Effect of internal iliac artery ligation on ovarian blood supply and ovarian reserve

Internal iliac artery ligation is one of the treatment methods used for obstetric hemorrhage. The long-term effects of that intervention on ovarian function remain unknown. The objective of the study was to evaluate the effect of iliac artery ligation on ovarian blood supply and ovarian reserve.

Six patients who had undergone internal iliac artery ligation were recruited as the study group. Six women of the same age, parity and time after delivery who had not undergone the internal iliac artery ligation procedure served as the control group. Quantitative digital angiography and angio-CT of the ovarian arteries and the ovarian branches of the uterine arteries were carried out from 6 to 26 months after the operation. Blood samples were taken on the 3rd day of the menstrual cycle for subsequent hormone analysis of follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH).

Following angio-CT, in the study group, reversed blood flow in the ovarian branches of the uterine arteries was observed: contrast medium flowed from the ovarian arteries towards the ovaries and from the ovarian branches of the uterine arteries to the uterine arteries. In the control group, there was no contrast medium flow from the ovaries towards the ovarian branches of the uterine arteries. Quantitative digital angiography of the ovarian arteries showed that, in the study group, the mean ovarian artery diameter was significantly dilated (p < 0.05). In the study group, AMH levels were significantly lower (p < 0.05), while there were no significant differences in FSH levels between groups (p > 0.05).

Internal iliac artery ligation in the treatment of obstetric hemorrhage leads to dilation of the ovarian arteries and reversed flow in the ovarian branches of the uterine arteries. These change the blood supply to the ovaries and impair ovarian reserve.