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Endometriosis and Pregnancy: A Single Institution Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020401. [PMID: 31936225 PMCID: PMC7014217 DOI: 10.3390/ijerph17020401] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 12/17/2022]
Abstract
Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.
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102
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A Relationship Between Endometriosis and Obstetric Complications. Reprod Sci 2020; 27:771-778. [DOI: 10.1007/s43032-019-00118-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022]
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Matsuzaki S, Okada A, Endo M, Nagase Y, Nakagawa S, Hiramatsu K, Kakigano A, Mimura K, Takiuchi T, Tomimatsu T, Ueda Y, Ogita K, Kimura T. Horizontal Cervix as a Novel Sign for Predicting Adhesions on the Posterior Extrauterine Wall in Cases of Placenta Previa. J Clin Med 2019; 8:jcm8122141. [PMID: 31817169 PMCID: PMC6947443 DOI: 10.3390/jcm8122141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/28/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
We aimed to identify a magnetic resonance imaging (MRI) feature that can predict posterior extrauterine adhesion (posterior adhesion) antenatally, in patients with placenta previa. We retrospectively reviewed patients with placenta previa who underwent a preoperative MRI examination of placenta accreta spectrum. We categorized the patients into two groups based on whether the cervix was anterior or posterior to a line perpendicular to the anatomical conjugate on the MRI. We projected the perpendicular line toward a straight line through the broad of the back on T2-weighted sagittal MRI images and measured the angle between this line and the line passing through the cervical canal. We analyzed the correlation of the cervical canal angle with the presence of posterior adhesions. Of the 96 patients analyzed, 71 patients had an anteverted cervix and 25 patients had a retroverted cervix. There were 21 posterior adhesions. The adhesion rate was significantly higher in patients with a retroverted cervix than those with an anteverted cervix (8.5% vs. 60%; p = 0.00). The cervical canal angle was ≤10° in 25 patients; of these 17 had adhesions (sensitivity, 81.0%; specificity, 89.3%; area under the curve, 0.887; 95% confidence interval, 0.792–0.981). This finding, labeled “positive horizontal cervix sign,” may be a promising indicator of posterior adhesions in patients with placenta previa.
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Affiliation(s)
- Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
- Correspondence: (S.M.); (A.K.); Tel.: +81-6-6879-3355 (S.M. & A.K.); Fax: +81-6-6879-3359 (S.M. & A.K.)
| | - Aiko Okada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
- Department of Obstetrics and Gynecology, Aizenbashi Hospital, Osaka 556-0005, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
- Department of Health Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yoshikazu Nagase
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Satoshi Nakagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Kosuke Hiramatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
- Correspondence: (S.M.); (A.K.); Tel.: +81-6-6879-3355 (S.M. & A.K.); Fax: +81-6-6879-3359 (S.M. & A.K.)
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
| | - Kazuhide Ogita
- Department of Obstetrics and Gynecology, Rinku General Medical Center, Osaka 598-0048, Japan;
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (A.O.); (M.E.); (Y.N.); (S.N.); (K.H.); (K.M.); (T.T.); (T.T.); (Y.U.); (T.K.)
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Hashimoto A, Iriyama T, Sayama S, Tsuruga T, Kumasawa K, Nagamatsu T, Osuga Y, Fujii T. Impact of endometriosis and adenomyosis on pregnancy outcomes. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayako Hashimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo
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105
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Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 2019; 15:666-682. [PMID: 31488888 DOI: 10.1038/s41574-019-0245-z] [Citation(s) in RCA: 461] [Impact Index Per Article: 92.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 02/08/2023]
Abstract
Endometriosis is a chronic inflammatory disease defined as the presence of endometrial tissue outside the uterus, which causes pelvic pain and infertility. This disease should be viewed as a public health problem with a major effect on the quality of life of women as well as being a substantial economic burden. In light of the considerable progress with diagnostic imaging (for example, transvaginal ultrasound and MRI), exploratory laparoscopy should no longer be used to diagnose endometriotic lesions. Instead, diagnosis of endometriosis should be based on a structured process involving the combination of patient interviews, clinical examination and imaging. Notably, a diagnosis of endometriosis often leads to immediate surgery. Therefore, rethinking the diagnosis and management of endometriosis is warranted. Instead of assessing endometriosis on the day of the diagnosis, gynaecologists should consider the patient's 'endometriosis life'. Medical treatment is the first-line therapeutic option for patients with pelvic pain and no desire for immediate pregnancy. In women with infertility, careful consideration should be made regarding whether to provide assisted reproductive technologies prior to performing endometriosis surgery. Modern endometriosis management should be individualized with a patient-centred, multi-modal and interdisciplinary integrated approach.
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Affiliation(s)
- Charles Chapron
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France.
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France.
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France.
| | - Louis Marcellin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Bruno Borghese
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department 'Development, Reproduction and Cancer', Institut Cochin, INSERM U1016, Université Paris Descartes, Paris, France
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Fox CW, Savaris RF, Jeong JW, Kim TH, Miller PB, Likes CE, Schammel DP, Young SL, Lessey BA. Unexplained recurrent pregnancy loss and unexplained infertility: twins in disguise. Hum Reprod Open 2019; 2020:hoz021. [PMID: 36694811 PMCID: PMC9869655 DOI: 10.1093/hropen/hoz021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/07/2019] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Is B-cell CLL/lymphoma 6 (BCL6) endometrial expression, a surrogate biomarker of endometriosis, elevated in women with unexplained recurrent pregnancy loss (uRPL) and unexplained infertility (UI) compared to fertile subjects? SUMMARY ANSWER Endometrial BCL6 expression is elevated to a similar degree in women with uRPL and UI compared to fertile controls. WHAT IS KNOWN ALREADY Endometriosis has been linked to the genesis of endometrial progesterone resistance and to specific nuclear proteins, including endometrial BCL6. BCL6 overexpression (immune histologic score > 1.4) has been strongly associated with poor reproductive outcomes in IVF cycles in women with UI. Our previous data have demonstrated an accuracy of 94% for diagnosing endometriosis, and BCL6 protein is elevated in the decidua of women with uRPL. STUDY DESIGN SIZE DURATION In this case-control study, at a tertiary university teaching hospital, 110 samples (control n = 28; uRPL n = 29; UI n = 53) from pathological archives were analyzed. Timed endometrial biopsies were obtained between 2 January 2002 and 31 December 2016. PARTICIPANTS/MATERIALS SETTING METHOD LH-timed endometrial biopsies were obtained from women with UI, uRPL (two or more consecutive losses) and normal fertile subjects during the mid-secretory phase of the menstrual cycle. Endometrial BCL6 protein levels were compared in women with UI and uRPL and fertile controls using western blot analysis and immunohistochemistry (HSCORE). MAIN RESULTS AND THE ROLE OF CHANCE The mean age of the uRPL group was significantly higher than the others [mean (SD)] control = 32.7 (2.6); uRPL = 35.8 (3.7); UI = 32.7 (4.4); P = 0.002, ANOVA]. Seventy-nine percent of women in both subfertile groups (uRPL and UI, 65 out of 82) displayed elevated BCL6 protein levels. From these, a subset of cases with abnormal BCL6 went to laparoscopy and endometriosis was found in 9 out of 11 cases of uRPL and in 20 out of 21 cases of UI. Median BCL6 HSCORE for controls versus uRPL and UI was significantly different [median (interquartile); control = 0.3 (0.02 to 0.5); uRPL = 3 (1.9 to 3.6); UI = 2.9 (1.6 to 3.1); P < 0.0001, Kruskal-Wallis]. A significant trend in the association between the degree of infertility (fertile, uRPL and UI) and the HSCORE level (negative, medium and high) was found (P < 0.001; x 2 for trend). Western blot of representative samples from each group demonstrated similar findings based on protein levels in the whole endometrium. After running ANCOVA analysis for age difference, the BCL6 difference among groups was still significant (P-value < 0.0001). LIMITATIONS REASONS FOR CAUTION We studied subjects with two consecutive pregnancy losses rather than the definition adopted in Europe of three losses. The findings may lack external validity in other clinical settings (e.g. low prevalence of endometriosis). WIDER IMPLICATIONS OF THE FINDINGS Based on the data presented here, we postulate that the degree of BCL6 expression may represent a continuum of progesterone resistance and response to inflammation that occurs in women with endometriosis, yielding different degrees of infertility, from uRPL to UI. STUDY FUNDING/COMPETING INTERESTS This study was supported by NICHD/NIH R01 HD067721 (SLY and BAL), by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior: Grant 99999.003035/2015-08 (BAL) and by CAPES/PROAP (RFS). Two authors (BAL, SLY) have licensed intellectual property for the detection of endometriosis. Dr Bruce Lessey is an unpaid scientific Advisor for CiceroDx. The other authors report no conflict of interest.
