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Pais AS, Flagothier C, Tebache L, Almeida Santos T, Nisolle M. Impact of Surgical Management of Endometrioma on AMH Levels and Pregnancy Rates: A Review of Recent Literature. J Clin Med 2021; 10:jcm10030414. [PMID: 33499120 PMCID: PMC7865255 DOI: 10.3390/jcm10030414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 01/13/2023] Open
Abstract
Ovarian endometrioma are found in up to 40% of women with endometriosis and 50% of infertile women. The best surgical approach for endometrioma and its impact on pregnancy rates is still controversial. Therefore, we conducted a literature review on surgical management of ovarian endometrioma and its impact on pregnancy rates and ovarian reserve, assessed by anti-Müllerian hormone (AMH) serum levels. Ovarian cystectomy is the preferred technique, as it is associated with lower recurrence and higher spontaneous pregnancy rate. However, ablative approaches and combined techniques are becoming more popular as ovarian reserve is less affected and there are slightly higher pregnancy rates. Preoperative AMH level might be useful to predict the occurrence of pregnancy. In conclusion, AMH should be included in the preoperative evaluation of reproductive aged women with endometriosis. The surgical options for ovarian endometrioma should be individualized. The endometrioma ablation procedure seems to be the most promising treatment.
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Affiliation(s)
- Ana Sofia Pais
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal;
- Obstetrics Department, Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Biophysics Institute of Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-548 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-548 Coimbra, Portugal
- Correspondence:
| | - Clara Flagothier
- Department of Obstetrics and Gynaecology, Hospital CHR Liège, University of Liège, 4000 Liège, Belgium; (C.F.); (L.T.); (M.N.)
| | - Linda Tebache
- Department of Obstetrics and Gynaecology, Hospital CHR Liège, University of Liège, 4000 Liège, Belgium; (C.F.); (L.T.); (M.N.)
| | - Teresa Almeida Santos
- Reproductive Medicine Unit, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal;
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
| | - Michelle Nisolle
- Department of Obstetrics and Gynaecology, Hospital CHR Liège, University of Liège, 4000 Liège, Belgium; (C.F.); (L.T.); (M.N.)
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Cobo A, Coello A, de Los Santos MJ, Giles J, Pellicer A, Remohí J, García-Velasco JA. Number needed to freeze: cumulative live birth rate after fertility preservation in women with endometriosis. Reprod Biomed Online 2021; 42:725-732. [PMID: 33573907 DOI: 10.1016/j.rbmo.2020.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/15/2020] [Accepted: 12/29/2020] [Indexed: 11/16/2022]
Abstract
RESEARCH QUESTION How does the number of oocytes used affect the cumulative live birth rate (CLBR) in endometriosis patients who had their oocytes vitrified for fertility preservation? DESIGN Retrospective observational study including data from 485 women with endometriosis who underwent fertility preservation from January 2007 to July 2018. Survival curves and Kaplan-Meier plots were used to analyse the CLBR according to the number of vitrified oocytes used. Endometriosis curves were compared with plots developed using elective fertility preservation (EFP) patients as control group. Log-rank, Breslow and Tarone-Ware tests were used to compare the survival curves. RESULTS The CLBR increased as the number of oocytes used per patient rose, reaching 89.5% (95% confidence interval [CI] 80.0-99.1%) using 22 oocytes. Higher outcomes were observed in young women (≤35 years old versus >35 years old). In the younger group, the CLBR was 95.4% (95% CI 87.2-103.6%) using approximately 20 oocytes versus 79.6% (95% CI 58.1-101.1%) in older women (log-rank [Mantel-Cox] P = 0.002). The mean age was higher in EFP patients (37.2 ± 4.9 versus 35.7 ± 3.7; P < 0.001). The outcome was better in the endometriosis group as compared with EFP: a CLBR of 89.5% (95% CI 80.0-99.1%) versus 59.9% (95% CI 51.4-68.6%) when 22 oocytes were used (log-rank [Mantel-Cox] P < 0.00001). CONCLUSION The probability of live birth increases as the number of oocytes used increases in patients with endometriosis, but better outcomes were observed among young women. The information provided here may be of interest to both patients and treating physicians for counselling purposes.
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Affiliation(s)
- Ana Cobo
- IVIRMA Valencia, Plaza de la Policía Local 3, Valencia 46015, Spain.
| | - Aila Coello
- IVIRMA Valencia, Plaza de la Policía Local 3, Valencia 46015, Spain
| | | | - Juan Giles
- IVIRMA Valencia, Plaza de la Policía Local 3, Valencia 46015, Spain
| | - Antonio Pellicer
- IVIRMA Valencia, Plaza de la Policía Local 3, Valencia 46015, Spain
| | - José Remohí
- IVIRMA Valencia, Plaza de la Policía Local 3, Valencia 46015, Spain
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Wattanayingcharoenchai R, Rattanasiri S, Charakorn C, Attia J, Thakkinstian A. Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021; 128:25-35. [PMID: 32558987 PMCID: PMC7754428 DOI: 10.1111/1471-0528.16366] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND The efficacy of hormonal regimens for the prevention of endometrioma recurrence in women who have undergone conservative surgery is still controversial. OBJECTIVE To compare the efficacy of different hormonal regimens in this context and to rank them. SEARCH STRATEGY MEDLINE and Scopus databases were searched through January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) or cohorts, comparing the effect of any pair of interventions (i.e. cyclic oral contraceptives [OC], continuous OC, gonadotropin-releasing hormone agonist [GnRHa], dienogest [DNG], levonorgestrel-releasing intrauterine system [LNG-IUS] and expectant management) on endometrioma recurrence were selected. DATA COLLECTION AND ANALYSIS Data were independently extracted by two reviewers. Relative treatment effects were estimated using network meta-analysis (NMA) and ranked in descending order. MAIN RESULTS Six RCTs (675 patients) and 16 cohorts (3089 patients) were included. NMA of the RCTs involving expectant management, cyclic OC, continuous OC, GnRHa and GnRHa + LNG-IUS, showed that all hormonal regimens had a nonsignificant lower risk of endometrioma recurrence compared with expectant management. NMA of the cohorts involving expectant, cyclic OC, continuous OC, GnRHa, DNG, LNG-IUS, GnRHa + OC, and GnRHa + LNG-IUS indicated that LNG-IUS, DNG, continuous OC, GnRHa + OC and cyclic OC had a significantly lower risk of endometrioma recurrence than expectant management. LNG-IUS was ranked highest, followed by DNG and GnRHa + LNG-IUS. Long-term use of hormonal treatment either OC or progestin had a significantly lower risk of endometrioma recurrence than expectant treatment. CONCLUSION In the NMA of RCTs, there was no evidence supporting hormonal treatment for postoperative prevention of endometrioma recurrence. This was at odds with the cohort evidence, which found the protective effect of OC and progestin regimens, especially long-term treatment. Large-scale RCTs of these agents are still required. TWEETABLE ABSTRACT Hormonal regimens given as long-term treatment tend to reduce risk of endometrioma recurrence after conservative surgery.
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Affiliation(s)
- R Wattanayingcharoenchai
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand,Department of Obstetrics and GynaecologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - S Rattanasiri
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - C Charakorn
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand,Department of Obstetrics and GynaecologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - J Attia
- Centre for Clinical Epidemiology and BiostatisticsSchool of Medicine and Public HealthFaculty of Health and MedicineUniversity of NewcastleNew LambtonAustralia
| | - A Thakkinstian
- Department of Clinical Epidemiology and BiostatisticsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
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Hong YH, Lee HK, Kim SK, Lee JR, Suh CS. The Significance of Planned Fertility Preservation for Women With Endometrioma Before an Expected Ovarian Cystectomy. Front Endocrinol (Lausanne) 2021; 12:794117. [PMID: 34975763 PMCID: PMC8715896 DOI: 10.3389/fendo.2021.794117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/25/2021] [Indexed: 01/21/2023] Open
Abstract
Endometrioma is known to reduce the ovarian reserve and the extent of the decrease is more severe when ovarian surgery is performed. Therefore, to prevent this decline in fertility, patients with endometrioma are considered candidates for preoperative fertility preservation (FP). In this study, we evaluate the efficacy of FP in women with endometrioma before planned ovarian surgery. A total of 95 cycles in 62 patients with endometrioma, undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin-releasing hormone (GnRH) antagonist protocol before an expected ovarian surgery, were enrolled retrospectively. COS outcomes were compared according to endometrioma laterality. Additionally, first COS cycle outcomes in patients with endometrioma were compared with those in infertile patients, or in patients with a benign ovarian cyst using propensity score matching. When multiple COS cycles were performed, the results of cumulative cycles were analyzed. Embryo quality was worse in the bilateral endometrioma group. Compared with the infertile patient group, the patients with endometrioma had significantly lower Anti-Müllerian Hormone (AMH) and fewer numbers of oocytes retrieved (median, 3.3 vs. 1.2, p<0.001; 7.0 vs. 4.0, p=0.009, respectively). Compared with mature oocytes in infertile patients or patients with a benign cyst, mature oocytes were fewer in patients with endometrioma, but this was not statistically significant (median, 4.0 vs. 3.0, p=0.085; 5.5 vs. 3.0, p=0.052, respectively). The median value of the cumulative number of cryopreserved oocytes or embryos was 14.5 up to the fourth cycle compared to 3 up to the first cycle, with cumulative effect. Women with endometrioma should be counseled for FP before planned ovarian cystectomy. The number of cryopreserved oocytes or embryos can be increased by repeated cycles.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Kyoung Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Jung Ryeol Lee,
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgical Oncology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
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Iwami N, Kawamata M, Ozawa N, Yamamoto T, Watanabe E, Mizuuchi M, Moriwaka O, Kamiya H. New treatment strategy for endometriosis using progestin-primed ovarian stimulation with dienogest: A prospective cohort study, comparison of dienogest versus dydrogesterone. Reprod Biol 2020; 21:100470. [PMID: 33333410 DOI: 10.1016/j.repbio.2020.100470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022]
Abstract
Dienogest (DNG) is an oral progestin effective for the treatment of symptomatic endometriosis, such as reduction of endometrial lesion and control of pain intensity. Progestin-primed ovarian stimulation (PPOS) is a new controlled ovarian hyperstimulation (COH) regimen, and several reports have shown that dydrogesterone (DYG) is an appropriate progestin for PPOS. The purpose of this study was to evaluate the efficacy of DNG in patients undergoing PPOS during COH in comparison with DYG. This was a prospective, cohort, parallel-group, non-inferiority trial of 150 women with endometriosis undergoing assisted reproductive technology between February 2018 and May 2020 at the single fertility center. The assignment to each protocol was based on the optimal treatment for each patient. Patients taking DNG 2 mg continuously were assigned in the DNG group(n = 73). The other patients were allocated in DYG group(n = 77). All viable embryos were cryopreserved for subsequent transfer. The main outcome measures were the mature oocyte and fertilization rates. During this study, no premature LH surge was detected. A smaller number of oocytes were retrieved in the DNG group than in the DYG group (6.18 ± 3.60 vs. 9.85 ± 5.77); however, the rate of mature oocytes was significantly higher in the DNG group than in the DYG group (89.1 % vs. 78.9 %). The fertilization rate was comparable between two groups. Therefore, patients taking DNG for PPOS can continue endometriosis treatment and obtain good-quality embryos during COH. Further prospective randomized-controlled trial should be performed to confirm of this novel strategy of DNG.
