Combining tadalafil and hyperbaric oxygen therapy protects against ovarian ischemia‑reperfusion damage in rats

A frequently occurring surgical emergency in gynecology is ovarian torsion, which occurs when the ovary twists on its ligamentous supports, which obstructs blood flow. The aim of the present study was to evaluate the protective effects of hyperbaric oxygen therapy (HBOT) and tadalafil against ischemia‑reperfusion (IR) injury in a rat model of ovarian torsion. Female Wistar albino rats were randomly assigned to five groups (n=8/group): Control, IR, IR + tadalafil, IR + HBOT and IR + tadalafil + HBOT. Ovarian torsion was induced under anesthesia for 2 h, followed by daily post‑operative treatments with tadalafil (10 mg/kg) and/or HBOT (2.4 atmospheres absolute for 1 h) for 7 days. Blood and ovarian tissue specimens were collected for analysis at the end of the treatment period. IR‑induced ovarian tissue injury significantly decreased the counts of primordial, primary and preantral follicles compared with those in the control group. In addition, serum ELISA and immunohistochemical analysis revealed that IR injury reduced anti‑Müllerian hormone (AMH) levels in serum and the granulosa cells of primary, preantral and secondary follicles. HBOT alone resulted in a significant increase in the counts of primordial, primary and preantral cells, as did the combination of HBOT with tadalafil. In addition, AMH immunoreactivity significantly increased in primary, preantral and secondary follicles following treatment with HBOT and tadalafil. Furthermore, all therapeutic interventions elevated serum AMH levels in the IR model rats. These findings suggest that tadalafil treatment combined with HBOT may help protect ovarian reserve and mitigate IR‑induced tissue damage in rat ovaries.