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Affiliation(s)
- Chelsea W Fox
- University of San Diego, Department of Obstetrics and Gynecology, San Diego, CA, USA
| | - Ricardo F Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Jae-Wook Jeong
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Tae Hoon Kim
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Paul B Miller
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - Creighton E Likes
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - David P Schammel
- Pathology Associates, Greenville Health System, Greenville, SC, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bruce A Lessey
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wake Forest Health, Winston-Salem, NC 27157, USA
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Miura M, Ushida T, Imai K, Wang J, Moriyama Y, Nakano-Kobayashi T, Osuka S, Kikkawa F, Kotani T. Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy Childbirth 2019; 19:373. [PMID: 31640604 PMCID: PMC6805464 DOI: 10.1186/s12884-019-2514-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Endometriosis is a common disease occurring in 1–2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes. Methods This case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31). Results In the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p < 0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56–6.50, p < 0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66–1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11–10.10, p < 0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19–6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups. Conclusion Women who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.
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Affiliation(s)
- Mayo Miura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jingwen Wang
- Laboratory of Bell Research Center-Department of Obstetrics and Gynecology collaborative research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoko Nakano-Kobayashi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoko Osuka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Center for Maternal-Neonatal Care, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan. .,Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
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108
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Farland LV, Prescott J, Sasamoto N, Tobias DK, Gaskins AJ, Stuart JJ, Carusi DA, Chavarro JE, Horne AW, Rich-Edwards JW, Missmer SA. Endometriosis and Risk of Adverse Pregnancy Outcomes. Obstet Gynecol 2019; 134:527-536. [PMID: 31403584 PMCID: PMC6922084 DOI: 10.1097/aog.0000000000003410] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the relationship between endometriosis and adverse pregnancy outcomes. METHODS Women between ages 25 and 42 years in 1989 (n=116,429) reported detailed information on pregnancies and reproductive health at baseline and every 2 years thereafter in the Nurses' Health Study II, a cohort study. In 2009, they completed a detailed, pregnancy-focused questionnaire. A total of 196,722 pregnancies were reported. Adverse pregnancy outcomes included spontaneous abortion, ectopic pregnancy, stillbirth, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (preeclampsia or gestational hypertension), preterm birth, and low birth weight. We estimated the relative risks (RRs) and 95% CIs of adverse pregnancy outcomes comparing pregnancies in women with and without a history of laparoscopically confirmed endometriosis using multivariable log-binomial regression, with generalized estimating equations to account for multiple pregnancies per woman. RESULTS Endometriosis was associated with a greater risk of pregnancy loss (spontaneous abortion: RR 1.40, 95% CI 1.31-1.49; ectopic pregnancy: RR 1.46, 95% CI 1.19-1.80). Endometriosis was also associated with a greater risk of GDM (RR 1.35, 95% CI 1.11-1.63) and hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.16-1.45). CONCLUSIONS We observed an association between laparoscopically confirmed endometriosis and several adverse pregnancy outcomes. Future research should focus on the potential biological pathways underlying these relationships to inform screening or preventive interventions.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona; the Channing Division of Network Medicine, the Department of Obstetrics, Gynecology, and Reproductive Biology, the Division of Preventive Medicine, and the Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Nutrition and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; the MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland; and the Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, Michigan
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Epidemiology of antenatal depression among women with high-risk pregnancies due to obstetric complications: a scoping review. Arch Gynecol Obstet 2019; 300:849-859. [DOI: 10.1007/s00404-019-05270-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
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110
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Rabaglino MB, Conrad KP. Evidence for shared molecular pathways of dysregulated decidualization in preeclampsia and endometrial disorders revealed by microarray data integration. FASEB J 2019; 33:11682-11695. [PMID: 31356122 DOI: 10.1096/fj.201900662r] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Microarray data of chorionic villous samples (CVSs) obtained from women of ∼11.5 gestational weeks who developed preeclampsia with severe features (sPE; PE-CVS) revealed a molecular signature of impaired endometrial maturation (decidualization) before and during early pregnancy. Because endometrial disorders are also associated with aberrant decidualization, we asked whether they share molecular features with sPE. We employed microarray data integration to compare the molecular pathologies of PE-CVS and endometrial disorders, as well as decidua obtained postpartum from women with sPE. Eight public databases were reanalyzed with R software to determine differentially expressed genes (DEGs) in pathologic tissues relative to normal controls. DEGs were then compared to explore overlap. Shared DEGs were examined for enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Principal component and network analyses were subsequently applied to selected DEGs. There was significant overlap of DEGs changing in the same direction for PE-CVS and endometrial disorders, suggesting common molecular pathways. Shared DEGs were enriched for cytokine-cytokine receptor interaction. Genes in this pathway revealed expression patterns forming 2 distinct clusters, one for normal and the other pathologic endometrium. The most affected hub genes were related to decidualization and NK cell function. Few DEGs were shared by PE-CVS, and PE decidua obtained postpartum. sPE may be part of a biologic continuum of "endometrial spectrum disorders."-Rabaglino, M. B., Conrad, K. P. Evidence for shared molecular pathways of dysregulated decidualization in preeclampsia and endometrial disorders revealed by microarray data integration.