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Affiliation(s)
- Nanako Iwami
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan.
| | - Miho Kawamata
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Naoko Ozawa
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Takahiro Yamamoto
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Eri Watanabe
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Masahito Mizuuchi
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Osamu Moriwaka
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
| | - Hirobumi Kamiya
- Kamiya Ladies Clinic, 2-1, Nishi 2, Kita 3, Chuo-ku, Sapporo, Hokkaido, 060-0003, Japan
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56
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Miller CE. The Endometrioma Treatment Paradigm when Fertility Is Desired: A Systematic Review. J Minim Invasive Gynecol 2020; 28:575-586. [PMID: 33249267 DOI: 10.1016/j.jmig.2020.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To establish an endometrioma treatment paradigm (decision tree) in the treatment of an ovarian endometrioma through the review of current literature. DATA SOURCES A thorough literature search, including PubMed, Google Scholar, and the Cochrane Library, was performed from April 2020 to July 2020. The review was completed by using the following keywords: METHODS OF STUDY SELECTION: Articles published in English that addressed the endometrioma in regard to the following were included: (1) diagnosis, (2) treatment of pain on the basis of size and/or surgical intervention, (3) treatment of fertility on the basis of size and/or surgical intervention, (4) surgical technique, (5) in vitro fertilization success on the basis of size and/or surgical intervention, (6) risk of rupture at the time of egg retrieval, (7) impact on the antimüllerian hormone and antral follicle count postsurgery, and (8) impact on implantation. TABULATION, INTEGRATION, AND RESULTS Fifty-six articles were included in this systematic review. While conducting this literature review, several themes were noted. In general, the literature on the ovarian endometrioma seems to be homogeneous in regard to imaging the endometrioma, excision rather than desiccation for an endometrioma ≥3-cm causing pain and/or infertility, minimal use of bipolar energy at the time of ovarian surgery, and risk of severe infection secondary to inadvertent rupture of cysts during egg retrieval. Conversely, studies on the ovarian endometrioma are much more heterogeneous in terms of surgery and assisted reproductive technology, that is, whether surgery should be performed. Certainly, an endometrioma ≥5-cm should be excised before assisted reproductive technology. Moreover, it seems that the antral follicle count and implantation may be enhanced with surgery. CONCLUSION By completing an extensive literature review, an easy-to-use algorithm for the diagnosis, evaluation, and treatment of endometriomas was developed to help clinicians in their treatment of patients with endometriosis in the short and long terms.
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Affiliation(s)
- Charles E Miller
- Department of Clinical Sciences, Rosalind Franklin University of Medicine and Science, North Chicago; Department of Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois..
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Jourdain H, Flye Sainte Marie H, Courbière B, Lazaro G, Boukerrou M, Tran PL. Evaluation of physicians' practice patterns in France concerning fertility preservation in women with endometriosis. J Gynecol Obstet Hum Reprod 2020; 50:101985. [PMID: 33189944 DOI: 10.1016/j.jogoh.2020.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/03/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aim to evaluate the knowledge and physicians' practices concerning fertility preservation in women with endometriosis. DESIGN Descriptive, observational, national study using an online self-questionnaire, sent by email to French gynaecologists in October 2019 within 2 months. RESULTS We obtained 110 analyzable responses from mainly surgeons (54 %) and reproductive clinicians (19 %) with a good experience (average 15 years of practice). Amongst these practitioners, 91 % seemed aware of latest French recommendations on endometriosis issued in December 2017. The most commonly used surgical techniques for management of endometriomas were intra-peritoneal cystectomy (51 %), vaporization by plasma energy (29 %) and destruction by bipolar coagulation (8.5 %). Preoperative AMH was systematically or often prescribed by 78 % of the practitioners against 37.3 % who did it postoperatively. Furthermore, 74 % also considered and performed fertility preservation strategy to manage endometriosis. It was offered in situations of bilateral or recurrent endometrioma, but only 33 % offered it in unilateral endometrioma cases. In the cases recorded, vitrification of mature oocytes appears to be the most common fertility preservation technique (used by 87 % of the practitioners). CONCLUSION We observed in our population of sensitized practitioners a good and adequate knowledge concerning endometriosis physiopathology and recommendations for its management, with good information delivery to women. Operating techniques are adapted although information and education concerning fertility preservation indications seem necessary. The place of multidisciplinary concertation meeting in endometriosis appears essential both for discussion of surgical indications and for fertility preservation possibilities. Creation of dedicated structures should be encouraged.
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Affiliation(s)
- H Jourdain
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France.
| | - H Flye Sainte Marie
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France
| | - B Courbière
- Centre d'Assistance Médicale à la Procréation, AP-HM La Conception, 147 bd Baille, 13005, Marseille, France; Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France
| | - G Lazaro
- Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, London, UK
| | - M Boukerrou
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Centre d'Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Unité de formation et de recherche santé de La Réunion, Faculté de Médecine, 97490, Saint Denis, La Réunion, France
| | - P L Tran
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France; Centre d'Etudes Périnatales Océan Indien, Centre Hospitalier Universitaire Sud-Réunion, BP 350, 97448, Saint-Pierre Cedex, La Réunion, France
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Asoglu MR, Celik C, Bahceci M. Frozen blastocyst transfer improves the chance of live birth in women with endometrioma. Gynecol Endocrinol 2020; 36:902-906. [PMID: 32568558 DOI: 10.1080/09513590.2020.1781082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: The existing literature is scarce regarding outcomes of fresh vs frozen embryo blastocyst transfers in women with endometrioma. The goal of the study was to compare outcomes between fresh and frozen blastocyst transfers (fresh-BT vs. frozen-BT) in endometrioma-affected women. Materials and methods: This study included 315 endometrioma-affected women aged between 20 and 39 years who underwent blastocyst transfer. Primary outcome was live birth rate (an alive birth after 24 completed weeks gestation). Results: The study groups did not differ in terms of patient characteristics and treatment variables. The live birth rate was 40.7% in fresh-BT group and 56.1% in frozen-BT group (OR:1.86, 95% CI:1.18-2.92 p = .007). The approach of frozen embryo transfer was an independent factor of live birth (adjusted OR:1.83, 95% CI:1.16-2.90, p = .009). Conclusion: The approach of frozen blastocyst transfer increases the chance of live birth in endometrioma-affected patients compared with fresh blastocyst transfer. Thus, a frozen embryo transfer may be the choice of strategy in these patients.
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Affiliation(s)
| | - Cem Celik
- Bahceci Umut Assisted Reproduction Center, Istanbul, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, Uskudar University, Istanbul, Turkey
| | - Mustafa Bahceci
- Bahceci Fulya Assisted Reproduction Center, Istanbul, Turkey
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Cecchino GN, Cozzolino M, Roque M, García-Velasco JA. Endometrioma and reproductive issues: a well-informed patient may be the driver for change. ACTA ACUST UNITED AC 2020; 72:149-156. [PMID: 33000615 DOI: 10.23736/s0026-4784.20.04595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Endometriosis affects a great proportion of women during their reproductive years and may impair female fertility in several ways. Ovarian endometrioma (OE) is the most frequent phenotype and growing evidence suggest an endometrioma-mediated damage to the ovary, ovarian reserve and oocyte quality. Traditionally, surgery has been the first-line treatment in cases of OE. Great advances in assisted reproduction and fertility preservation techniques opened new possibilities towards a more conservative approach. Herein we discuss multiple mechanisms responsible for the deterioration of the reproductive capacity in cases of OE as well as the pros and cons of different treatment options. The management of endometrioma-related subfertility remains controversial and it will depend on patient's intentions and priorities. In the "internet era" patients tend to be hyper-informed and more participative, but they are often misguided and misinformed. Thus, doctors should be able to convert these individuals into well-informed patients in order to facilitate the process of shared decision making, which is extremely relevant in the context of OEs.
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Affiliation(s)
- Gustavo N Cecchino
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil - .,Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain - .,Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil -
| | - Mauro Cozzolino
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,IVIRMA, IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Juan A García-Velasco
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Reproductive Medicine and Infertility, IVIRMA Madrid, Madrid, Spain
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Nankali A, Kazeminia M, Jamshidi PK, Shohaimi S, Salari N, Mohammadi M, Hosseinian-Far A. The effect of unilateral and bilateral laparoscopic surgery for endometriosis on Anti-Mullerian Hormone (AMH) level after 3 and 6 months: a systematic review and meta-analysis. Health Qual Life Outcomes 2020; 18:314. [PMID: 32972380 PMCID: PMC7513290 DOI: 10.1186/s12955-020-01561-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. METHODS In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. RESULTS In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). CONCLUSION The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.
