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Alasia I, Agostini A, Faust C, Berbis J, Pivano A. Effect of hormonal treatment on evolution of endometriomas: An observational study. J Gynecol Obstet Hum Reprod 2023; 52:102637. [PMID: 37527765 DOI: 10.1016/j.jogoh.2023.102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/03/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To evaluate the evolution of endometriomas with or without medical treatment. METHODS This retrospective observational study was performed at the Gynaecological Center, Hôpital La Conception (Assistance Publique Hopitaux de Marseille). We reviewed clinical data of patients with at least one endometrioma diagnosed by magnetic resonance imaging (MRI) and at least one other MRI exam after more than three months. Patients were divided into groups receiving medical treatment and without medical treatment (high-dose progestins, low-dose progestins or combined contraceptives). The primary objective was to evaluate the evolution of endometriomas with or without hormonal treatment. The primary evaluation criterion was the diameter of the endometriomas, and the secondary evaluation criterion was the number of endometriomas for each patient observed. The secondary objective was to evaluate whether different categories of hormonal treatment have different efficacity in the evolution of endometriomas. RESULTS We included 68 patients, 39 (57,4%) with hormonal treatment and 29 (42,6%) without hormonal treatment. There were 105 total endometriomas identified at the first MRI, 52 in patients with hormonal treatment and 53 in patients without treatment. The mean diameter of the endometriomas in patients with hormonal treatment was 31,48 ± 18,1 mm at the first MRI and 23,60 ± 15,3 mm at the second MRI. The mean diameter of the endometriomas in patients without treatment was 33,57 ± 19,7 mm at the first MRI and 40,11 ± 25,7 mm at the second MRI (statistically significant difference, p = 0.01). The mean number of endometriomas in patients with treatment was 1,79 ± 1,1 at the first MRI and 1,18 ± 0,9 at the second MRI, while the mean number of endometriomas in patients without hormonal treatment was 1,38 ± 0,6 at the first MRI and 1,97 ± 1,5 at the second MRI (difference not statistically significant, p = 0.38). The subgroup analysis differentiated by category of hormonal treatment did not show statistically significant results. CONCLUSIONS The present study shows that there is a positive effect of hormonal treatment on reducing the diameter of endometriomas and also a significative increase in endometrioma size in the absence of treatment. There is no evidence of an advantage of a single category of hormonal treatment on this effect on endometriomas. Thus, any medical treatment could be proposed as a first-line therapy for endometriomas that would reduce the size of the endometrioma and thereby help to avoid surgical intervention.
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Affiliation(s)
- Ilaria Alasia
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France
| | - Aubert Agostini
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France.
| | - Cindy Faust
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France.
| | - Julie Berbis
- CEReSS - Health Services and Quality of Life Research, Department of Epidemiology, Aix-Marseille University, Marseille, France.
| | - Audrey Pivano
- Department of Obstetrics and Gynecology, Hôpital La Conception, Aix-Marseille University, 107 avenue de Montredon, Marseille 13008, France.
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Nie J, Zhao C, Laganà AS, Liu X, Guo SW. Identification of lesional attributes of dysmenorrhea severity and the serum antimüllerian hormone levels in women with ovarian endometriomas. Fertil Steril 2022; 118:191-202. [DOI: 10.1016/j.fertnstert.2022.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 01/06/2023]
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Araujo RSDC, Maia SB, Baracat CMF, Fernandes CQBDA, Ribeiro HSAA, Ribeiro PAAG. Ovarian function following use of various hemostatic techniques during treatment for unilateral endometrioma: A randomized controlled trial. Int J Gynaecol Obstet 2021; 157:549-556. [PMID: 34478564 DOI: 10.1002/ijgo.13912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 09/02/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To compare the effect of hemostatic techniques (bipolar energy versus hemostatic sealants versus suture) on the ovarian reserve of patients submitted to laparoscopic cystectomy for the surgical excision of unilateral endometrioma. METHODS A randomized controlled trial conducted in a teaching hospital included 84 patients with unilateral endometrioma. The patients underwent laparoscopic stripping for excision of the unilateral endometrioma between March 2018 and February 2020. Three different hemostatic techniques-bipolar energy (Group 1), hemostatic sealants (Group 2), and suture (Group 3)-were compared. Anti-Müllerian hormone (AMH) levels were measured before, and 1 and 6 months after surgery to determine changes in ovarian function. RESULTS Following surgery, AMH levels decreased in all the groups; however, this decrease was not statistically significant. Comparison between groups showed no statistically significant differences in AMH levels between the three hemostatic techniques used. Six months after surgery, median AMH levels were: 1.65 ng/mL (interquartile range [IQR] 0.62-2.08 ng/mL) in Group 1, 1.87 ng/mL (IQR 1.27-2.97 ng/mL) in Group 2, and 1.53 ng/mL (IQR 1.18-2.44 ng/mL) in Group 3. CONCLUSION The present study suggests that there is no difference between the different hemostatic techniques used in laparoscopic cystectomy for the treatment of unilateral endometriomas. Registered at ClinicalTrials.gov: NCT03430609. https://clinicaltrials.gov/ct2/show/NCT03430609.