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Affiliation(s)
- Maria Belen Rabaglino
- Instituto de Investigación en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina; and
| | - Kirk P Conrad
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA.,Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
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111
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Endometriosis and cumulative live birth rate after fresh and frozen IVF cycles with single embryo transfer in young women: no impact beyond reduced ovarian sensitivity-a case control study. J Assist Reprod Genet 2019; 36:1649-1656. [PMID: 31313013 PMCID: PMC6707971 DOI: 10.1007/s10815-019-01519-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/02/2019] [Indexed: 01/20/2023] Open
Abstract
Purpose To investigate the impact of symptomatic and surgically confirmed endometriosis on ovarian sensitivity index (OSI) and cumulative live-birth rates (LBR) using predominantly single embryo transfer (SET). Methods Cross-sectional case-control study in a University-based ART program. Women with symptomatic and surgically confirmed endometriosis (N = 172), who underwent IVF/ICSI at Karolinska University Hospital were compared to controls without clinically suspected endometriosis (N = 2585). Two thousand seven hundred fifty-seven patients underwent 8236 treatment cycles (4598 fresh and 3638 frozen cycles). Primary outcome measures included Ovarian Sensitivity Index (OSI) estimated as collected oocytes/FSH dose and cumulative LBR/oocyte pickup (OPU). Generalized estimated equation (GEE) model accounting for dependencies between consecutive treatments were applied. Secondary outcomes included number of oocytes, pregnancy rate per OPU and per ET, LBR per ET, and miscarriage rate. Results Patients diagnosed with endometriosis had significantly fewer oocytes collected (8.47 vs. 9.54, p = 0.015) and lower OSI (p = 0.011) than controls. There were no differences in cycle cancelations (p = 0.59) or miscarriages (p = 0.95) between the two groups. Cumulative LBR/OPU did not differ between women with endometriosis and controls (35.6% vs. 34.7%, respectively, p = 0.83). In both groups, more than 60% of women had consecutive FETs after fresh ETs (p = 0.49) with SET in > 70% of cases. The results were similar whether ovarian endometrioma was present or not. Conclusions Our data support that a diagnosis of endometriosis, with or without present endometrioma, does not negatively affect ART cumulative results. The impact of endometriosis was discernible on OSI but not on clinical relevant outcomes including pregnancy and LBR.
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112
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Ectopic pregnancy and outcomes of future intrauterine pregnancy. Fertil Steril 2019; 112:112-119. [DOI: 10.1016/j.fertnstert.2019.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 01/09/2023]
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113
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Gomez AM, Arteaga S, Ingraham N, Arcara J. Medical conditions, pregnancy perspectives and contraceptive decision-making among young people: an exploratory, qualitative analysis. Contraception 2019; 100:72-78. [PMID: 30980830 PMCID: PMC6589374 DOI: 10.1016/j.contraception.2019.03.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore perspectives on family planning among young people who perceive they are infertile or will have difficulty carrying a pregnancy to term owing to medical conditions or procedures. METHODS This exploratory analysis examined pregnancy plans and contraceptive behavior among 12 young adults with a diagnosed medical condition or who had undergone a medical procedure associated with impaired fertility, and who had discussed fertility with a healthcare provider. We utilized data from a larger study investigating prospective pregnancy intentions and plans among 50 young (ages 18-24) women and their male partners (n=100). RESULTS Medical conditions included endometriosis, polycystic ovary syndrome, and lupus. For some, medical conditions/procedures led to use of no or less effective contraception; perceived risk for pregnancy was low, though seven participants had previously experienced pregnancies. Participants also described how medical conditions altered their timelines for pregnancy and overall desire for children; for example, one participant described continuing an unplanned pregnancy because she feared it would be her only chance to parent. CONCLUSION This exploratory analysis suggests that among young people, medical issues perceived to affect fertility and pregnancy may influence pregnancy planning and contraceptive behavior. Young people may lack knowledge about fertility and the impact of a medical condition; thus it is critical that providers clarify the difference between anticipated difficulty conceiving and complete infertility. Tailored contraceptive care is needed for young adults with medical conditions that may affect fertility to ensure they have the necessary information to make informed family planning decisions. IMPLICATIONS Medical conditions known to affect fertility may influence young people's family planning desires and behaviors. Understanding how young adults process information about medical conditions' impact on their fertility and change or make plans in response is important in order to best meet their family planning needs.
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Affiliation(s)
- Anu Manchikanti Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA.
| | - Stephanie Arteaga
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
| | - Natalie Ingraham
- Department of Sociology and Social Services, California State University, East Bay, 25800 Carlos Bee Boulevard, Hayward, CA 94542, USA
| | - Jennet Arcara
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall MC 7400, Berkeley, CA 94720-7400, USA
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Ansariniya H, Hadinedoushan H, Javaheri A, Zare F. Vitamin C and E supplementation effects on secretory and molecular aspects of vascular endothelial growth factor derived from peritoneal fluids of patients with endometriosis. J OBSTET GYNAECOL 2019; 39:1137-1142. [PMID: 31234682 DOI: 10.1080/01443615.2019.1601167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Endometriosis is an extremely heterogeneous disease and affects about ten percent of the female population during their reproductive years. Recent studies showed that endometriosis is an angiogenesis-dependent disease. Peritoneal macrophages are a well-characterised source of vascular endothelial growth factor (VEGF). The aim of this study was to determine the VEGF gene expression and production in peritoneal macrophages of patients with endometriosis under the effects of vitamins C and E in comparison with control. The lab trial study carried out on 50 patients undergoing laparoscopy and peritoneal fluid samples were collected from them. We compared the VEGF gene expression and production in peritoneal macrophages among groups by using real-time polymerase chain reaction and enzyme-linked immunosorbent assay methods, respectively. Our results showed that gene expressions influenced by vitamin C increased in different concentrations and incubation times, except for the incubation time after 48 h. In the case of vitamin E, this was evident with the exception of vitamin E 50 μM after 24 h and vitamin E 100 μM after 48 h. Our findings indicated that vitamin C and E in different concentrations and incubation times altered VEGF gene expression in the peritoneal macrophages but they had not affected on VEGF productions. Impact statement What is already known on this subject? Previous studies showed that antioxidants play a key role in the inhibition of oxidative stress-induced damages and the reduction of pelvic pain in patients with endometriosis. Vitamin E and vitamin C are the main components in neutralising free radicals. Also, antioxidant consumption such as vitamin C and vitamin E in women with endometriosis showed an inverse correlation between antioxidant intake and endometriosis pathology. What do the results of this study add? Vitamin C and E in different concentrations and times of incubation altered vascular endothelial growth factor gene expression and production in peritoneal macrophages. What are the implications of these findings for clinical practice and/or further research? Further studies are needed to determine the effects of C and E vitamins in different concentrations on vascular endothelial growth factor gene expression and production in peritoneal macrophages and the possible roles of these vitamins in treating endometriosis.
