"When compared to patients who underwent a hysterectomy, individuals with
congenital absence of the uterus had significantly more oocytes retrieved (P
< 0.006), fertilized, cleaved and more embryos available for transfer
despite being of comparable age....Patients with congenital absence of the
uterus responded to ovulation induction better than patients who underwent a
hysterectomy, perhaps due in part to ovarian compromise from previous
surgical procedures. " [1]

In [2], 5 out of 16 women who had hysterectomies either did not produce any
eggs in response to stimulation, or did not produce viable eggs. The
outcome for the others was good, though.

[3] and [4] found that cattle and sheep which had been hysterectomized
responded differently to hormone injections than those which had not. I do
not know enough about endocrinology to discuss the significance of the
differences, but the refs are below for anyone who is interested. [5] found
that follicles matured earlier in hysterectomized rats.

There are some discussions on this website between women whose ovarian
function changed after hysterectomy:
http://www.hystersisters.com/shutdown.php

The ovaries and uterus work as a team to achieve and sustain pregnancy; we
still don't know everything about quite how this works, so it's not
surprising that if you take the uterus away, ovarian function can be
affected. The endometrium produces various chemicals, for example - how
much feedback effect is there from these on the ovaries?

Yours,
Angela H.

[1] Fifteen years experience with an in-vitro fertilization surrogate
gestational pregnancy programme.
AUTHORS: Goldfarb JM; Austin C; Peskin B; Lisbona H; Desai N; de Mola JR
AUTHOR AFFILIATION: Department of Reproductive Biology, Case Western
Reserve University School of Medicine, Cleveland, Cleveland, Ohio, USA.
SOURCE: Hum Reprod 2000 May;15(5):1075-8
CITATION IDS: PMID: 10783355 UI: 20247295
ABSTRACT: The purpose of our study was to review and evaluate
retrospectively the experience of an in-vitro fertilization (IVF) surrogate
gestational programme in a tertiary care and academic centre. In a 15 year
period from 1984 to 1999, a total of 180 cycles of IVF surrogate gestational
pregnancy was started in 112 couples. On average, the women were 34.4 +/-
4.4 years of age, had 11.1 +/- 0.72 oocytes obtained per retrieval, 7.1 +/-
0.5 oocytes fertilized and 5. 8 +/- 0.4 embryos subsequently cleaved.
Sixteen cycles (8.9%) were cancelled due to poor stimulation. Except for six
cycles (3.3%) where there were no embryos available, an average of 3.2 +/-
0.1 embryos was transferred to each individual recipient. The overall
pregnancy rate per cycle after IVF surrogacy was 24% (38 of 158), with a
clinical pregnancy rate of 19% (30 of 158), and a live birth rate of 15.8%
(25 of 158). When compared to patients who underwent a hysterectomy,
individuals with congenital absence of the uterus had significantly more
oocytes retrieved (P < 0.006), fertilized, cleaved and more embryos
available for transfer despite being of comparable age. IVF surrogate
gestation is an established, yet still controversial, approach to the care
of infertile couples. Take-home baby rates are comparable to conventional
IVF over the same 15 year span in our programme. Patients with congenital
absence of the uterus responded to ovulation induction better than patients
who underwent a hysterectomy, perhaps due in part to ovarian compromise from
previous surgical procedures.

[2] Experience with gestational surrogacy as a treatment for sterility
resulting from hysterectomy.
AUTHORS: Meniru GI; Craft IL
AUTHOR AFFILIATION: London Gynaecology and Fertility Centre, UK.
SOURCE: Hum Reprod 1997 Jan;12(1):51-4
CITATION IDS: PMID: 9043901 UI: 97196812
ABSTRACT: A retrospective study was carried out to assess the potential of
16 hysterectomized women to achieve surrogate pregnancies. A total of 11
patients completed 16 cycles of assisted conception treatment incorporating
in-vitro fertilization and gestational surrogacy. Three other women failed
to respond to ovulation induction while two more patients produced few
oocytes which also failed to fertilize. Six host mothers became pregnant
thereby giving a pregnancy rate of 37.5% (6/16) per patient and embryo
transfer and 27.3% (6/22) per cycle of treatment commenced. Two women later
miscarried, three have given birth to twins and the remaining host has
delivered a male infant. The commissioning mother's age was closely related
to occurrence and continuation of pregnancy in the host. Hysterectomized
women demonstrate varying patterns of response to assisted conception
treatment but gestational surrogacy generally appears to be a feasible
option especially in younger patients.