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Affiliation(s)
- Anisodowleh Nankali
- School of Medicine, Department of Obstetrics and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parnian Kord Jamshidi
- School of Medicine, Department of Obstetrics and Gynecology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
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Tian Z, Zhang Y, Zhang C, Wang Y, Zhu HL. Antral follicle count is reduced in the presence of endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 2020; 42:237-247. [PMID: 33168492 DOI: 10.1016/j.rbmo.2020.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
Abstract
Studies suggest that the presence of endometriosis may lead to impaired ovarian reserve, while results evaluating the changes in antral follicle count (AFC) in endometriosis remain controversial. A systematic search returned 15 studies, of which nine compared AFC between patients with and without endometriosis, five articles reported differences in AFC between affected and unaffected ovaries in patients with unilateral ovarian endometriosis and one reported both of the above two situations. Overall results showed a significant decrease in AFC and anti-Müllerian hormone (AMH) and increase in serum FSH concentrations in patients with endometriosis when compared with controls. Additionally, the AFC for the ovary with the endometrioma was also significantly lower than that of the contralateral ovary in patients with unilateral ovarian endometriosis. Moreover, it appears that the AFC in patients with endometriosis where the ovaries are not affected or in early stage were not significantly different in the control group. These findings demonstrate that endometriosis is associated with reduced AFC and AMH and elevated serum concentrations of FSH, suggesting a reduction in ovarian reserve in patients with endometriosis, especially in those with ovarian endometrioma and advanced stage.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yang Zhang
- Department of Pediatrics, People's Hospital, Peking University, Beijing 100044, China
| | - Chen Zhang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing 100044, China.
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Koo JH, Lee I, Han K, Seo SK, Kim MD, Lee JK, Kwon JH, Kim GM, Lee J, Won JY. Comparison of the therapeutic efficacy and ovarian reserve between catheter-directed sclerotherapy and surgical excision for ovarian endometrioma. Eur Radiol 2020; 31:543-548. [PMID: 32770376 DOI: 10.1007/s00330-020-07111-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/10/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the efficacies of catheter-directed sclerotherapy (CDS) with 99% ethanol and surgery for ovarian endometrioma and their impact on the ovarian reserve. METHODS From January 2011 to June 2019, 71 patients who underwent surgical excision (n = 51) or CDS (n = 20) for symptomatic ovarian endometriomas were reviewed. To analyze the effect on the ovarian reserve, serum anti-Müllerian hormone (AMH) levels were compared before and after the procedure. Symptoms, serum cancer antigen 125 (CA-125), lesion size, recurrence, hospitalization, and complications were reviewed retrospectively. RESULTS During a mean follow-up of 22.3 months (range, 6 to 94 months), no significant difference in symptom relief was found between CDS and surgery (95.0% [19/20] and 92.2% [47/51], respectively, p > 0.999). The hospital stay was shorter with CDS than with surgery (2.6 ± 0.6 days and 4.1 ± 0.5 days, respectively, p < 0.001). There was no significant difference in serum AMH levels before and after CDS (2.3 (interquartile range (IQR) 1.1-5.3) ng/mL and 2.6 (IQR 0.9-4.9) ng/mL, respectively, p = 0.243), but there was a significant decrease in serum AMH in the surgery group (3.0 (IQR 1.3-5.5) ng/mL and 1.6 (IQR 0.7-3.2) ng/mL, respectively, p < 0.001). CA-125 decreased in both CDS and surgery groups (p = 0.001 and < 0.001, respectively). Two minor complications occurred in the surgery group, while no complication was observed in the CDS group. CONCLUSIONS The therapeutic efficacy of CDS appears to be comparable to that of surgical resection for ovarian endometrioma. Ovarian function was well-preserved, and a shorter hospital stay was required in patients who underwent CDS. KEY POINTS • There was no significant difference in symptom relief between CDS and surgery (95.0% [19/20], 92.2% [47/51], respectively, p >0.999). • No significant difference in serum AMH levels was seen before and after CDS (2.3 (1.1, 5.3)* ng/mL, 2.6 (0.9, 4.9)* ng/mL, respectively, p = 0.243), whereas serum AMH levels significantly decreased after surgical resection (3.0 (1.3, 5.5)* ng/mL, 1.6 (0.7, 3.2)* ng/mL, respectively, p <0.001). *Median (25 quartiles, 75 quartiles) • The hospitalization period was shorter with CDS than with surgery (2.6 ± 0.6 days, 4.1 ± 0.5 days, respectively, p <0.001).
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Affiliation(s)
- Ja Ho Koo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Man-Deuk Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jae Kyung Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Junhyung Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
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Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality. J Clin Med 2020; 9:jcm9082478. [PMID: 32752267 PMCID: PMC7464781 DOI: 10.3390/jcm9082478] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorly understood. This study aimed to evaluate the impact of endometriosis on in vitro fertilization (IVF) parameters, especially on embryo quality and IVF outcomes. A total of 1124 cycles with intracytoplasmic sperm injection were retrospectively evaluated, including 155 cycles with endometriosis and 969 cycles without endometriosis. Women with endometriosis had significantly lower ovarian reserve markers (AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher doses of exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, and top-quality embryos than women in the control group. Multivariate analysis did not reveal any association between endometriosis and the proportion of top-quality embryo (OR = 0.87; 95% CI [0.66-1.12]; p = 0.3). The implantation rate and the live birth rate per cycle were comparable between the two groups (p = 0.05), but the cumulative live births rate was significantly lower in in the endometriosis group (32.1% versus 50.7%, p = 0.001), as a consequence of the lower number of frozen embryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing the number of embryos available to transfer, but not their quality.
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Vignali M, Belloni GM, Pietropaolo G, Barbasetti Di Prun A, Barbera V, Angioni S, Pino I. Effect of Dienogest therapy on the size of the endometrioma. Gynecol Endocrinol 2020; 36:723-727. [PMID: 32065005 DOI: 10.1080/09513590.2020.1725965] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Studies have been published on the efficacy of Dienogest in the management of pain symptoms in endometriosis. Nonetheless, few data are available on the reducing effect on endometrioma's size. The aim of the study was to evaluate if Dienogest could determine significant changes in size, as well as in symptoms. In this prospective observational study, patients were enrolled with pain symptoms and at least one endometrioma diagnosed via TV-US. The volume of the endometrioma and pain symptoms was measured according to the LxDxWx0.5233 formula and VAS, respectively. Dienogest 2 mg was administered daily. Follow-up visits were scheduled after 6 and 12 months of treatment to assess changes in patients' symptoms and endometrioma's volume. Seventy patients were enrolled, 63 patients completed a 6-month treatment. The reduction of the mean volume after 6 months was 66.71%. Fifty-eight patients completed the 12 month-treatment. The reduction of the mean volume after 12 months was 76.19%. Dysmenorrhea showed a 74.05% reduction after 6 months and a 96.55% reduction after 12 months. Patients reported a reduction in dyspareunia and chronic pelvic pain of 42.71% and 48.91% after 6 months and 51.93% and 59.96% after 12 months, respectively. Dienogest leads to a statistically significant reduction of endometrioma's volume and pain symptoms.
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Affiliation(s)
- Michele Vignali
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Gaia Maria Belloni
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Giuliana Pietropaolo
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Allegra Barbasetti Di Prun
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Valeria Barbera
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
| | - Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Ida Pino
- Department of Biomedical Science for the Health, University of Milan, Macedonio Melloni Hospital, Milan, Italy
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Ottolina J, Ferrari S, Bartiromo L, Bonavina G, Salmeri N, Schimberni M, Makieva S, Tandoi I, Papaleo E, ViganÒ P, Candiani M. Ovarian responsiveness in assisted reproductive technology after CO2 fiber laser vaporization for endometrioma treatment: preliminary data. MINERVA ENDOCRINOL 2020; 45:288-294. [PMID: 32638581 DOI: 10.23736/s0391-1977.20.03256-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data about endometrioma ablation using energies with little thermal spread reported good results in terms of ovarian reserve and postoperative pregnancy rates. The aim of the present study was to assess the impact of one step CO<inf>2</inf> fiber laser vaporization for endometrioma on subsequent controlled ovarian stimulation. METHODS This prospective observational cohort study included a consecutive series of infertile patients who have undergone CO<inf>2</inf> fibre laser vaporization for endometrioma treatment. The primary endpoint was to assess the number of follicles per ovary growing during controlled ovarian stimulation. The secondary endpoints included the number of oocytes retrieved, the total number of embryos obtained and the cumulative clinical pregnancy rate per patient treated. RESULTS Twenty-six patients underwent assisted reproductive technology after surgery for endometriosis-related infertility. In unilateral operated ovaries at the end of controlled ovarian stimulation no significant differences emerged from comparison of total recruited follicles in the operated ovary and in the contralateral ovary (P=0.55). If considering only bilateral endometriomas, the number of recruited follicles at the end of controlled ovarian stimulation was similar in both operated ovaries (P=0.79). The number of cumulative clinical pregnancies was 15 (57.7%; 95% CI: 38.5-76.9%). When comparing women aged ≤35 years to those aged >35 years, controlled ovarian stimulation outcomes were significantly higher in the younger patients. Age at the time of assisted reproductive technology was the only independent predictor for follicular growth during ovarian hyperstimulation (95% CI: -1.27 to -0.116, P=0.027). CONCLUSIONS CO2 laser-treated endometrioma is associated with favorable reproductive assisted reproductive technology outcomes.
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Affiliation(s)
- Jessica Ottolina
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Stefano Ferrari
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ludovica Bartiromo
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bonavina
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Noemi Salmeri
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Schimberni
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Makieva
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Iacopo Tandoi
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola ViganÒ
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Department of Gynecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Effect of GnRH agonist before IVF on outcomes in infertile endometriosis patients: a randomized controlled trial. Reprod Biomed Online 2020; 41:653-662. [PMID: 32782170 DOI: 10.1016/j.rbmo.2020.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
RESEARCH QUESTION Does 3-months of gonadotrophin releasing hormone agonist (GnRHa) treatment before IVF improve clinical pregnancy rate in infertile patients with endometriosis? DESIGN Single-blind, placebo-controlled clinical trial of 200 infertile women with endometriosis assigned to use GnRHa (study group) or placebo (control group) for 3 months before IVF. Clinical, embryological outcomes and stimulation parameters were analysed. Clinical pregnancy rate was the primary endpoint. In a subgroup of 40 patients, follicular fluid levels of oestradiol, testosterone and androstendione were measured. Gene expression profile of CYP19A1 was analysed in cumulus and mural granulosa cells. RESULTS Implantation or clinical pregnancy rate were not significantly different between the two groups. Clinical pregnancy rates were 25.3% and 33.7% in the study and control groups, respectively (P = 0.212). Cumulative live birth rate was not significantly different: 22.0% (95% CI 13.0 to 31.0) in the study group and 33.7% (95% CI 24.0 to 44.0) in the control group (P = 0.077). Ovarian stimulation was significantly longer and total dose of gonadotrophins significantly higher in the study group (both P < 0.001). Serum oestradiol levels on the day of HCG were significantly lower in the study group (P = 0.001). Cancellation rate was significantly higher in the study group (P = 0.042), whereas cleavage embryos were significantly more numerous in the control group (P = 0.023). No significant differences in the expression of CYP19A1 gene in mural or cumulus granulosa cells or steroid levels in follicular fluid between the two groups were observed, but testosterone was significantly lower in the study group (P < 0.001). CONCLUSION Three-months of GnRHa treatment before IVF does not improve clinical pregnancy rate in women with endometriosis.