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Affiliation(s)
- Hossein Ansariniya
- Department of Immunology, Reproductive Immunology Reseach Center, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Hossein Hadinedoushan
- Department of Immunology, Reproductive Immunology Reseach Center, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Atiyeh Javaheri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Sadughi University of Medical Sciences , Yazd , Iran
| | - Fateme Zare
- Department of Immunology, Reproductive Immunology Reseach Center, Shahid Sadoughi University of Medical Sciences , Yazd , Iran
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Vercellini P, Viganò P, Frattaruolo MP, Borghi A, Somigliana E. Bowel surgery as a fertility-enhancing procedure in patients with colorectal endometriosis: methodological, pathogenic and ethical issues. Hum Reprod 2019; 33:1205-1211. [PMID: 29741687 DOI: 10.1093/humrep/dey104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/12/2018] [Indexed: 12/12/2022] Open
Abstract
Bowel surgery for colorectal endometriosis is being promoted to infertile women without severe sub-occlusive symptoms, with the objective of improving the likelihood of conception. Contrary to rectal shaving, bowel surgery involving full-thickness disk excision and segmental resection entails opening of the intestinal lumen thus increasing the risk of postoperative infectious complications. About 1 in 10 patients undergoing colorectal resection for intestinal endometriosis will experience severe sequelae, including anastomotic dehiscence, rectovaginal fistula formation, and bladder and bowel denervation. Similar to other surgical procedures aiming at enhancing fertility in women with endometriosis, bowel surgery has been introduced into clinical practice without adequate evaluation through randomized controlled trials. According to systematic literature reviews based mainly on case series, the incremental gain of adding bowel procedures to standard surgery appears uncertain in terms of pregnancy rate after both natural attempts and IVF. Considering the methodological drawbacks and the high risk of bias in the available observational studies, it is not possible to exclude the suggestion that the benefit of colorectal surgery has been overestimated. Given the risk of harms to women's health and the important ethical implications, less emphasis should be put on strict statistical significance and more emphasis should be placed on the magnitude of the effect size. In this regard, the published data may not be generalizable, as the surgeons publishing their results may not be representative of all surgeons. Until the results of adequately designed and conducted RCTs are available, colorectal surgery with the sole intent of improving the reproductive performance of infertile patients with intestinal endometriosis should be performed exclusively within research settings and by highly experienced surgeons. Women should be informed about the uncertainties regarding the harms and benefits of bowel surgery in different clinical conditions, and preoperative counselling must be conducted impartially with the objective of achieving a truly shared medical decision.
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Affiliation(s)
- Paolo Vercellini
- Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Maria Pina Frattaruolo
- Gynaecological Surgery and Endometriosis Departmental Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, Milan, Italy
| | - Alessandra Borghi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy.,Infertility Departmental Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Fanti 6, Milan, Italy
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116
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Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019; 220:354.e1-354.e12. [PMID: 30625295 DOI: 10.1016/j.ajog.2018.12.039] [Citation(s) in RCA: 325] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 01/02/2023]
Abstract
Endometriosis can have a profound impact on women's lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse sequelae is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. Inherent challenges include a gold standard based on an invasive surgical procedure (laparoscopy) and diverse symptomatology, contributing to the well-established delay of 4-11 years from first symptom onset to surgical diagnosis. We believe that remedying the diagnostic delay requires increased patient education and timely referral to a women's healthcare provider and a shift in physician approach to the disorder. Endometriosis should be approached as a chronic, systemic, inflammatory, and heterogeneous disease that presents with symptoms of pelvic pain and/or infertility, rather than focusing primarily on surgical findings and pelvic lesions. Using this approach, symptoms, signs, and clinical findings of endometriosis are anticipated to become the main drivers of clinical diagnosis and earlier intervention. Combining these factors into a practical algorithm is expected to simplify endometriosis diagnosis and make the process accessible to more clinicians and patients, culminating in earlier effective management. The time has come to bridge disparities and to minimize delays in endometriosis diagnosis and treatment for the benefit of women worldwide.
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117
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Likes CE, Cooper LJ, Efird J, Forstein DA, Miller PB, Savaris R, Lessey BA. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet 2019; 36:483-490. [PMID: 30610661 PMCID: PMC6439015 DOI: 10.1007/s10815-018-1388-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. METHODS All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. RESULTS Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. CONCLUSIONS Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.
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Affiliation(s)
- Creighton E Likes
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Leah J Cooper
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - Jessica Efird
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - David A Forstein
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Paul B Miller
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Ricardo Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-903, Brazil
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA.
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118
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Yang P, Wang Y, Wu Z, Pan N, Yan L, Ma C. Risk of miscarriage in women with endometriosis undergoing IVF fresh cycles: a retrospective cohort study. Reprod Biol Endocrinol 2019; 17:21. [PMID: 30755216 PMCID: PMC6371538 DOI: 10.1186/s12958-019-0463-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/31/2019] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Endometriosis is thought to affect the effectiveness of ART by an increased risk of miscarriage. We aimed to investigate the impact of endometriosis in women achieving singleton pregnancies through IVF fresh cycles and risk of miscarriage. METHODS This retrospective cohort study included all women undergoing a first IVF cycle and achieving singleton pregnancies after fresh embryo transfer in a tertiary university hospital reproductive medical center between January 2008 and June 2016. Women with endometriosis were compared with women with no endometriosis. Women in the endometriosis group were all with a history of laparoscopy or laparotomy for endometriosis and/or with ovarian endometrioma. The control group was matched 1:2 according to age and study period. RESULTS Among the cohort, we identified 1006 women with endometriosis as study group and 2012 unaffected women matched in a 1:2 ratios as control group. The miscarriage rate between women with and without endometriosis was similar (22.4 and 20.1%, P = 0.085). The odds ratio after adjusting for the risk factors for miscarriage was 1.14 (95% confidence interval 0.95-1.37). In the study group, the women with and without endometrioma did not show a significant risk of miscarriage, (19.8 and 23.8%, P = 0.152, OR 0.79, 95% CI 0.58-1.09). The miscarriage rate in women with endometrioma ≥30 mm (37.3 ± 7.1 mm) and < 30 mm (19.3 ± 5.5 mm) was not significantly different, (24.7 and 18.5%, P = 0.229, OR 1.44, 95% CI 0.79-2.63). After adjustment for risk factors for miscarriage, the presence of endometrioma and the size of endometrioma, regression model confirmed no significant increase for the risk of miscarriage in the subgroup analyses. CONCLUSIONS The risk of miscarriage did not statistically increase in women with endometriosis who achieved pregnancy through IVF fresh cycles.