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Affiliation(s)
- Raquel Silveira da Cunha Araujo
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.,Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Sabina Bastos Maia
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Clara Micalli Ferruzzi Baracat
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | | | - Helizabet Salomão Abdalla Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, São Paulo, Brazil
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Park SJ, Seol A, Lee N, Lee S, Kim HS. A randomized controlled trial of ovarian reserve preservation and hemostasis during ovarian cystectomy. Sci Rep 2021; 11:8495. [PMID: 33875738 PMCID: PMC8055671 DOI: 10.1038/s41598-021-87965-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
The preservation of ovarian reserve during laparoendoscopic single-site (LESS) ovarian cystectomy is crucial for reproductive-age women. This study was a single-blinded, single-center, and randomized controlled trial to evaluate the effect of hemostatic agents on the preservation of ovarian reserve and hemostasis during LESS ovarian cystectomy. Patients with unilateral ovarian cyst were randomized to the hemostatic agent and coagulation groups according to the hemostasis method. Afterwards, the patients underwent LESS ovarian cystectomy, and hemostasis was performed after ovarian cyst excision according to the assigned hemostasis method. If hemostasis was not completed within 10 min. After discharge, the patients were followed until 3 months after surgery. We compared the hemoglobin, anti-Müllerian hormone (AMH) levels, and ovarian volumes before surgery, and 2 days, 1 week, and 3 months after surgery (3 M-POST), and the decline ratio between the two groups. The decline ratio of serum AMH levels was greater at 3 M-POST in the coagulation than in the hemostatic agent group (median intention-to-treat [ITT], − 36.7 vs. − 13.3%; per-protocol [PP], − 36.8 vs. − 13.3%; P < 0.05). Notably, the difference of the decline ratio of serum AMH levels was only shown in endometriosis patients (median; ITT, − 50.7 vs. − 14.4%; PP, − 50.7% vs. − 14.4%; P < 0.05), while there was no difference in non-endometriosis patients. In conclusion, Hemostatic agents may be non-inferior to bipolar coagulation for preserving ovarian reserve and hemostasis during LESS ovarian cystectomy, in particular, for endometriosis patients. (Trial registry: ClinicalTrials.gov Identifier NCT03374397).
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Affiliation(s)
- Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Aeran Seol
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, 06135, Republic of Korea
| | - Seungmee Lee
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, 41931, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
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Does large endometrioma per se increase AMH level? Reprod Biomed Online 2021; 42:691-693. [PMID: 33583699 DOI: 10.1016/j.rbmo.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/14/2020] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
Women with endometriosis, especially those with endometrioma, present a considerable challenge for ovarian reserve appraisal. This diagnostic difficulty arises from several fundamental questions inherently linked to patient management: the potential influence of endometrioma on ovarian reserve; the adverse effect of ovarian surgery on ovarian reserve; and the adequacy of the established ovarian reserve biomarkers, anti-Müllerian hormone and antral follicle count, to appraise ovarian reserve accurately in these women. Until recently, a key argument was that the development and growth of endometriomas is associated with a progressive damage to normal ovarian tissue, resulting in a concomitant reduction in serum AMH levels. Contrary to this widely accepted position; recent studies have reported that, in women with no previous history of ovarian surgery, AMH levels were increased in women with large endometriomas. These findings are surprising and, if replicated, would have substantial clinical implications. In this commentary, we would, however, urge caution before these reports lead to systematic changes in clinical practice, and recommend urgent replication as the finding linking large endometrioma to high serum AMH levels seems to be biologically implausible, and contradicts the existing extensive body of research.
