 6 months to measure follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, antral follicle counts, and ovarian volume.

Results: The study comprised 62 patients in the IIAL group and 86 in the control group. No significant differences were found in FSH and LH levels between the two groups (P > 0.05). However, the numbers of antral follicles in both the right and left ovaries were significantly lower in the IIAL group than in the control group (P < 0.05). Ovarian volume did not show a significant difference between the groups (P > 0.05).

Conclusion: The findings suggest that IIAL leads to a significant decrease in the number of ovarian follicles at 6 months post-operation. However, it does not significantly impact FSH and LH levels or ovarian volume.

Keywords: follicle‐stimulating hormone; internal iliac artery; ligation; ovarian follicle; postpartum hemorrhage.

MeSH terms

  • Adolescent
  • Adult
  • Case-Control Studies
  • Female
  • Fertility Preservation / methods
  • Follicle Stimulating Hormone* / blood
  • Humans
  • Iliac Artery* / surgery
  • Ligation / methods
  • Luteinizing Hormone* / blood
  • Middle Aged
  • Ovarian Follicle
  • Ovarian Reserve*
  • Ovary / blood supply
  • Ovary / surgery
  • Postpartum Hemorrhage* / surgery
  • Pregnancy
  • Retrospective Studies
  • Young Adult

Substances

  • Luteinizing Hormone
  • Follicle Stimulating Hormone