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Affiliation(s)
- Puyu Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
| | - Yang Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Zhangxin Wu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Ningning Pan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
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Castiglione Morelli MA, Iuliano A, Schettini SCA, Petruzzi D, Ferri A, Colucci P, Viggiani L, Cuviello F, Ostuni A. NMR metabolic profiling of follicular fluid for investigating the different causes of female infertility: a pilot study. Metabolomics 2019; 15:19. [PMID: 30830455 DOI: 10.1007/s11306-019-1481-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several metabolomics studies have correlated follicular fluid (FF) metabolite composition with oocyte competence to fertilization, embryo development and pregnancy but there is a scarcity of research examining the metabolic effects of various gynaecological diseases. OBJECTIVES In this study we aimed to analyze and correlate the metabolic profile of FF from women who were following in vitro fertilization (IVF) treatments with their different infertility pathologies. METHODS We selected 53 women undergoing IVF who were affected by: tubal diseases, unexplained infertility, endometriosis, polycystic ovary syndrome (PCOS). FF of the study participants was collected at the time of oocytes retrieval. Metabolomic analysis of FF was performed by nuclear magnetic resonance (NMR) spectroscopy. RESULTS FF presents some significant differences in various infertility pathologies. Although it was not possible to discriminate between FF of control participants and women with tubal diseases and unexplained infertility, comparison of FF metabolic profile from control women with patients with endometriosis and PCOS revealed significant differences in some metabolites that can be correlated to the causes of infertility. CONCLUSION NMR-based metabolic profiling may be successfully applied to find diagnostic biomarkers for PCOS and endometriosis and it might be also used to predict oocyte developmental potential and subsequent outcome.
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Affiliation(s)
| | - Assunta Iuliano
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | | | - Donatina Petruzzi
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Angela Ferri
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Paola Colucci
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Licia Viggiani
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Flavia Cuviello
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Angela Ostuni
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy.
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Pavone D, Turrini I, Sorbi F, Vannuccini S, Capezzuoli T, Fambrini M, Petraglia F. Hormones and Inflammation: An Update on Endometriosis. MENSTRUAL CYCLE RELATED DISORDERS 2019. [DOI: 10.1007/978-3-030-14358-9_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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121
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Jones RL, Lang SA, Kendziorski JA, Greene AD, Burns KA. Use of a Mouse Model of Experimentally Induced Endometriosis to Evaluate and Compare the Effects of Bisphenol A and Bisphenol AF Exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:127004. [PMID: 30675821 PMCID: PMC6371646 DOI: 10.1289/ehp3802] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND Endometriosis is a gynecological disease affecting 1 in 10 women of reproductive age. Endometriosis incidence has risen; however, whether this rise is due to disease awareness or environmental contamination is not known. OBJECTIVE The objective of this study was to determine if bisphenol A (BPA) or bisphenol AF (BPAF) potentiate the development of endometriosis and if hormonal status alters how toxicant exposure affects disease. METHODS A mouse model of endometriosis, where minced uterine tissue is injected into the peritoneal cavity of a host mouse, was used to examine the effects of BPA and BPAF on endometriosis lesion development in ovariectomized and hormonally intact mice. BPA and BPAF were delivered through diet to include no-observed-adverse-effect-level (NOAEL) and the low-observed-adverse-effect-level (LOAEL) exposure levels. After six weeks (at necropsy), lesions, ovaries, and blood were collected to examine characteristics, gene expression, and hormonal regulation. RESULTS BPA and BPAF treatments affected endometriosis in a manner specific to dose and hormonal status of the host mouse. Estrogen and endometriosis-mediated differences in lesion target gene expression also depended on hormonal status. In intact mice, ovarian steroidogenic pathways were disrupted, progesterone levels were lowered, and atretic oocyte numbers were higher with toxicant exposure. BPAF, more so than BPA, resulted in more endometriosis lesion growth, but both toxicants disrupted normal ovarian signaling. CONCLUSION These findings further our understanding of the effects and hormonal impacts of BPA and BPAF on endometriosis perturbation in ovariectomized and hormonally intact mice. BPAF appeared to be similar if not more estrogenic than BPA and may be affecting an environmental contribution of the increased incidence of endometriosis. https://doi.org/10.1289/EHP3802.
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Affiliation(s)
- Rebecca L Jones
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stephanie A Lang
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica A Kendziorski
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexis D Greene
- Department of Obstetrics and Gynecology, University of Cincinnati Center for Reproductive Health, Cincinnati, Ohio, USA
| | - Katherine A Burns
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Isono W, Wada-Hiraike O, Akino N, Terao H, Harada M, Hirata T, Hirota Y, Koga K, Fujii T, Osuga Y. The efficacy of non-assisted reproductive technology treatment might be limited in infertile patients with advanced endometriosis in their 30s. J Obstet Gynaecol Res 2018; 45:368-375. [PMID: 30280468 DOI: 10.1111/jog.13826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/31/2018] [Indexed: 01/01/2023]
Abstract
AIM To determine the efficacious treatment for infertile couples, we assessed the impact of infertility factors including endometriosis on assisted reproductive technology (ART) and non-ART treatment, and the effect of age in infertility treatment outcomes was also investigated. METHODS The medical records of 1864 females, infertile patients from January 2000 to December 2015 at our hospital, were retrospectively reviewed under the approval of the Institutional Review Board. We extracted 10 representative factors and calculated the cumulative live birth rate (CLBR) in these patients. Multivariate analysis of ART and non-ART treatment was performed to assess the impact of infertility factors, and the age-related decline in cumulative live birth rate was calculated by creating eight age-stratified subgroups. RESULTS In total, 21.9% and 49.4% of the patients conceived after being treated with non-ART and ART, respectively. Multivariate analysis revealed that age > 35, advanced endometriosis defined by the revised American Society for Reproductive Medicine classification system stages III to IV, and the past history or current presence of uterine fibroid had significantly negative impact on the outcome of non-ART. Age stratification revealed that advanced endometriosis adversely affected the outcome of non-ART, especially for patients in their 30s. Assisted reproductive technology treatment for patients with advanced endometriosis was shown to be efficacious because the negative impact had been diminished. CONCLUSION Considering that non-ART treatment had limited role in patients with advanced endometriosis, prompt initiation of ART in these patients aged as young as 30 years can be recommended to achieve conception.