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Reproductive Outcomes and Fertility Preservation Strategies in Women with Malignant Ovarian Germ Cell Tumors after Fertility Sparing Surgery. Biomedicines 2020; 8:biomedicines8120554. [PMID: 33265938 PMCID: PMC7761340 DOI: 10.3390/biomedicines8120554] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Malignant ovarian germ cell tumors are rare tumors that mainly affect patients of reproductive age. The aim of this study was to investigate the reproductive outcomes and fertility preservation strategies in malignant ovarian germ cell tumors after fertility-sparing surgery. Data in literature support that fertility-sparing surgery is associated with an excellent oncological outcome not only in early stages malignant ovarian germ cell tumors but also in advanced stages. Moreover, the possibility of performing conservative treatment should be considered even in case of relapse or advanced disease, given the high chemosensitivity. Indeed, available data have shown that menstrual function is maintained after platinum-based regimens in over 85-95% of patients with malignant ovarian germ cell tumors and rate of premature menopause reported in literature ranges between 3% and 7.4%, while premature ovarian failure rates are between 3.4% and 5%. Moreover, reproductive outcomes are about 80% with no increase in the risk of teratogenicity compared to general population. Therefore, conservative surgery for malignant ovarian germ cell tumors currently may represent a therapeutic option in patients who wish to preserve fertility but must be available for extended follow-up and after subscribing to informed consent.
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7
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Araujo RSDC, Maia SB, Baracat CMF, Lima MD, Soares ESS, Ribeiro HSAA, Ribeiro PAAG. Ovarian function after the use of various hemostatic techniques during treatment for endometrioma: protocol for a randomized clinical trial. Trials 2019; 20:410. [PMID: 31288827 PMCID: PMC6617678 DOI: 10.1186/s13063-019-3524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/13/2019] [Indexed: 12/25/2022] Open
Abstract
Background Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma. Methods An open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069. Discussion Bearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used. Trial registration ClinicalTrials.gov, NTC03430609. Registered on XX.10/31/2017. ISRCTN Registry, ISRCTN11469394. Registered on XX.17/12/2017. Unique Protocol ID: U1111–1203-2508.
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Affiliation(s)
- Raquel Silveira da Cunha Araujo
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil. .,Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil.
| | - Sabina Bastos Maia
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Clara Micalli Ferruzzi Baracat
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
| | - Moisés Diogo Lima
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Eduardo Sérgio Sousa Soares
- Department of Obstetrics and Gynecology, Lauro Wanderley University Hospital, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Helizabet Salomão Abdalla Ayroza Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
| | - Paulo Augusto Ayroza Galvão Ribeiro
- Gynecological Endoscopy and Endometriosis Division, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, São Paulo, São Paulo, Brazil
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonin C, Busacca M, Candiani M, Centini G, D’Alterio MN, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Raimondo D, Remorgida V, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Venturella R, Vercellini P, Viganó P, Vignali M, Zullo F, Zupi E. When more is not better: 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod Open 2019; 2019:hoz009. [PMID: 31206037 PMCID: PMC6560357 DOI: 10.1093/hropen/hoz009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.
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Marcellin L, Santulli P, Bourdon M, Comte C, Maignien C, Just PA, Streuli I, Borghese B, Chapron C. Serum antimüllerian hormone concentration increases with ovarian endometrioma size. Fertil Steril 2019; 111:944-952.e1. [DOI: 10.1016/j.fertnstert.2019.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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10
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Muzii L, Di Tucci C, Di Feliciantonio M, Galati G, Di Donato V, Musella A, Palaia I, Panici PB. Antimüllerian hormone is reduced in the presence of ovarian endometriomas: a systematic review and meta-analysis. Fertil Steril 2019; 110:932-940.e1. [PMID: 30316440 DOI: 10.1016/j.fertnstert.2018.06.025] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/22/2018] [Accepted: 06/17/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate if the presence of endometriomas impacts on the ovarian reserve as evaluated with antimüllerian hormone (AMH). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Patients with unoperated endometriomas versus controls without endometriomas. INTERVENTION(S) Electronic databases searched up to June 2017 to identify articles evaluating AMH levels in patients with unoperated endometriomas versus controls without endometriomas. MAIN OUTCOME MEASURE(S) The primary analysis was aimed at evaluation of AMH levels (mean and SD) in patients with and without endometriomas. Secondary analyses were aimed at evaluating AMH levels in patients with ovarian endometriomas compared to patients with either non-endometriosis benign ovarian cysts or healthy ovaries. RESULT(S) Of the 39 studies evaluated in detail, 17 were included, for a total of 968 patients with endometriomas and 1874 without endometriomas. AMH was significantly lower in patients with unoperated endometriomas compared to patients with no endometriomas (mean difference -0.84, with 95% confidence interval [CI] -1.16 to -0.52). At secondary analyses, AMH in patients with endometriomas was significantly lower both versus non-endometriosis benign ovarian cysts (mean difference -0.85, 95% CI -1.37 to -0.32, and versus women with healthy ovaries (mean difference -0.61, 95% CI -0.99 to -0.24). CONCLUSION(S) Ovarian reserve evaluated with AMH is reduced in patients with ovarian endometriomas compared both to patients with other benign ovarian cysts, and to patients with healthy ovaries.