===
[3]
Norgestomet- and oestradiol valerate-induced luteolysis is dependent upon
the uterus.
AUTHORS: Peterson CA; Huhn JC; Kesler DJ
AUTHOR AFFILIATION: Department of Animal Sciences, University of Illinois,
Urbana, IL 61801, USA.
SOURCE: Anim Reprod Sci 2000 Mar 15;58(3-4):253-9
CITATION IDS: PMID: 10708899 UI: 20175883
ABSTRACT: Beef heifers were assigned to three groups: (1) untreated
controls (n=4), (2) Syncro-Mate B(R) (SMB)-treated (n=5), and (3)
hysterectomized and SMB-treated (n=4). SMB was administered 8 or 9 days
after oestrus, approximately 30 days after hysterectomy. This study was
conducted to determine if the uterus was necessary for SMB to induce
luteolysis. SMB induced premature luteolysis as only 20% of the intact
SMB-treated heifers had >/=0.75 ng/ml of progesterone 7 days after the time
of SMB treatment, compared to all (100%) of the untreated heifers (p<0.05).
By 9 days after the time of SMB treatment, 25% of the untreated heifers and
none (0%) of the intact SMB-treated heifers had >/=0.75 ng/ml of
progesterone; however, all (100%) of the hysterectomized SMB-treated heifers
had >/=0.75 ng/ml of progesterone (p<0.05). Therefore, SMB-induced
luteolysis required the involvement of the uterus. The luteolysin,
prostaglandin F(2alpha), is probably the secretion from the uterus that
mediates the SMB-induced luteolysis. SMB treatment, however, required 7-8
days to induce luteolysis.
===

[5] Effects of hysterectomy on ovulation and related ovarian functions in
regular estrous cycle rats.
AUTHORS: Tanaka M; Kumai T; Watanabe M; Matsumoto C; Hirai M; Kobayashi S
AUTHOR AFFILIATION: Department of Pharmacology, St. Marianna University
School of Medicine, Kanagawa, Japan.
SOURCE: Life Sci 1994;55(3):237-43
CITATION IDS: PMID: 8007765 UI: 94276789
ABSTRACT: The number of ovulation was significantly higher in
hysterectomized rats with regular estrous cycles than in sham-operated rats
at the estrous stage 20-24 days after operations (13.2 +/- 0.33 vs. 11.8 +/-
0.41, P < 0.05). This finding suggests that hysterectomy facilitates the
follicular maturation in rats. To examine the mechanism of facilitation on
follicular maturation in hysterectomized rats, plasma FSH level, ovarian
estradiol-17 beta (E2) and ovarian aromatase activity were measured 20 days
after hysterectomy. Hysterectomy had no effect on plasma FSH levels at any
of the estrous stages. Ovarian E2 level and aromatase activity (AA) were
significantly increased by hysterectomy only at diestrus-2 stage of the
estrous cycle (E2; 3.76 +/- 0.49 vs. 1.48 +/- 0.49 ng/g ovarian tissue, P <
0.05, AA; 1.36 +/- 0.15 vs. 0.83 +/- 0.11 pmol/h. mg ovarian tissue, P <
0.05), but ovarian testosterone level was not affected by the operation.
These results support the hypothesis that in rats hysterectomy facilitates
follicular maturation. This may be due to an increase in ovarian E2 level at
the diestrus-2 stage, caused by heightened ovarian aromatase activity.

MEDLINE

Anna gave me the reference for her reading about hysterectomy affecting
> ovarian function. She read about it in:
> The Ultimate Rape
> Elizabeth L Ploude
> ISBN 0-9661735-0-3
>
> "Today's research confirms that overies can, indeed, be damaged by
> disruption to the blood vessels or the nerves leading to them. Every part
> of the body is dependent on a supply supply of blood and nerves. ...
One
> study, looking into this potentiality, found that during surgery the
blood
> flow though the ovaries can be reduced by 52 - 89% in premenopausal women.
> Even though it is temporary, this acute reduction of blood could lead to
> impaired functioning of the overies, which may not be recognised until
> menopausal symptoms surface."
>
> The book's reference for this is study [1] below.
>
> It also mentions a 1932 article which said that menopause symptoms in
> hysterectomized women under 40 were 8 times higher, with 92% showing
> symptoms within two years. I don't have the reference for this, but I
> expect Anna could dig it out if necessary. Hopefully things will be less
> bleak than that nowadays as we can only hope that surgical techniques have
> been refined since 1932.
>
> This is clearly an ongoing question, as Chalmers in 1996 [2] wrote that:
> "Some research indicates an increase in incidence and severity of
menopausal
> symptoms following removal of the uterus, despite the ovaries remaining in
> place; others have failed to find evidence of a decrease in ovarian
> endocrine secretion, implying that the ovaries are unaffected. "
> and in 1993, Nilas and Loft concluded:
> "A possible explanation for the altered ovarian function after
hysterectomy
> is reduced ovarian blood supply caused by the operation, but the existence
> of a direct endocrine function of the uterus can not be excluded. " [3]
>
> I hope that Anna, and anyone else who has had a hysterectomy, will take
> comfort from the fact that any disruption in ovarian function seems to be
> unusual, and that most women's ovaries continue to work well, or perhaps
> have a temporary disturbance which resolves after a few months. Mind you,
> this will probably not reassure Anna much as she was also told that
> complications following a caesarean are rare...
>
> Anna wondered if caesareans themselves could involve a temporary
disruption
> to the ovarian blood supply too - I have not read anything about this, so
> don't know whether it's been studied or not. One of the studies below,
> though, looked at ovarian function following sterilization (tubal
ligation)
> and found that it could be disturbed by this and by hysterectomy [4].
>
> Best wishes,