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Affiliation(s)
- Wataru Isono
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Wada-Hiraike
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nana Akino
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Terao
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Koga
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynaecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sokol J, Skerenova M, Biringer K, Simurda T, Kubisz P, Stasko J. Glycoprotein VI Gene Variants Affect Pregnancy Loss in Patients With Platelet Hyperaggregability. Clin Appl Thromb Hemost 2018; 24:202S-208S. [PMID: 30278775 PMCID: PMC6714835 DOI: 10.1177/1076029618802358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to evaluate GP6 gene in patients with sticky platelet
syndrome (SPS) and fetal loss. Platelet aggregability was tested with
platelet-rich plasma using PACKS-4 aggregometer (Helena Laboratories).
High-resolution melting analysis on LightCycler 480 II (Roche Diagnostics) was
used for single-nucleotide polymorphism (SNP) genotyping. We examined 64
patients with SPS and 54 control participants. We found significantly higher
occurrence of 5 SNPs in patients with SPS versus controls (rs1671152, rs1654433,
rs1613662, rs1654416, and rs2304167). Moreover, the haplotype analysis showed a
significantly higher occurrence of 7 haplotypes in patients with SPS compared to
controls (acgg and aagg in GP6_5reg haplotype; ccgt in GP6_3reg haplotype; gg
and ta in GP6_REG haplotype; SKTH and PEAN in GP6_PEAN haplotype). Our results,
especially higher occurrence of 4 nonsynonymous variants within the coding
region, support the idea that GP6 polymorphisms are associated with the platelet
hyperaggregability accompanied by fetal loss.
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Affiliation(s)
- Juraj Sokol
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Maria Skerenova
- Department of Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Kamil Biringer
- Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomas Simurda
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubisz
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jan Stasko
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Leiomyomatous uterus and preterm birth: an exposed/unexposed monocentric cohort study. Am J Obstet Gynecol 2018; 219:410.e1-410.e7. [PMID: 30153432 DOI: 10.1016/j.ajog.2018.08.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The risk of preterm birth may increase in the presence of uterine leiomyomas during pregnancy. Whether myomectomy abrogates this risk has never been studied. OBJECTIVE Our aim was to evaluate the association between the presence of uterine leiomyomas during pregnancy and preterm birth and, if an association exists, to evaluate its persistence in case of a history of myomectomy. STUDY DESIGN This exposed/unexposed monocentric retrospective cohort study included all women with singleton pregnancies delivering >22 weeks in a tertiary university hospital maternity unit from January 2011 through September 2015. Women with a leiomyomatous uterus were compared to women with no myomas. Women in the leiomyomatous uterus group were women with uterine leiomyoma(s) during pregnancy (≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) seen on at least 1 obstetric ultrasound without history of myomectomy, or women with a history of myomectomy (removal of ≥1 leiomyoma, measuring ≥20 mm or multiple leiomyomas whatever the size) by hysteroscopy, laparoscopy, or laparotomy with or without persistent leiomyomas. The association between leiomyomatous uterus and preterm birth was assessed through univariate and multivariable logistic regression. RESULTS Among the 19,866 women in the cohort, 301 (1.5%) had a leiomyomatous uterus (154 unoperated women and 147 operated women). The rate of premature delivery was 12.0% in the leiomyomatous uterus group and 8.4% in the nonleiomyomatous uterus group. After adjusting for the risk factors for preterm birth, leiomyomatous uterus was significantly associated with preterm birth (adjusted odds ratio, 2.5; 95% confidence interval, 1.7-3.7). This association was significant for unoperated women (adjusted odds ratio, 2.7; 95% confidence interval, 1.6-4.6) as well as operated women (adjusted odds ratio, 2.3; 95% confidence interval, 1.3-3.9) when compared to the nonleiomyomatous uterus group. CONCLUSION Uterine leiomyomas are associated with preterm birth and this association persists after myomectomy.
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Pérez-López FR, Calvo-Latorre J, Alonso-Ventura V, Bueno-Notivol J, Martínez-Domínguez SJ, Chedraui P. Systematic review and meta-analysis regarding the association of endometriosis and preeclampsia in women conceiving spontaneously or through assisted reproductive technology. Pregnancy Hypertens 2018; 14:213-221. [DOI: 10.1016/j.preghy.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/02/2018] [Indexed: 01/13/2023]
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Lalani S, Choudhry AJ, Firth B, Bacal V, Walker M, Wen SW, Singh S, Amath A, Hodge M, Chen I. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum Reprod 2018; 33:1854-1865. [PMID: 30239732 PMCID: PMC6145420 DOI: 10.1093/humrep/dey269] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/04/2018] [Accepted: 09/04/2018] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy? SUMMARY ANSWER Women with endometriosis are at elevated risk for serious and important adverse maternal (pre-eclampsia, gestational diabetes, placenta praevia and Cesarean section) and fetal or neonatal outcomes (preterm birth, PPROM, small for gestational age, stillbirth and neonatal death). WHAT IS KNOWN ALREADY A number of studies have shown an association between endometriosis and certain adverse maternal and fetal outcomes, but the results have been conflicting with potential for confounding by the use of assisted reproductive technology. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis of observational studies (1 January 1990-31 December 2017) that evaluated the effect of endometriosis on maternal, fetal and neonatal outcomes was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS Studies were considered for inclusion if they were prospective or retrospective cohort or case-control studies; included women greater than 20 weeks gestational age with endometriosis; included a control group of gravid women without endometriosis; and, reported at least one of the outcomes of interest. Each study was reviewed for inclusion, data were extracted and risk of bias was assessed by two independent reviewers. MAIN RESULTS AND THE ROLE OF CHANCE The search strategy identified 33 studies (sample size, n = 3 280 488) for inclusion. Compared with women without endometriosis, women with endometriosis had higher odds of pre-eclampsia (odds ratio [OR] = 1.18 [1.01-1.39]), gestational hypertension and/or pre-eclampsia (OR = 1.21 [1.05-1.39]), gestational diabetes (OR = 1.26 [1.03-1.55]), gestational cholestasis (OR = 4.87 [1.85-12.83]), placenta praevia (OR = 3.31 [2.37, 4.63]), antepartum hemorrhage (OR = 1.69 [1.38-2.07]), antepartum hospital admissions (OR = 3.18 [2.60-3.87]), malpresentation (OR = 1.71 [1.34, 2.18]), labor dystocia (OR = 1.45 [1.04-2.01]) and cesarean section (OR = 1.86 [1.51-2.29]). Fetuses and neonates of women with endometriosis were also more likely to have preterm premature rupture of membranes (OR = 2.33 [1.39-3.90]), preterm birth (OR = 1.70 [1.40-2.06]), small for gestational age <10th% (OR = 1.28 [1.11-1.49]), NICU admission (OR = 1.39 [1.08-1.78]), stillbirth (OR = 1.29 [1.10, 1.52]) and neonatal death (MOR = 1.78 [1.46-2.16]). Among the subgroup of women who conceived spontaneously, endometriosis was found to be associated with placenta praevia, cesarean section, preterm birth and low birth weight. Among the subgroup of women who conceived with the use of assisted reproductive technology, endometriosis was found to be associated with placenta praevia and preterm birth. LIMITATIONS, REASONS FOR CAUTION As with any systematic review, the review is limited by the quality of the included studies. The diagnosis for endometriosis and the selection of comparison groups were not uniform across studies. However, the effect of potential misclassification would be bias towards the null hypothesis. WIDER IMPLICATIONS OF THE FINDINGS The association between endometriosis with the important and serious pregnancy outcomes observed in our meta-analysis, in particular stillbirth and neonatal death, is concerning and warrants further studies to elucidate the mechanisms for the observed findings. STUDY FUNDING/COMPETING INTEREST(S) Dr Shifana Lalani is supported by a Physicians' Services Incorporated Foundation Research Grant, and Dr Innie Chen is supported by a University of Ottawa Clinical Research Chair in Reproductive Population Health and Health Services. Dr Singh declares conflicts of interests with Bayer, Abvie, Allergan and Cooper Surgical. All other authors have no conflicts of interests to declare. REGISTRATION NUMBER PROSPERO CRD42015013911.