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Affiliation(s)
- Ludovico Muzii
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
| | - Chiara Di Tucci
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | | | - Giulia Galati
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Violante Di Donato
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Angela Musella
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Innocenza Palaia
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
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Benaglia L, Castiglioni M, Paffoni A, Sarais V, Vercellini P, Somigliana E. Is endometrioma-associated damage to ovarian reserve progressive? Insights from IVF cycles. Eur J Obstet Gynecol Reprod Biol 2017; 217:101-105. [DOI: 10.1016/j.ejogrb.2017.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 12/27/2022]
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12
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13
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Fertility preservation in women with borderline ovarian tumours. Cancer Treat Rev 2016; 49:13-24. [DOI: 10.1016/j.ctrv.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/15/2022]
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Taniguchi F, Sakamoto Y, Yabuta Y, Azuma Y, Hirakawa E, Nagira K, Uegaki T, Deura I, Hata K, Harada T. Analysis of pregnancy outcome and decline of anti-Müllerian hormone after laparoscopic cystectomy for ovarian endometriomas. J Obstet Gynaecol Res 2016; 42:1534-1540. [DOI: 10.1111/jog.13081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/15/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Fuminori Taniguchi
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yasuko Sakamoto
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yuko Yabuta
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Eriko Hirakawa
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Kei Nagira
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Takashi Uegaki
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Imari Deura
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
| | - Koukichi Hata
- Department of Nursing; The University of Shimane; Izumo Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology; Tottori University Faculty of Medicine; Yonago Japan
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15
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Bénard J, Calvo J, Comtet M, Benoit A, Sifer C, Grynberg M. [Fertility preservation in women of the childbearing age: Indications and strategies]. ACTA ACUST UNITED AC 2016; 45:424-44. [PMID: 27021926 DOI: 10.1016/j.jgyn.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
Advances on cryopreservation techniques now allow considering oocyte, embryo or ovarian tissue freezing for female fertility preservation. Originally developed for patients suffering from cancer, fertility preservation has rapidly invaded others medical fields, and represents now the standard of care for all young patient diagnosed with a disease that could impair fertility or having to receive possibly gonadotoxic treatment. As a result, autoimmune diseases, some genetic pathologies or iterative pelvic surgeries, at risk of premature ovarian failure, have become common indications of fertility preservation. In addition, the social egg freezing aiming at preventing the age-related fertility decline is still debated in France, although authorized in numerous countries. This review will discuss the different strategies of fertility preservation in young girls and women of reproductive age, regarding different medical or non-medical indications.
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Affiliation(s)
- J Bénard
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France
| | - J Calvo
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Comtet
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - A Benoit
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - C Sifer
- Service de cytogénétique et biologie de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France
| | - M Grynberg
- Service de médecine de la reproduction, hôpital Jean-Verdier, avenue du 14-Juillet, 93140 Bondy, France; Université Paris XIII, 93000 Bobigny, France; Unité Inserm U1133, université Paris-Diderot, 75013 Paris, France.
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16
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Sanchez AM, Somigliana E, Vercellini P, Pagliardini L, Candiani M, Vigano P. Endometriosis as a detrimental condition for granulosa cell steroidogenesis and development: From molecular alterations to clinical impact. J Steroid Biochem Mol Biol 2016; 155:35-46. [PMID: 26407755 DOI: 10.1016/j.jsbmb.2015.07.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
Endometriosis is an estrogen-dependent chronic inflammatory condition that affects women in their reproductive period. Alterations in ovarian follicle morphology and function have been documented in affected women. The local intrafollicular environment has been as well examined by various groups. In the present review, we aimed to summarize the molecular evidence supporting the idea that endometriosis can negatively influence growth, steroidogenesis and the function of the granulosa cells (GCs). Reduced P450 aromatase expression, increased intracellular ROS generation and altered WNT signaling characterize the GCs of women with endometriosis. Clear evidence for an increased level of GC apoptosis has been provided in association with the downregulation of pro-survival factors. Other potentially negative effects include decreased progesterone production, locally decreased AMH production and lower inflammatory cytokine expression, although these have been only partially clarified. The possibility that endometriosis per se may influence IVF clinical results as a consequence of the detrimental impact on the local intrafollicular environment is also discussed.