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YILDIZ Ş, KAYA C, ALAY İ, EKİN M, YAŞAR L. Laparoskopik endometrioma kistektomi cerrahilerinde elektrokoagülasyon veya sütür tekniği ile sağlanan hemostazın rekürrens ve gebelik sağlama oranına etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.635204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rocha RM, Barcelos IDES. Practical Recommendations for the Management of Benign Adnexal Masses. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:569-576. [PMID: 32559804 PMCID: PMC10309218 DOI: 10.1055/s-0040-1714049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To perform a comprehensive review to provide practical recommendations regarding the diagnosis and treatment of benign adnexal masses, as well as information for appropriate consent, regarding possible loss of the ovarian reserve. METHODS A comprehensive review of the literature was performed to identify the most relevant data about this subject. RESULTS In total, 48 studies addressed the necessary aspects of the review, and we described their epidemiology, diagnoses, treatment options with detailed techniques, and perspectives regarding future fertility. CONCLUSIONS Adnexal masses are extremely common. The application of diagnosis algorithms is mandatory to exclude malignancy. A great number of cases can be managed with surveillance. Surgery, when necessary, should be performed with adequate techniques. However, even in the hands of experienced surgeons, there is a significant decrease in ovarian reserves, especially in cases of endometriomas. There is an evident necessity of studies that focus on the long-term impact on fertility.
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Affiliation(s)
- Rodrigo Manieri Rocha
- Departament of Gynecology and Obstetrics, Universidade Estadual do Oeste do Paraná, Cascavel, Paraná, PR, Brazil
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Rius M, Gracia M, Ros C, Martínez-Zamora MÁ, deGuirior C, Quintas L, Carmona F. Impact of endometrioma surgery on ovarian reserve: a prospective, randomized, pilot study comparing stripping with CO 2 laser vaporization in patients with bilateral endometriomas. J Int Med Res 2020; 48:300060520927627. [PMID: 32527167 PMCID: PMC7294500 DOI: 10.1177/0300060520927627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess ovarian reserve through antral follicle count (AFC) and ovarian volume (OV) determination after decapsulation (stripping technique) or CO2 laser vaporization in the surgical treatment of patients with bilateral ovarian endometriomas. Methods This prospective, randomized, blinded, self-controlled pilot study was set in a tertiary university hospital between January 2017 and December 2017, and included consecutive patients with bilateral ovarian endometriomas ≥3 cm. The study was registered with ClinicalTrials.gov under the title ‘Impact on ovarian reserve according to the type of ovarian endometrioma excision: laser versus conventional cystectomy’; NCT 03826355. For each patient, the endometrioma on one side was randomly selected to undergo CO2 laser vaporization and the contralateral endometrioma to undergo laparoscopic decapsulation. Results A total of 16 patients were included. There were no statistically significant between-group differences in OV and AFC levels at baseline. At the 6-month follow-up, OV and AFC levels were significantly higher in the laser-treated group versus the stripping technique. Conclusion Lower OV and AFC levels following excisional surgery for endometrioma versus CO2 laser vaporization suggest a higher impact on ovarian reserve after the stripping procedure.
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Affiliation(s)
- Mariona Rius
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Meritxell Gracia
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Ros
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Cristian deGuirior
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lara Quintas
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Carmona
- Endometriosis Unit, ICGON, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Maheshwari A, Healey J, Bhattacharya S, Cooper K, Saraswat L, Horne AW, Daniels J, Breeman S, Brian K, Burns G, Hudson J, Gillies K. Surgery for women with endometrioma prior to in vitro fertilisation: proposal for a feasible multicentre randomised clinical trial in the UK. Hum Reprod Open 2020; 2020:hoaa012. [PMID: 32529045 PMCID: PMC7275637 DOI: 10.1093/hropen/hoaa012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Is it feasible to undertake a randomised controlled trial to establish whether surgical removal of endometrioma or not, improves live birth rates from IVF? SUMMARY ANSWER A randomised controlled trial (RCT) comparing surgery versus no surgery to endometrioma prior to IVF is only feasible in UK if an adaptive rather than traditional study design is used; this would minimise resource wastage and complete the trial in an acceptable time frame. WHAT IS KNOWN ALREADY There is wide variation in the management of endometriomas prior to IVF, with decisions about treatment being influenced by personal preferences. STUDY DESIGN, SIZE, AND DURATION This was a mixed-methods study consisting of an online survey of clinicians, a focus group and individual interviews with potential trial participants. PARTICIPANTS/MATERIALS, SETTING, METHODS Endometriosis and fertility experts across the UK were invited to participate in an online anonymised questionnaire. Potential future trial participants were recruited from a tertiary care fertility centre and invited to participate in either individual interviews or focus groups. MAIN RESULTS AND THE ROLE OF CHANCE Clinicians and potential trial participants confirmed the need for an RCT to inform the management of an endometrioma prior to IVF. There were 126 clinicians who completed the survey, and the majority (70%) were willing to recruit to a trial. Half of those who responded indicated that they see at least 10 eligible women each year. The main barriers to recruitment were waiting lists for surgery and access to public funding for IVF. One focus group (n = 7) and five interviews were conducted with potential trial participants (n = 3) and their partners (n = 2). The findings from these discussions highlighted that recruitment and retention in a potential RCT could be improved by coordination between IVF and surgical services such that an operation does not delay IVF or affect access to public funding. Live birth was considered the most important outcome with an improvement of at least 10% considered the minimum acceptable by both patients and clinicians. LIMITATIONS, REASONS FOR CAUTION This feasibility study captured views of clinicians across the UK, but as patients were from a single Scottish centre, their views may not be representative of other areas with limited public funding for IVF. WIDER IMPLICATIONS OF THE FINDINGS There is a need for an appropriately powered RCT to establish whether or not surgical treatment of endometrioma prior to IVF improves live birth rates. There are logistical issues to be considered due to limited number of participants, funding of IVF and waiting times. These could be overcome in a RCT by using an adaptive design which would include a prospectively planned opportunity for modification of specified aspects of the study design based on interim analysis of the data, coordination of IVF treatments and endometriosis surgeries and international collaboration. Similar principles could be used for other questions in fertility where a traditional approach for randomised trials is not feasible. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the NHS Grampian R&D pump priming fund (RG14437-12). S.B. is Editor-in-Chief of HROPEN, and A.W.H. is Deputy Editor of HROPEN. Neither was involved in the review of this manuscript. L.S. reports grants from CSO and NIHR to do endometriosis research, outside the submitted work. K.C. reports grants from NIHR/HTA and CSO during the conduct of the study. J.H.e., A.W.H., J.D., S.B.r., K.B., G.B., J.H.u. and K.G. report no conflict of interest.
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Affiliation(s)
- Abha Maheshwari
- Aberdeen Fertility Centre, NHS Grampian, Aberdeen AB25 2ZL, UK
| | - Jemma Healey
- Health Service Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Siladitya Bhattacharya
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | | | - Andrew W Horne
- The Queen's Medical Research InstituteEdinburgh, EH16 4TJ, UK
| | - Jane Daniels
- Faculty of Medical & Health Sciences, Nottingham, NG7 2UH, UK
| | - Suzanne Breeman
- Clinical Trials Unit, Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Kate Brian
- Women's Voices, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK
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Chamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC. Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis. Abdom Radiol (NY) 2020; 45:1847-1865. [PMID: 32030450 DOI: 10.1007/s00261-020-02434-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.
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Affiliation(s)
- Luciana P Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
- Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
| | - Duarte M F R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Gladis M P A R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Paulo C Serafini
- Clínica Huntington de Medicina Reprodutiva, São Paulo, São Paulo, Brazil
- Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Xholli A, Filip G, Previtera F, Cagnacci A. Modification of endometrioma size during hormone therapy containing dienogest. Gynecol Endocrinol 2020; 36:545-549. [PMID: 31842632 DOI: 10.1080/09513590.2019.1703942] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to evaluate whether hormone therapy containing dienogest is effective in reducing endometrioma size. A retrospective observational study was conducted on 116 women with endometrioma which was evaluated after 6 and 12 months of either no treatment (n = 46), or hormonal therapy containing dienogest (n = 70), without (DNG; n = 34) or with ethinylestradiol (DNG/EE; n = 36). Median (interquartile range) cyst diameter (23.0 mm (21.0 mm)) and volume (9941.2 mm3 (14240.1 mm3)) of untreated were similar to cyst diameter (25.0 mm (14.5 mm) and volume (7587.7 mm3 (13806.2 mm3)) of treated women. After 12 months, endometrioma volume did not vary in untreated women (-34.0 mm3 (55595.0 mm3); -0.77% (93.9%)) while it significantly decreased (-5400 mm3 (15378.7 mm3); -100.0% (27.7%); p<.0001) during hormone therapy. Volume decrease was linearly related to endometrioma volume ([Formula: see text] R2 = 0.899, p<.0001). The effect tended to be greater during DNG alone than DNG/EE (-100.0% (0.0%) vs. -87.9% (47.7%); p<.0004). Cyst disappearance was observed in 4.4% of untreated cases and in 57.1% of cases on hormone therapy (p<.0001) (38.9% with DNG/EE and 76.5% with DNG; p<.03). The early diagnosis and treatment of endometrioma with dienogest-based hormone therapy may be effective in controlling cyst growth and in reducing the need for surgery.