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Affiliation(s)
- S Lalani
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
| | - A J Choudhry
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - B Firth
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - V Bacal
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - Mark Walker
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - S W Wen
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - S Singh
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - A Amath
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - M Hodge
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
| | - I Chen
- Department of Obstetrics and Gynecology, University of Ottawa/The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada
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Glavind MT, Møllgaard MV, Iversen ML, Arendt LH, Forman A. Obstetrical outcome in women with endometriosis including spontaneous hemoperitoneum and bowel perforation: a systematic review. Best Pract Res Clin Obstet Gynaecol 2018; 51:41-52. [DOI: 10.1016/j.bpobgyn.2018.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
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Nirgianakis K, Gasparri ML, Radan AP, Villiger A, McKinnon B, Mosimann B, Papadia A, Mueller MD. Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: a case–control study. Fertil Steril 2018; 110:459-466. [DOI: 10.1016/j.fertnstert.2018.04.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/09/2018] [Accepted: 04/24/2018] [Indexed: 10/28/2022]
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Abstract
Endometriosis is a common inflammatory disease characterized by the presence of tissue outside the uterus that resembles endometrium, mainly on pelvic organs and tissues. It affects ~5-10% of women in their reproductive years - translating to 176 million women worldwide - and is associated with pelvic pain and infertility. Diagnosis is reliably established only through surgical visualization with histological verification, although ovarian endometrioma and deep nodular forms of disease can be detected through ultrasonography and MRI. Retrograde menstruation is regarded as an important origin of the endometrial deposits, but other factors are involved, including a favourable endocrine and metabolic environment, epithelial-mesenchymal transition and altered immunity and inflammatory responses in genetically susceptible women. Current treatments are dictated by the primary indication (infertility or pelvic pain) and are limited to surgery and hormonal treatments and analgesics with many adverse effects that rarely provide long-term relief. Endometriosis substantially affects the quality of life of women and their families and imposes costs on society similar to those of other chronic conditions such as type 2 diabetes mellitus, Crohn's disease and rheumatoid arthritis. Future research must focus on understanding the pathogenesis, identifying disease subtypes, developing non-invasive diagnostic methods and targeting non-hormonal treatments that are acceptable to women who wish to conceive.
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Muanda FT, Sheehy O, Bérard A. Use of trimethoprim-sulfamethoxazole during pregnancy and risk of spontaneous abortion: a nested case control study. Br J Clin Pharmacol 2018; 84:1198-1205. [PMID: 29424001 PMCID: PMC5980587 DOI: 10.1111/bcp.13542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 01/21/2018] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS Data available on the fetal safety of trimethoprim-sulfamethoxazole (TMP-SMX) exposure during pregnancy remains scarce and inconclusive. A previous study assessing the link between TMP-SMX exposure during pregnancy and the risk of spontaneous abortion (SA) did not control for protopathic bias and indication bias. METHODS We conducted a nested control study (n = 77 429 pregnancies including 7039 cases of SA and 70 390 controls) within the Quebec Pregnancy Cohort. For each case of SA, we selected 10 controls at the index date that were matched on gestational age and year of pregnancy. TMP-SMX exposure was defined as either having filled at least one prescription between the first day of gestation (1DG) and the index date, or as having filled a prescription before pregnancy but with a duration overlapping the 1DG (102 pregnancies exposed to TMP-SMX, including 25 cases of SA and 77 controls). RESULTS Adjusting for potential confounders, TMP-SMX exposure was associated with an increased risk of SA (AOR 2.94, 95% C 1.89-4.57, 25 exposed cases). Similar results were found after controlling for indication bias and protopathic bias. CONCLUSION Given that this drug is widely use in HIV patients to prevent opportunistic infections and malaria, there is an urgent need to identify potential data sources in Africa for analysis of early pregnancy exposure to TMP-SMX.
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Affiliation(s)
- Flory T. Muanda
- Faculty of PharmacyUniversity of Montreal2900 Edouard MontpetitMontréalQuébecCanadaH3T 1J4
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
| | - Odile Sheehy
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
| | - Anick Bérard
- Faculty of PharmacyUniversity of Montreal2900 Edouard MontpetitMontréalQuébecCanadaH3T 1J4
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
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Bruun MR, Arendt LH, Forman A, Ramlau-Hansen CH. Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97:1073-1090. [PMID: 29753309 DOI: 10.1111/aogs.13364] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this systematic review and meta-analysis was to evaluate the risk of preterm delivery and having a small-for-gestational-age (SGA) child in women with endometriosis and adenomyosis compared with women without these two diseases. MATERIAL AND METHODS Studies on endometriosis or adenomyosis and risk of preterm delivery and/or SGA infant were included. The systematic search was conducted for all published articles in PubMed and Embase published from 1950 to 2017 using specific search terms. After duplicates were removed, two authors independently reviewed all studies, initially based on title and subsequently based on abstract. Studies considered relevant were read in full text by both reviewers to identify if studies met the inclusion criteria. RESULTS The search found 21 studies on a total of 2 517 516 women meeting the inclusion criteria. Women with endometriosis had an increased odds of preterm delivery [odds ratio (OR) 1.47, 95% CI 1.28-1.69] and SGA infant (OR 1.26, 95% CI 1.04-1.549). Compared with endometriosis, adenomyosis implied an even higher odds of both preterm delivery (OR 3.09, 95% CI 1.88-5.09) and SGA infant (OR 3.23, 95% CI 1.71-6.09) as well. CONCLUSIONS Women with endometriosis or adenomyosis had a higher odds of preterm delivery and having a child that was SGA compared with women without endometriosis or adenomyosis. The odds of both adverse birth outcomes was highest among women with adenomyosis. The results suggest a closer prenatal monitoring among pregnant women with endometriosis or adenomyosis.
