From the Research
Bilateral uterine artery ligation during management of postpartum hemorrhage appears to have minimal to no significant long-term effect on ovarian reserve. This procedure, which involves surgically tying off the uterine arteries to reduce blood flow and control hemorrhage, preserves the ovarian blood supply since it does not directly affect the ovarian arteries. The ovaries receive their primary blood supply from the ovarian arteries, which branch directly from the aorta, with additional supply from the ovarian branches of the uterine arteries. Studies measuring anti-Müllerian hormone (AMH) levels, antral follicle counts, and other markers of ovarian reserve before and after uterine artery ligation have generally shown no significant reduction in ovarian function, as seen in a study published in 2019 1. Any temporary changes in ovarian blood flow typically normalize within weeks to months as collateral circulation develops.
Some key points to consider include:
- The primary blood supply to the ovaries comes from the ovarian arteries, which are not directly affected by uterine artery ligation.
- Markers of ovarian reserve, such as AMH levels and antral follicle counts, have been shown to remain unaffected by bilateral uterine artery ligation 1.
- Alternative procedures, like hypogastric artery ligation, might have a greater theoretical risk to ovarian blood supply, though evidence remains limited 2.
- The procedure is life-saving and can preserve the uterus, making it a valuable option for reproductive-aged women experiencing postpartum hemorrhage.
Overall, women who undergo bilateral uterine artery ligation can generally be reassured that their future fertility and hormonal function are unlikely to be compromised by this specific intervention, based on the most recent and highest quality evidence available 1.