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Affiliation(s)
- Anjeza Xholli
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Gabriele Filip
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Francesca Previtera
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Clinic, Hospital San Martino-IRCCS, University of Genova, Genova, Italy
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Ibrahim ZM, Ghoneim HM, Kishk EA, Abbas AM, Greash MA, Atwa KA. Bipolar Electrocoagulation Versus Intracorporeal Hemostatic Suturing for Laparoscopic Ovarian Cystectomy: Prospective Cohort Study on Effects. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Zakia M. Ibrahim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hanan M. Ghoneim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman A. Kishk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed M. Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut, Egypt
| | - Mahmoud A. Greash
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Khaled A. Atwa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Kaya C, Usta T, Baghaki HS, Oral E. Relation between educational reliability and viewer interest in YouTube® videos depicting endometrioma cystectomy surgical techniques. J Gynecol Obstet Hum Reprod 2020; 50:101808. [PMID: 32428780 DOI: 10.1016/j.jogoh.2020.101808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the reliability of YouTube® endometrioma cystectomy videos based on technical video analysis and considering the surgical steps. MATERIAL AND METHOD The present study yielded 756 videos after a search on YouTube® with the keywords "endometriosis cystectomy, endometrioma cystectomy, chocolate cyst cystectomy, and endometrioma surgery'' during the period from January 7, 2007 to January 7, 2019. The viewer interest parameters such as total number of subscribers, views, likes, dislikes, comments, source of the videos, and the date of upload were assessed. Besides, the surgical steps were also evaluated considering committee suggestions. RESULTS There were 140 (78.7 %) videos in Group 1 (not useful and slightly useful) and 38 (21.3 %) videos in Group 2 (useful and very useful). The mean numbers of subscribers, views, and likes were 5737.843 ± 15741.302, 10614.257 ± 32702.339, and 17.7 ± 43.57, respectively, in Group 1, and 851.052 ± 1613.599, 8192.55 ± 15989.955, and 11.92 ± 27.52, respectively, in Group 2. The type of surgery was significantly different between the study groups. The videos of cases with robotic surgeries presented more useful descriptive information (p = 0.003). There was a significant difference between the study groups regarding the type of hemostasis. The presence of didactic steps was higher in Group 2 (47.4 %) compared to Group 1 (28.6 %) (p = 0.02) CONCLUSIONS: Overall, only around 21 % of YouTube videos presenting endometrioma surgery were defined as useful or very useful. The interest rates of the viewers may not compatible with the usefulness rate of the videos.
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Affiliation(s)
- Cihan Kaya
- University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Taner Usta
- Acıbadem University, Altunizade Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Hayriye Sema Baghaki
- University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Engin Oral
- Private Obstetrics and Gynecology Clinic, Istanbul, Turkey
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Asadzadeh N, Chaichian S, Ziadloo M, Mirgaloy Bayat S, Sheikhvatan M. Long-term Recurrence of Endometriosis in Women with Subfertility Caused by Endometriosis: A Comparison of the Efficacy of Surgery and Assisted Reproductive Technology as Fertilization Treatment Approaches. SHIRAZ E-MEDICAL JOURNAL 2020; 22. [DOI: 10.5812/semj.99676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Background: The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence. Objectives: The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART. Methods: The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for five years for endometriosis recurrence. Results: Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28.6% and 44.4%, respectively, indicating no significant difference between the groups (P = 0.436). In this regard, the 1-, 2-, and 3-year recurrence-free survival rate in the ART group was 87.5%, 50.0%, and 50.0%, and in the surgery group was 96.9%, 90.6%, and 70.5%, respectively. Using the Cox proportional hazard modeling adjusted for baseline variables, the method of fertilization (ART or surgery) could not affect the rate of long-term recurrence of endometriosis (odds ratio = 1.428, 95% confidence interval: 0.177 - 9.900, P = 0.784). Conclusions: The method of fertilization treatment-e g, surgery, and ART- may not affect the rate of endometriosis recurrence in women with subfertility caused by endometriosis.
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Fertility Outcomes After Laparoscopic Cystectomy in Infertile Patients with Stage III-IV Endometriosis: a Cohort with 6-10 years of Follow-up. Adv Ther 2020; 37:2159-2168. [PMID: 32200536 DOI: 10.1007/s12325-020-01299-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Ovarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III-IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III-IV endometriosis during a long-term follow-up postoperatively. METHODS We collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III-IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013. RESULTS A total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort. CONCLUSION Infertile patients with endometrioma and stage III-IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery.
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Karadağ C, Demircan S, Turgut A, Çalışkan E. Effects of laparoscopic cystectomy on ovarian reserve in patients with endometrioma and dermoid cyst. Turk J Obstet Gynecol 2020; 17:15-20. [PMID: 32341825 PMCID: PMC7171546 DOI: 10.4274/tjod.galenos.2020.37605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/09/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: To compare the effects of laparoscopic cystectomy on ovarian reserve between women with endometrioma and dermoid cyst. Materials and Methods: Thirty-six patients were diagnosed as having endometrioma (group A) and 32 patients with dermoid cyst (group B) using ultrasonography. Preoperative anti-mullerian hormone (AMH) levels were measured and unilateral antral follicle counts (AFC) were calculated for the ovary side containing the cyst. Laparoscopic cystectomy was performed using the stripping technique for all participants. After 3 months, all participants were re-evaluated between the third and sixth day of their menstrual cycle to determine AFC and AMH levels. Results: The mean serum preoperative AMH level and AFC level were significantly lower in group A than in group B (p=0.001, p=0.002), respectively. At 3 months after the surgery, serum AMH levels decreased significantly in group A from 2.04±0.68 to 1.47±0.55 (p=0.001), and from 2.60±0.57 to 2.17±0.56 in group B (p=0.001). In group A, unilateral (operated side) AFC levels decreased significantly from 4.05±1.24 to 2.16±0.94 (p=0.001), and in group B, it decreased significantly from 4.93±0.94 to 3.40±0.87 (p=0.001). The decrease in AMH levels was significantly higher in group A than in group B (p=0.033). The decrease in AFC levels was also significantly higher in group A than in group B (p=0.044). Conclusion: Laparoscopic stripping has destructive effects on serum AMH levels and the operated side AFC levels after surgery for patients with endometrioma and dermoid cysts, and laparoscopic excision of endometrioma has more destructive effects on ovarian reserve than dermoid cysts.
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Affiliation(s)
- Cihan Karadağ
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Sinem Demircan
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Abdulkadir Turgut
- İstanbul Medeniyet University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
| | - Eray Çalışkan
- Okan University Faculty of Medicine, Department of Obstetrics and Gynecology, İstanbul, Turkey
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Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med 2020; 47:1-11. [PMID: 32088944 PMCID: PMC7127898 DOI: 10.5653/cerm.2019.02971] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility. Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis. The severity of endometriosis is related to ovarian reserve. With regard to infertility treatment, medical therapy as a neoadjuvant or adjuvant to surgical therapy has no definite beneficial effect. Surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve. To overcome this disadvantage, a multistep technique has been proposed to minimize the reduction of ovarian reserve. When considering surgical treatment of endometriosis in patients experiencing infertility, it should be kept in mind that ovarian reserve can be reduced both due to endometriosis itself and by the process of removing endometriosis. In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy. In cases of severe endometriosis, the characteristics of the patient should be considered in a multidisciplinary manner to determine the prioritization of treatment modalities, including surgical treatment and assisted reproduction methods such as in vitro fertilization. The risk of cancer, complications after pregnancy, and infection during oocyte retrieval should also be considered when making treatment decisions.
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Affiliation(s)
- Dayong Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Chul Jee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Guo H, Gao H, Li J, Cong Y, Chen Q, Wang Y, Zhu Q, Lyu Q, Wu L, Chai W, Kuang Y. Impacts of medroxyprogesterone acetate on oocytes and embryos: matched case-control study in women with stage III-IV ovarian endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:377. [PMID: 32355821 PMCID: PMC7186739 DOI: 10.21037/atm.2020.02.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background This study investigated the effects of medroxyprogesterone acetate (MPA) on the oocytes and embryos in patients with advanced endometriosis who had a normal ovarian reserve and tubal infertility and received controlled ovarian hyperstimulation (COH) and explored the characteristics and pregnancy outcomes in subsequent frozen-thawed embryo transfer (FET) cycles. Methods In this prospective controlled study, 150 advanced endometriosis patients involving 150 in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycles and 163 FET cycles and 150 age-matched tubal infertility patients requiring 150 IVF/ICSI cycles and 115 FET cycles were recruited. Patients with endometriosis were sub-grouped into surgery group (n=102) (they were diagnosed with ovarian endometriomas and underwent 102 IVF/ICSI and 115FET cycles) and aspiration group (n=48) [they had ovarian "chocolate" cysts (>3 cm) that were aspirated and underwent 48 IVF/ICSI and 74 FET cycles]. Results Lower oocyte retrieval rate was noted in the endometriosis group than in the control group. Similar oocyte yield and peak estrogen (E2) level were found in two groups. The rates of mature oocyte, fertilization, cleavage, high-quality embryo, viable embryo, cancellation, implantation, and clinical pregnancy were similar between two groups. A higher oocyte yield was observed in the EMS cyst group than in the surgery group. Conclusions The ovary response, oocytes, embryos and pregnancy outcome were not influenced by the advanced endometriosis and the use of MPA and also independent of endometrioma or cyst surgery.