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Affiliation(s)
- Mette R Bruun
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Linn H Arendt
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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Jenabi E, Fereidooni B. The association between endometriosis and the risk of LBW: A meta-analysis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518774997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Many observational services have been conducted to evaluate the risk factors of low birth weight, but the results showed no consistency. Therefore, we conducted this meta-analysis to investigate the association between endometriosis (body mass index) and the risk of low birth weight. Methods: Relevant works that were published in major international electronic databases such as PubMed, Scopus, Web of Science, LILACS, SciELO, and Cochrane were systematically searched until February 2018. Begg’s and Egger’s tests were used to determine publication bias in included studies. The random-effects model was carried out to determine the odds ratio. Results: A meta-analysis of the 12 studies proposed a significant association between endometriosis and the risk of low birth weight (odds ratio = 1.34, 95% confidence interval = 1.08–1.60). The subgroup analysis was carried out based on the design, adjusted form, and use of assisted reproductive technology in studies. The pooled results based on subgroup analysis in case–control and cohort studies were 1.46 (0.79–2.12) and 1.32 (1.02–1.62), respectively. There was significant correlation between endometriosis and low birth weight in cohort studies. Also, heterogeneity was not reported among studies in the subgroup based on adjusted form. There was no significant correlation between endometriosis and low birth weight in studies using assisted reproductive technology methods Conclusion: The systematic review and meta-analysis showed that endometriosis increases the risk of low birth weight. Therefore, it is a risk factor for low birth weight.
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Affiliation(s)
- Ensiyeh Jenabi
- Pediatric Developmental Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Dai Y, Li X, Shi J, Leng J. A review of the risk factors, genetics and treatment of endometriosis in Chinese women: a comparative update. Reprod Health 2018; 15:82. [PMID: 29783992 PMCID: PMC5963030 DOI: 10.1186/s12978-018-0506-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/11/2018] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is one of the major causes of economic burden and compromised quality of life in a very large percentage of Asian women. While it is perceived as a benign condition, recent research has shown that it may be a significant cause of infertility and metastatic cancer. It has also been associated with other diseases linked to the functioning of the immune system. Genetic as well as environmental factors are known to affect the manifestation and progression of endometriosis. This review aims to summarize recent research pertaining to the risk factors, diagnosis and treatment of endometriosis in Chinese women. It also provides an overview of identified genetic mutations and polymorphisms and their effects on the risk of developing endometriosis in the Chinese population. A comparison has been drawn between Asian and European-American female populations and the differences in risk factors and treatment responses have been summarized. Since traditional Chinese medicine (TCM) is often used to treat endometriosis, wherever possible, a comparison between efficacies of Western medicine and TCM in the Chinese population has also been provided. Although much progress has been made in the treatment and resolution of endometriosis, several gaps remain and this review also highlights possible areas of future research and advancement that can result in an improvement in patient outcomes and quality of life.
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Affiliation(s)
- Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730 China
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Maruotti GM, Giudicepietro A, Saccone G, Castaldo G, Sarno L, Zullo F, Berghella V, Martinelli P. Risk of preeclampsia in of women who underwent chorionic villus sampling. J Matern Fetal Neonatal Med 2018; 32:3012-3015. [DOI: 10.1080/14767058.2018.1454899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Antonia Giudicepietro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Giuseppe Castaldo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples “Federico II”, Naples, Italy
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Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 2018; 298:27-34. [PMID: 29602980 DOI: 10.1007/s00404-018-4765-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Recent evidence suggests that assisted reproductive technology (ART) increases the risk of adverse pregnancy outcomes, including placental disorders. Similarly, endometriosis resulted detrimental on placenta previa. However, up to 50% of women with endometriosis suffer from infertility, thus requiring ART. The aim of our metanalysis is to compare women with and without endometriosis undergoing ART in terms of placenta disorders events, to establish if ART itself or endometriosis, as an indication to ART, increases the risk of placenta previa. METHODS Literature searches were conducted in January 2018 using electronic databases (PubMed, Medline, Scopus, Embase, Science Direct, and the Cochrane Library Scopus). Series comparing pregnancy outcome after ART in women with and without endometriosis were screened and data on placenta previa and placental abruption were extracted. RESULTS Five retrospective case-control studies met the inclusion criteria. The meta-analysis revealed that endometriosis is associated with an increased risk of placenta previa in pregnancies achieved through ART (OR 2.96 (95% CI 1.25-7.03); p = 0.01, I2 =69%, random-effect model). No differences in placental abruption incidence were found (OR 0.44 (95% CI 0.10-1.87); p = 0.26, I2 = 0%, fixed-effect model). CONCLUSION Patients with endometriosis undergoing ART may have additional risk of placenta previa. Despite the inability to determine if endometriosis alone or endometriosis plus ART increase the risk, physicians should be aware of the potential additional risk that endometriosis patients undergoing ART harbor.
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Mathieu d'Argent E, Cohen J, Chauffour C, Pouly JL, Boujenah J, Poncelet C, Decanter C, Santulli P. [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:357-367. [PMID: 29544710 DOI: 10.1016/j.gofs.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 01/27/2023]
Abstract
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.
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Affiliation(s)
- E Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J Cohen
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Chauffour
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J L Pouly
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Boujenah
- Service de gynécologie obstétrique, CHU de Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; UFR SMBH, université Paris 13, Sorbonne Paris-Cité, 93022 Bobigny, France
| | - C Decanter
- EA 4308 Gamétogenèse et qualité du gamète, service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU de Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris-Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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Yazdani A. Surgery orin vitrofertilization: The simplicity of this question belies its complexity. Aust N Z J Obstet Gynaecol 2017; 57:676-678. [DOI: 10.1111/ajo.12743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Anusch Yazdani
- University of Queensland; St Lucia Queensland Australia
- Queensland Fertility Group; Gold Coast Queensland Australia
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139
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Woeber K, Carlson NS. Current Resources for Evidence-Based Practice, January 2018. J Obstet Gynecol Neonatal Nurs 2017; 47:64-72. [PMID: 29144961 DOI: 10.1016/j.jogn.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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140
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Nezhat C, Young S, Burns MK, Johns E, Wang P. Pregnancy complications in patients with endometriosis. Fertil Steril 2017; 108:602-603. [PMID: 28965556 DOI: 10.1016/j.fertnstert.2017.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery and Camran Nezhat Institute, Palo Alto, California; Stanford University Medical Center, Stanford, California; University of California, San Francisco, California
| | - Stacy Young
- Center for Special Minimally Invasive and Robotic Surgery and Camran Nezhat Institute, Palo Alto, California; Stanford University Medical Center, Stanford, California
| | - Megan Kennedy Burns
- Center for Special Minimally Invasive and Robotic Surgery and Camran Nezhat Institute, Palo Alto, California; Stanford University Medical Center, Stanford, California
| | | | - Pengfei Wang
- New York University-Winthrop Hospital, New York, New York
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