>

>
> =====
>
> [1] The acute effect of hysterectomy on ovarian blood flow.
> AUTHORS: Janson PO; Jansson I
> SOURCE: Am J Obstet Gynecol 1977 Feb 15;127(4):349-52
> CITATION IDS: PMID: 319669 UI: 77109220
> ABSTRACT: Ovarian stromal blood flow was measured by 133xenon-clearance
> technique in five women before and immediately after abdominal
hysterectomy
> preserving the adnexae. The interval between the two measurements ranged
> from 35 to 76 minutes. The rate of xenon clearance was reduced by 52 to 89
> percent in four of the women who were in the fertile age and by 29 percent
> in one postmenopausal subject. These findings indicate that acute
reductions
> in ovarina blood flow may be responsible for the postoperative transient
> drop in ovarina steroid levels in peripheral plasma reported earlier.
> ===
>
> [2] Does hysterectomy in a premenopausal woman affect ovarian function?
> AUTHORS: Chalmers C
> AUTHOR AFFILIATION: Scottish Borders College of Nursing, Borders General
> Hospital NHS Trust, Melrose, UK.
> SOURCE: Med Hypotheses 1996 Jun;46(6):573-5
> CITATION IDS: PMID: 8803944 UI: 96396841
> ABSTRACT: Women undergoing a hysterectomy without oophorectomy in their
> premenopausal years would expect to benefit from continued secretion of
> oestrogens to protect them from the conditions and symptoms associated
with
> the climacteric and postmenopause. However, there is conflicting evidence
> regarding the effect of premenopausal hysterectomy on ovarian function.
Some
> research indicates an increase in incidence and severity of menopausal
> symptoms following removal of the uterus, despite the ovaries remaining in
> place; others have failed to find evidence of a decrease in ovarian
> endocrine secretion, implying that the ovaries are unaffected. This
article
> reviews the conflicting evidence regarding the effect of hysterectomy on
> ovarian function as well as examining evidence for counter-current
exchange
> between the ovarian and uterine blood supplies. An hypothesis is put
forward
> to explain how removal of a woman's uterus may affect her ovarian
function.
>
> ===
>
> [3] [Ovarian function after premenopausal hysterectomy (see comments)]
> VERNACULAR TITLE: Ovariets funktion efter praemenopausal hysterektomi.
> AUTHORS: Nilas L; Loft A
> AUTHOR AFFILIATION: Gynaekologisk-obstetrisk afdeling, Hvidovre Hospital,
> Kobenhavn.
> SOURCE: Ugeskr Laeger 1993 Nov 22;155(47):3818-22
> CITATION IDS: PMID: 8256381 UI: 94078431
> COMMENT: Comment in: Ugeskr Laeger 1994 Feb 21;156(8):1156
> ABSTRACT: In Denmark, about 6000 hysterectomies are performed annually,
and
> about 75% are performed on benign indications in women less than 50 years
of
> age. When deciding on oophorectomia per occasionem, the risk of disease in
> the retained ovaries must be weighed against the advantages of continued
> ovarian function. The literature about ovarian function after hysterectomy
> consists predominantly of older, retrospective and uncontrolled
> investigations describing earlier menopause, increased frequency of
> climacteric symptoms and increased risk of benign ovarian cysts.
> Hysterectomy is followed by histological changes in the retained ovaries,
> but a significant reduction in the ovarian hormone production is not
> documented. Several studies have indicated that hysterectomy is followed
by
> an increased risk of ischaemic heart disease, but the literature is
> equivocal. A possible explanation for the altered ovarian function after
> hysterectomy is reduced ovarian blood supply caused by the operation, but
> the existence of a direct endocrine function of the uterus can not be
> excluded. Solid prospective studies of the ovarian function following
> hysterectomy are needed.
>
> ====
>
> [4] Oestrogen deficiency after tubal ligation.
> AUTHORS: Cattanach J
> SOURCE: Lancet 1985 Apr 13;1(8433):847-9
> CITATION IDS: PMID: 2858712 UI: 85162561
> ABSTRACT: 4 of 7 women who had undergone tubal ligation within the past
> seven years were found to have oestrogen excretion concentrations at
> ovulation below the tenth percentile. A disturbance in the
> oestrogen/progesterone ratio as a consequence of localised hypertension at
> the ovary, when the utero-ovarian arterial loop is occluded at tubal
> ligation, is proposed as a possible cause of oestrogen deficiency
syndrome,
> dysfunctional uterine bleeding, and menorrhagia after tubal ligation.
> Similar pathophysiology may occur after hysterectomy with ovarian
> conservation.