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Affiliation(s)
- Haiyan Guo
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Hongyuan Gao
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Jianghui Li
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Yanyan Cong
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Qianqian Zhu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Qifeng Lyu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Ling Wu
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Weiran Chai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Center for Specialty Strategy Research of Shanghai Jiao Tong University China Hospital Development Institute, Shanghai 200011, China
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Zhao F, Lan Y, Chen T, Xin Z, Liang Y, Li Y, Wang S, Zhang J, Yang X. Live birth rate comparison of three controlled ovarian stimulation protocols for in vitro fertilization-embryo transfer in patients with diminished ovarian reserve after endometrioma cystectomy: a retrospective study. J Ovarian Res 2020; 13:23. [PMID: 32113477 PMCID: PMC7049193 DOI: 10.1186/s13048-020-00622-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Women with endometriosis and previous cystectomy may respond less well to gonadotropin stimulation, which results in fewer oocytes retrieved and poor pregnancy outcomes. Choosing an appropriate protocol for such populations is essential. This study involved an analysis of the effect of different controlled ovarian stimulation (COS) protocols on the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET) in women with diminished ovarian reserve (DOR) who underwent ovarian endometrioma cystectomy. Methods A total of 342 patients that underwent IVF-ET treatment at the Beijing Obstetrics and Gynecology Hospital from January 1, 2013 to April 30, 2018 were included in this retrospective study. The patients were distributed into three groups according to the COS protocols, namely prolonged GnRH-agonist (Group A, n = 113), GnRH-antagonist (Group B, n = 121), and long GnRH-agonist (Group C, n = 108). The clinical and laboratory parameters of the three protocols were analyzed and a logistic regression of clinical pregnancy and live births was conducted. Results There were no significant differences in the age, infertility duration, basic follicle stimulation hormone (FSH), luteinizing hormone (LH), or estradiol (E2) levels as well as other baseline characteristics among groups (P > 0.05). The total gonadotrophin (Gn) dosage and duration tended to be less in the GnRH-antagonist group than in the others (P < 0.05). No significant differences were found in the implantation rate and clinical pregnancy rate among the groups, but the prolonged GnRH-agonist group showed the highest rates. In addition, no significant differences were present in the number of retrieved oocytes, oocyte fertilization rate, embryo utilization rate, live birth rate, abortion rate, ectopic pregnancy rate, or multiple pregnancy rate in the three groups (P > 0.05). Age had a significant effect on both clinical pregnancy and live birth. Conclusion For those DOR patients who had undergone ovarian endometriosis cystectomy, the prolonged GnRH-agonist protocol may achieve better clinical IVF-ET outcomes, but there were no significant differences from the other groups. The GnRH-antagonist protocol may reduce the cost and time of drug treatment. Age should be considered for its influence on pregnancy outcome. However, a larger sample size may be needed for further study.
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Affiliation(s)
- Feiyan Zhao
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Yonglian Lan
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Tong Chen
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Zhimin Xin
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Yu Liang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Ying Li
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Shuyu Wang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China
| | - Jun Zhang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China.
| | - Xiaokui Yang
- Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yao jia yuan Road, Chaoyang District, Beijing, 100026, China.
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Kim SJ, Kim SK, Lee JR, Suh CS, Kim SH. Oocyte cryopreservation for fertility preservation in women with ovarian endometriosis. Reprod Biomed Online 2020; 40:827-834. [PMID: 32295746 DOI: 10.1016/j.rbmo.2020.01.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
RESEARCH-QUESTION What is the clinical usefulness of oocyte cryopreservation for fertility preservation in women with ovarian endometriosis? DESIGN Clinical characteristics were retrospectively analysed in 34 women with endometrioma before a planned ovarian cystectomy. Ovarian stimulation outcomes were compared according to laterality. A one-to-one propensity score-matched analysis was conducted to compare ovarian stimulation outcomes of the first cycle in patients with endometrioma undergoing fertility preservation with those in infertile patients without endometrioma who underwent IVF treatment. The number of oocytes cryopreserved in repeated ovarian stimulation cycles was analysed. RESULTS The mean endometrioma size at diagnosis was 6.0 ± 2.5 cm. The mean age, serum anti-Mullerian hormone levels and number of oocytes cryopreserved were 30.7 ± 5.9 years, 1.85 ± 1.14 ng/ml, and 4.8 ± 3.2, respectively. The number of oocytes cryopreserved in bilateral endometrioma compared with unilateral endometrioma patients was 4.1 ± 2.9 versus 5.7 ± 3.4 (P = 0.600). In the propensity score-matched cohort (n = 22 per group), the number of oocytes retrieved was significantly lower in the patients with endometrioma undergoing fertility preservation compared with that in infertile patients without endometrioma (5.4 ± 3.8 versus 8.1 ± 4.8; P = 0.045). A total of 13 (38.2%) patients with endometrioma underwent repeated stimulation. The median (interquartile range) number of cryopreserved oocytes at the first and the second cycle were 3.0 (2.5-6.0) and 5.0 (2.5-7.5), respectively. CONCLUSIONS Women with endometrioma should be counselled about oocyte cryopreservation for fertility preservation before surgery. The number of cryopreserved oocytes can be increased by repeated oocyte retrieval.
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Affiliation(s)
- Se Jeong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080; Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University School of Medicine, Seoul Korea 06125
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82 Gumiro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, Korea 13620; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea 03080
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Karacan T, Ozyurek E, Yesiralioglu S, Kiyak H, Usta T, Oral E. Endometriomas with low-risk malignancy potential in ultrasonography with high human epididymis protein 4 and risk of ovarian malignancy algorithm: a cases series. Gynecol Endocrinol 2020; 36:117-121. [PMID: 31429337 DOI: 10.1080/09513590.2019.1653842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Endometriosis is an estrogen-dependent disease that affects 5 to 15% of women of reproductive age. Data from large-cohort and case-control studies indicate an increased risk for ovarian cancers in women with endometrioma. Recently, as an ovarian cancer biomarker, human epididymal secretory protein E4 (HE4) has been increasingly investigated in the differentiating of endometrioma from ovary malignancy and in confirming the benign structure of the endometrioma. This case series study describes women who underwent surgery due to increased serum HE4 levels and higher Risk of Ovarian Malignancy Algorithm (ROMA) index, in whom the final pathology was reported as benign, although, ultrasonography and magnetic resonance imaging (MRI) findings showed features of "typical" endometrioma.
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Affiliation(s)
- Tolga Karacan
- Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Eser Ozyurek
- Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seyma Yesiralioglu
- Department of Obstetrics and Gynecology, Bagcilar Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Huseyin Kiyak
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Education Hospital, University of Health Sciences, Istanbul, Turkey
| | - Taner Usta
- Department of Obstetrics and Gynecology, Altunizade Hospital, Acıbadem University, Istanbul, Turkey
| | - Engin Oral
- Department of Obstetrics and Gynecology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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83
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Raad J, Rolland L, Grynberg M, Courbiere B, Mathieu d'Argent E. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Fertility]. ACTA ACUST UNITED AC 2020; 48:330-336. [PMID: 32004782 DOI: 10.1016/j.gofs.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Borderline ovarian tumours (BOT) represent around 15% of all ovarian neoplasms and are more likely to be diagnosed in women of reproductive age. Overall, given the epidemiological profile of BOT and their favourable prognosis, ovarian function and fertility preservation should be systematically considered in patients presenting these lesions. METHODS The research strategy was based on the following terms: borderline ovarian tumour, fertility, fertility preservation, infertility, fertility-sparing surgery, in vitro fertilization, ovarian stimulation, oocyte cryopreservation, using PubMed, in English and French. RESULTS AND CONCLUSIONS Fertility counselling should become an integral part of the clinical management of women with BOT. Patients with BOT should be informed that surgical management of BOT may cause damage ovarian reserve and/or peritoneal adhesions. Nomogram to predict recurrence, ovarian reserve markers and fertility explorations should be used to provide a clear and relevant information about the risk of infertility in patients with BOT. Fertility-sparing surgery should be considered for young women who wish preserving their fertility when possible. There is insufficient evidence to claim a causal relation between controlled ovarian stimulation (COS) and BOT. However, in case of poor prognosis factors, the use of COS should be considered cautiously through a multidisciplinary approach. In case of infertility after surgery for BOT, COS can be performed without delay, once histopathological diagnosis of BOT is confirmed. There is insufficient consistent evidence that fertility drugs and COS increase the risk of recurrence of BOT after conservative management. The conservative surgical treatment can be associated to oocyte cryopreservation considering the high risk of recurrence of the disease. In women with BOT recurrence in a single ovary and in women with bilateral ovarian involvement when the conservative management is not possible, other fertility preservation strategies are available, but still experimental.
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Affiliation(s)
- J Raad
- Service de médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - L Rolland
- Centre clinicobiologique d'AMP, pôle femmes-Parents-Enfants, hôpital de La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - M Grynberg
- Service de médecine de la reproduction, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Unité Inserm U1133, université Paris-Diderot, 75013 Paris, France
| | - B Courbiere
- Centre clinicobiologique d'AMP, pôle femmes-Parents-Enfants, hôpital de La Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE, Aix-Marseille université, Avignon université, 13005 Marseille, France
| | - E Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France; UMR_S938 université Pierre-et-Marie-Curie, Paris 6, institut universitaire de cancérologie (IUC), Paris, France
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84
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The clinical outcome of Dienogest treatment followed by in vitro fertilization and embryo transfer in infertile women with endometriosis. J Ovarian Res 2019; 12:123. [PMID: 31831028 PMCID: PMC6909621 DOI: 10.1186/s13048-019-0597-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Endometriosis is considered to be the most intractable cause of female infertility. Administering any type of treatment for endometriosis before in vitro fertilization and embryo transfer (IVF-ET) is an important strategy for improving the IVF-ET outcomes for infertile women with endometriosis. In fact, treatment with a gonadotropin-releasing hormone (GnRH) agonist just before IVF-ET has been reported to improve the clinical outcome in endometriosis patients. However, the benefit of Dienogest (DNG), a synthetic progestin, treatment just before IVF-ET remains unclear. METHODS Sixty-eight infertile women with Stage III or IV endometriosis (ovarian endometrial cyst < 4 cm) were recruited for this study. The subjects were divided into 2 groups: a DNG group (n = 33) and a control group (n = 35). DNG was administered orally every day for 12 weeks prior to the conventional IVF-ET cycle in the DNG group. Standard controlled ovarian hyperstimulation with the GnRH agonist long protocol was performed in the control group. The numbers of mature follicles and retrieved oocytes, fertilization rates, implantation rates, and clinical pregnancy rate were compared between the two groups. In addition, the concentrations of inflammatory cytokines, oxidative stress markers, and antioxidants in follicular fluids were also measured. RESULTS The numbers of growing follicles, retrieved oocytes, fertilized oocytes, and blastocysts were significantly lower in the DNG group than in the control group. The fertilization and blastocyst rates were also lower in the DNG group than in the control group. Although there was no significant difference in the implantation rate between the groups, the cumulative pregnancy rate and live birth rate were lower in the DNG group than in the control group. There was no significant difference in the abortion rate. Our results failed to show that DNG reduces the inflammatory cytokine levels and oxidative stress in follicular fluids. CONCLUSIONS Administering DNG treatment just before IVF-ET did not provide any benefits to improve the clinical outcomes for infertile women with endometriosis.
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Hartono E, Budipramana E, Abdullah N, Tessy T. Ovarian Cystectomy: Stitching or Cauterizing - A Comparison Study of Anti-Mullerian Hormone Level Pre- and Postoperatively. Gynecol Minim Invasive Ther 2019; 8:101-105. [PMID: 31544019 PMCID: PMC6743229 DOI: 10.4103/gmit.gmit_58_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/09/2019] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to analyze the influence of laparoscopic management in an ovarian cyst as measured by serum anti-Mullerian hormone (AMH) levels, by comparing cautery and suturing techniques. Subjects and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, and several private hospitals in Makassar, Indonesia, from January 1, 2016, to January 31, 2018. A total sample of 90 subjects diagnosed with ovarian cysts underwent cystectomy by laparoscopy. Serum AMH level was examined in all participants both preoperatively and 1-month postoperatively. Participants were divided into two groups based on cautery and suturing techniques used in the surgery. Serum AMH levels obtained were statistically analyzed and compared between cautery and suturing groups. P < 0.05 was considered statistically significant. Results: The research result indicated a significant decrease of AMH level in each sample groups using cautery and suturing techniques; however, it was not significantly different if both methods were statistically compared (mean AMH: 1.13 ± 0.34 and 1.02 ± 0.15, with P > 0.05). Both the groups showed a greater decrease with a significant result in endometriotic cyst type and when adhesion was present during laparoscopy (P < 0.05). Other parameters such as unilateral/bilateral cyst and variety of cyst size were not showing significant differences (P > 0.05). Conclusions: This study showed that serum AMH levels clearly decreased after operative laparoscopy for different types of ovarian cysts in female patients; however, there is no significant difference regardless of surgical procedures.
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Affiliation(s)
- Eddy Hartono
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia.,The International Society for Gynaecologic Endoscopy Board Member 2017-2021
| | - Edwin Budipramana
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Nusratuddin Abdullah
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Telly Tessy
- Department of Obstetrics and Gynecology, Reproductive Medicine Division, Faculty of Medicine Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
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Lantsberg D, Fernando S, Cohen Y, Rombauts L. The Role of Fertility Preservation in Women with Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2019; 27:362-372. [PMID: 31546067 DOI: 10.1016/j.jmig.2019.09.780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To summarize the available evidence concerning fertility preservation techniques in the context of women with endometriosis. DATA SOURCES We searched for studies published between 1984 and 2019 on endometriosis and Assisted Reproductive Technology outcomes. We searched MEDLINE and PubMed and performed a manual search of reference lists within identified studies. METHODS OF STUDY SELECTION A total of 426 articles were identified, and 7 studies were eligible to be included for the systematic review. We included all published studies, excluding reviews, case reports, and animal studies. TABULATION, INTEGRATION, AND RESULTS Despite a significant increase in the number of studies addressing fertility preservation over the study period, we found a relative lack of evidence addressing the use of fertility preservation techniques in women with endometriosis. The studies identified included 2 case reports, 1 histological science study, and 4 retrospective cohort studies. CONCLUSION Women with endometriosis may benefit from fertility preservation techniques. However, there currently is a paucity of data in this population, especially when compared with other indications for fertility preservation. Although much knowledge can be translated from the oncofertility discipline, we have identified and discussed endometriosis-related changes to ovarian reserve and oocyte health that justify further well-designed research to confirm that fertility preservation outcomes are similar for women with endometriosis.
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Affiliation(s)
- Daniel Lantsberg
- Department of Obstetrics, Gynecology and Fertility, Lis Maternity Hospital (Drs. Lantsberg and Cohen); Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel.
| | - Shavi Fernando
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia
| | - Yoni Cohen
- Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Monash IVF Group, Richmond (Prof Rombauts), Australia
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Goldberg JM, Falcone T, Diamond MP. Current controversies in tubal disease, endometriosis, and pelvic adhesion. Fertil Steril 2019; 112:417-425. [DOI: 10.1016/j.fertnstert.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022]
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Shaltout MF, Elsheikhah A, Maged AM, Elsherbini MM, Zaki SS, Dahab S, Elkomy RO. A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve. J Ovarian Res 2019; 12:66. [PMID: 31325962 PMCID: PMC6642736 DOI: 10.1186/s13048-019-0542-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/09/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction Laparoscopic cystectomy provides more favourable outcomes as regards the recurrence and subsequent clinical pregnancy rates. It is associated with significant reduction in the ovarian reserve due to the inevitable removal of unaffected ovarian tissue. The aim of our study was to evaluate the efficiency of Surgicel in preventing recurrence of endometriomas after their laparoscopic conservative management (cystectomy or drainage). Material and methods A randomized controlled trial included two hundred women (candidate for conservative laparoscopic management of ovarian endometriomas). They were randomized into four groups; group D in which patients underwent laparoscopic drainage of the endometrioma, group C in which patients underwent laparoscopic cystectomy of the endometrioma, group DS in which patients underwent laparoscopic drainage followed by insertion of Surgicel inside the cyst cavity & group CS in which patients underwent laparoscopic cystectomy of the endometrioma followed by insertion of Surgicel inside the remaining ovarian tissues. All patients were followed up for 2 years & the primary outcome was the recurrence of endometriomas in the ipsilateral ovary & the postoperative ovarian reserve was reassessed as a secondary outcome. Results The Surgicel-treated groups had significantly lower hazard of recurrence compared to untreated groups (p = 0.004). Group CS had significantly lower hazard of recurrence compared to Group D & C (p = 0.014, 0.046 respectively). Group DS had significantly lower hazard of recurrence compared to Group D (p = 0.039) but it not significantly different from Group C (p = 0.112). Group DS had the lowest drop of AMH and was significantly lower than the other three groups. Conclusion Surgicel reduces effectively the recurrence risk of endometriomas and its use during laparoscopic drainage is an effective alternative for traditional laparoscopic cystectomy with minimal affection of the patient ovarian reserve. Trial registration Name of the registry: clinicaltrials.gov. Trial registration number NCT02947724. Date of registration October 28, 2016.
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Affiliation(s)
- Mohamed F Shaltout
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
| | - Ahmad Elsheikhah
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
| | - Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt.
| | - Moutaz M Elsherbini
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
| | - Sherif S Zaki
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
| | - Sherif Dahab
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
| | - Rasha O Elkomy
- Obstetrics and Gynecology Department, Cairo University, 481 King Faisal Street Haram, Giza, 12111, Egypt
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90
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Araujo RSDC, Maia SB, Baracat CMF, Lima MD, Soares ESS, Ribeiro HSAA, Ribeiro PAAG. Ovarian function after the use of various hemostatic techniques during treatment for endometrioma: protocol for a randomized clinical trial. Trials 2019; 20:410. [PMID: 31288827 PMCID: PMC6617678 DOI: 10.1186/s13063-019-3524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/13/2019] [Indexed: 12/25/2022] Open
Abstract
Background Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma. Methods An open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069. Discussion Bearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used. Trial registration ClinicalTrials.gov, NTC03430609. Registered on XX.10/31/2017. ISRCTN Registry, ISRCTN11469394. Registered on XX.17/12/2017. Unique Protocol ID: U1111–1203-2508.
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Affiliation(s)
- Raquel Silveira da Cunha Araujo
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil. .,Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil.
| | - Sabina Bastos Maia
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Clara Micalli Ferruzzi Baracat
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
| | - Moisés Diogo Lima
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Eduardo Sérgio Sousa Soares
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Helizabet Salomão Abdalla Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
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Kostrzewa M, Wilczyński JR, Głowacka E, Żyła M, Szyłło K, Stachowiak G. One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts. Int J Gynaecol Obstet 2019; 146:350-356. [DOI: 10.1002/ijgo.12884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 02/19/2019] [Accepted: 05/30/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Marta Kostrzewa
- Department of Operative Gynecology and Gynecologic OncologyPolish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Jacek R. Wilczyński
- Department of Gynecological Surgery and OncologyMedical University Lodz Poland
| | - Ewa Głowacka
- Laboratory Diagnostics CenterPolish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Monika Żyła
- Department of Operative Gynecology and Gynecologic OncologyPolish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Krzysztof Szyłło
- Department of Operative Gynecology and Gynecologic OncologyPolish Mother's Memorial Hospital Research Institute Lodz Poland
| | - Grzegorz Stachowiak
- Department of Operative Gynecology and Gynecologic OncologyPolish Mother's Memorial Hospital Research Institute Lodz Poland
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Dong Z, An J, Xie X, Wang Z, Sun P. Preoperative serum anti-Müllerian hormone level is a potential predictor of ovarian endometrioma severity and postoperative fertility. Eur J Obstet Gynecol Reprod Biol 2019; 240:113-120. [PMID: 31255930 DOI: 10.1016/j.ejogrb.2019.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish a model for predicting revised American Society of Reproductive Medicine (rASRM) scores before endometrioma surgery based on serum anti-Müllerian hormone (AMH) level and to identify factors that might reliably predict postoperative fertility of women diagnosed with endometrioma. STUDY DESIGN The study population was composed of 134 women with endometrioma, 58 with benign cyst, and 115 with non-ovarian lesion. Preoperative serum AMH level and clinical parameters were compared among three groups. Univariate correlation analyses and multivariate linear regression modeling with a stepwise method were performed for constructing an rASRM scores prediction model. Cox regression analysis was then used to identify predictive variables of spontaneous pregnancy following surgical treatment of endometrioma. RESULTS Preoperative AMH level were significantly lower in the endometrioma group than in the other two groups (p < 0.001). Multivariate linear regression analysis revealed that age (β=-0.324, p < 0.001), rASRM scores (β=-0.298, p < 0.001) and serum CA125 level (β=-0.176, p = 0.026) independently and negatively correlated with serum AMH level. Cox regression analysis of women with endometrioma who underwent surgical resection indicated that older age (per five-year increase, HR: 0.517; 95% CI, 0.299-0.896) and higher serum AMH level (cut-off value: >3.68 ng/ml, HR: 2.383; 95% CI, 1.093-5.197) were independent predictors for postoperative fertility. CONCLUSION Patients with advanced staged endometriosis tended to have a lower serum AMH level while postoperative infertility was more likely to occur in older patients with a lower level of serum AMH. Thus, timely detection of AMH levels to assess the severity of ovarian endometriosis and possibility for postoperative pregnancy success is necessary to ensure that optimal medical treatment can be provided.
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Affiliation(s)
- Zhenzhu Dong
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China; Department of Obstetrics and Gynecology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, 362000, China
| | - Jian An
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Xi Xie
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Zhenhong Wang
- Department of Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350001, China.
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonin C, Busacca M, Candiani M, Centini G, D’Alterio MN, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Raimondo D, Remorgida V, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Venturella R, Vercellini P, Viganó P, Vignali M, Zullo F, Zupi E. When more is not better: 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod Open 2019; 2019:hoz009. [PMID: 31206037 PMCID: PMC6560357 DOI: 10.1093/hropen/hoz009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.
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The effect of endometriosis on the antimüllerian hormone level in the infertile population. J Assist Reprod Genet 2019; 36:1179-1184. [PMID: 31020439 DOI: 10.1007/s10815-019-01450-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To determine whether the presence of endometriosis in infertile women without prior ovarian surgery influences markers of ovarian reserve, AMH and FSH. METHODS A retrospective cohort study included three groups of women who presented for IVF treatment at our tertiary care center from 04/27/2015 to 05/31/2017: women with endometriosis and prior ovarian surgery (EnSx), women with endometriosis without prior ovarian surgery (En), and women with a primary diagnosis of male factor infertility (MF; reference group). RESULTS There were 671 patients that met inclusion criteria (78 EnSx, 60 En, and 533 MF). Compared to the MF group (3.6 ± 3.0), a lower mean AMH level (ng/mL) was observed in the EnSx group (2.5 ± 2.5; aβ - 1.21; 95% CI [- 1.79, -0.62]) and in the En group (2.5 ± 2.2; aβ - 1.11; 95% CI [- 1.68, - 0.54]). Both endometriosis groups had a statistically significantly higher proportion of patients with an AMH < 1 (EnSx, 24.4%; OR, 2.39 [95% CI, 1.31, 4.36]; En, 28.3%; OR, 2.67 [95% CI, 1.41, 5.08]) compared to the MF group (13.9%). The mean baseline FSH level (lU/L) was statistically significantly higher in both endometriosis groups (EnSx, 8.6 ± 4.3; β, 1.37 [95% CI, 0.39, 2.34]; En, 8.4 ± 3.7; β, 0.96 [95% CI, 0.04, 1.87]) compared to the MF group (7.3 ± 2.2). CONCLUSIONS Among infertility patients with endometriosis, with and without a history of ovarian surgery, ovarian reserve markers were worse (lower AMH and higher FSH) and a higher proportion had decreased ovarian reserve as measured by AMH compared to women with MF.
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Marshall V, Siebert TI. Effect of Laparoscopic Cystectomy for Ovarian Endometriomas on Ovarian Reserve, as Measured by Anti-Müllerian Hormone: A Prospective Cohort Study. CURRENT WOMEN S HEALTH REVIEWS 2019. [DOI: 10.2174/1573404814666180724125608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Cystectomy for ovarian endometriomas is commonly performed, however
recent publications have shown a deleterious effect of cystectomy on ovarian reserve.
Objectives:
The study aimed to evaluate what effect laparoscopic cystectomy for ovarian
endometriomas has on the ovarian reserve.
Methods:
This is a prospective cohort study performing standard laparoscopic cystectomies for
ovarian endometriomas. The primary outcome was the assessment of the ovarian reserve using
Anti-Müllerian hormone (AMH), done pre- and six months postoperatively. Secondary outcome
was spontaneous pregnancy during follow up.
Results:
We enrolled 59 participants. Twenty-five participants were lost to follow up and a further
3 were excluded from the analysis. The average age was 33.1 years. Thirty-one participants
completed the six months follow up. The mean preoperative and postoperative AMH value was
3.21ng/mL [95% CI: 2.24 - 4.18ng/mL, SD 2.64] and 1.48ng/mL [95% CI: 1.06 - 1.91ng/mL, SD
1.17] respectively: equating to a 53.89% decline, P=0.002. Twenty participants had unilateral cysts
whilst the remaining 11 had bilateral endometriomas. The mean preoperative and postoperative
AMH for unilateral cysts was 3.22ng/mL [95% CI:1.93 - 4.51ng/mL, SD 2.76] and 1.82ng/mL
[95% CI: 1.23 – 2.41ng/mL, SD 1.26] respectively, representing a 43.48% decrease, P=0.072. Of
the 11 with bilateral endometriomas, the mean preoperative AMH was 3.19ng/mL [95% CI: 1.49 -
4.89ng/mL, SD 2.54] with 0.88ng/mL [95% CI: 0.43 - 1.33ng/mL, SD 0.67] representing the postoperative
AMH, equating to a 72.41% reduction, P=0.005.
Conclusion:
Serum AMH is negatively affected by laparoscopic cystectomy for ovarian
endometriomas, with a significant decline in ovarian reserve as measured six months postoperatively.
A greater decline was seen in patients with bilateral endometriomas compared to unilateral disease.
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Affiliation(s)
- Vaughan Marshall
- Tygerberg Hospital, Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa
| | - Thomas Ignatius Siebert
- Tygerberg Hospital, Department of Obstetrics and Gynaecology, University of Stellenbosch, Cape Town, South Africa
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96
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Oncologic and fertility impact of surgical approach for borderline ovarian tumours treated with fertility sparing surgery. Eur J Cancer 2019; 111:61-68. [DOI: 10.1016/j.ejca.2019.01.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 01/16/2023]
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98
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Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Di Donato V, Musella A, Palaia I, Panici PB. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis. Fertil Steril 2019; 110:932-940.e1. [PMID: 30316440 DOI: 10.1016/j.fertnstert.2018.06.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/22/2018] [Accepted: 06/17/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate if the presence of endometriomas impacts on the ovarian reserve as evaluated with antimüllerian hormone (AMH). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Patients with unoperated endometriomas versus controls without endometriomas. INTERVENTION(S) Electronic databases searched up to June 2017 to identify articles evaluating AMH levels in patients with unoperated endometriomas versus controls without endometriomas. MAIN OUTCOME MEASURE(S) The primary analysis was aimed at evaluation of AMH levels (mean and SD) in patients with and without endometriomas. Secondary analyses were aimed at evaluating AMH levels in patients with ovarian endometriomas compared to patients with either non-endometriosis benign ovarian cysts or healthy ovaries. RESULT(S) Of the 39 studies evaluated in detail, 17 were included, for a total of 968 patients with endometriomas and 1874 without endometriomas. AMH was significantly lower in patients with unoperated endometriomas compared to patients with no endometriomas (mean difference -0.84, with 95% confidence interval [CI] -1.16 to -0.52). At secondary analyses, AMH in patients with endometriomas was significantly lower both versus non-endometriosis benign ovarian cysts (mean difference -0.85, 95% CI -1.37 to -0.32, and versus women with healthy ovaries (mean difference -0.61, 95% CI -0.99 to -0.24). CONCLUSION(S) Ovarian reserve evaluated with AMH is reduced in patients with ovarian endometriomas compared both to patients with other benign ovarian cysts, and to patients with healthy ovaries.
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Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
| | - Chiara Di Tucci
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | | | - Giulia Galati
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Angela Musella
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Innocenza Palaia
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
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Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Pecorella I, Radicioni A, Anzuini A, Piccioni MG, Patacchiola F, Benedetti Panici P. Ovarian Reserve Reduction With Surgery Is Not Correlated With the Amount of Ovarian Tissue Inadvertently Excised at Laparoscopic Surgery for Endometriomas. Reprod Sci 2019; 26:1493-1498. [DOI: 10.1177/1933719119828055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to evaluate the effect of laparoscopic cystectomy on ovarian reserve by means of anti-Müllerian hormone (AMH) serial measurements and to compare AMH values with the number of inadvertently removed follicles in histological specimens. Fifty-two women were enrolled: 34 patients with endometriomas (group 1) and 18 patients with other benign ovarian cysts (group 2). All patients underwent laparoscopic cystectomy performed by a single experienced surgeon. The AMH was measured before, and 1, 3, and 6 months after cystectomy in group 1, and before and 6 months after surgery in group 2. Preoperative AMH levels (mean [standard deviation, SD]) in group 1 (3.39 [2.43] ng/mL) were not significantly different from group 2 (3.74 [2.57] ng/mL; P = .68). In group 1, a significant decrease in AMH levels of 43.4% was observed at 1 month (1.93 [1.36]; P = .003), and of 63.1% at 3 months (1.25 [1.00]; P = .007) postoperatively. The AMH increased not significantly between the third and sixth months in group 1 (+9.4%). Six months after surgery, AMH was reduced by 59.3% compared to baseline values in group 1 ( P = .012), and by 29.5% in group 2 ( P = .200). A significant difference in the AMH decrease was present between bilateral and monolateral endometriomas ( P = .006). There was no correlation between the reduction rate of AMH and the number of follicles inadvertently removed in patients with endometriomas ( P = .669). In conclusion, AMH decreases significantly after surgical excision of ovarian endometriomas. The postoperative decrease does not appear to correlate with the amount of ovarian tissue inadvertently excised with the endometrioma wall.
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Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, “Sapienza” University of Rome, Rome, Italy
| | - Chiara Di Tucci
- Department of Obstetrics and Gynecology, “Sapienza” University of Rome, Rome, Italy
| | | | - Giulia Galati
- Department of Obstetrics and Gynecology, “Sapienza” University of Rome, Rome, Italy
| | - Irene Pecorella
- Department of Pathology, “Sapienza” University of Rome, Rome, Italy
| | - Antonio Radicioni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, “Sapienza” University of Rome, Rome, Italy
| | - Antonella Anzuini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, “Sapienza” University of Rome, Rome, Italy
| | | | - Felice Patacchiola
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Inal ZO, Engin Ustun Y, Yilmaz N, Aktulay A, Bardakci Y, Gulerman C. Does the anti-Müllerian hormone truly reflect ovarian response in women with endometrioma? J OBSTET GYNAECOL 2019; 39:516-521. [PMID: 30744464 DOI: 10.1080/01443615.2018.1533542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2-4) vs. 3 (2-3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p = .135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p = .125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI. Impact statement What is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response. What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI). What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?
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Affiliation(s)
- Zeynep Ozturk Inal
- a Department of Reproductive Endocrinology , Konya Education and Research Hospital , Konya , Turkey
| | - Yaprak Engin Ustun
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Nafiye Yilmaz
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Ayla Aktulay
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Yesim Bardakci
- c Department of Embryology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
| | - Cavidan Gulerman
- b Department of Reproductive Endocrinology , Zekai Tahir Burak Women's Health Education and Research Hospital , Ankara , Turkey
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