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Affiliation(s)
- Ana Maria Sanchez
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Edgardo Somigliana
- Department of Obstetrics, Gynecology and Neonatology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Paolo Vercellini
- Department of Obstetrics, Gynecology and Neonatology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Pagliardini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Massimo Candiani
- Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milano, Italy
| | - Paola Vigano
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milano, Italy.
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Nieweglowska D, Hajdyla-Banas I, Pitynski K, Banas T, Grabowska O, Juszczyk G, Ludwin A, Jach R. Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery. Reprod Biol Endocrinol 2015; 13:128. [PMID: 26596960 PMCID: PMC4657379 DOI: 10.1186/s12958-015-0125-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/17/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Endometriosis is a well-known cause of infertility, and the anti-Mullerian hormone (AMH) is an accepted biomarker of ovarian reserve and response to artificial reproductive technology procedures. The present study was a prospective analysis of age-dependent AMH serum concentration in women with bilateral and unilateral ovarian endometriomas before therapy onset compared with healthy controls. METHODS This prospective cross-sectional study included 384 women aged 18-48 years. AMH serum concentration was assessed between days 3 and 6 of the menstrual cycle in 78 patients with bilateral and 157 patients with unilateral ovarian endometriomas and compared with 149 healthy controls. Ovarian endometriosis was confirmed histopathologically, and data were presented as medians with interquartile range (IQR). RESULTS Stage III endometriosis was diagnosed in 53.2 %, stage IV in 18.3 %, stage V in 23.4 % and stage VI in 5.4 % of the patients. Patients with bilateral ovarian endometriomas showed the lowest median AMH levels compared with patients suffering from unilateral ovarian endometriosis (0.55; IQR: 0.59 vs. 2.00; IQR: 2.80; p < 0.001) and the control group (0.55; IQR: 0.59 vs. 2.84; IQR: 3.2; p < 0.001). Median AMH concentration values were not significantly different between patients with unilateral ovarian endometriosis and the healthy controls (2.00; IQR: 2.80 vs. 2.84; IQR: 3.2; p = 0.182). A strongly negative correlation between AMH levels and age was confirmed in healthy individuals (R = -0.834; p < 0.001) and women with unilateral ovarian endometriomas (R = -0.774; p < 0.001). Patients with bilateral ovarian endometriosis showed a significantly negative but only moderate correlation between AMH levels and age (R = -0.633; p < 0.001), which was significantly lower than in the healthy controls (R = -0.633 vs. R = -0.834; p = 0.006) but not in the patients with unilateral ovarian endometriosis (R = -0.663 vs. R-0.774; p = 0.093). Based on a multivariate regression analysis, only bilateral localization of ovarian endometrial cysts (p = 0.003) and patient age (p < 0.001), but not left/right localization of unilateral cyst or cyst volume, were negatively associated with AMH serum concentration. CONCLUSION According to our data, unilateral ovarian endometriosis had a moderately negative and nonsignificant effect on AMH-based ovarian reserve evaluated prior to surgery, irrespective of age. In contrast, the ovarian reserve was significantly reduced in women with bilateral ovarian endometriomas.
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Affiliation(s)
- Dorota Nieweglowska
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Iwona Hajdyla-Banas
- Center of Rheumatology, Immunology and Rehabilitation, Dietl Specialistic Hospital, Krakow, Poland
| | - Kazimierz Pitynski
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland.
| | - Tomasz Banas
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Oliwia Grabowska
- Nuffield Division of Clinical Laboratory Science, University of Oxford, Level 4, John Radcliffe Hospital, Headington, OX3 9DU, Oxford, UK
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Chair of Gynecology and Obstetrics, Krakow, 21 Kopernika Str, 30-501, Krakow, Poland
| | - Robert Jach
- Department of Gynecological Endocrinology, Jagiellonian University Medical College, Krakow, Poland
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Benaglia L, Candotti G, Busnelli A, Paffoni A, Vercellini P, Somigliana E. Antral follicle count as a predictor of ovarian responsiveness in women with endometriomas or with a history of surgery for endometriomas. Fertil Steril 2015; 103:1544-50.e1-3. [DOI: 10.1016/j.fertnstert.2015.03.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 11/15/2022]
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19
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Somigliana E, Viganò P, Filippi F, Papaleo E, Benaglia L, Candiani M, Vercellini P. Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod 2015; 30:1280-6. [PMID: 25883035 DOI: 10.1093/humrep/dev078] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 03/17/2015] [Indexed: 12/14/2022] Open
Abstract
The increasing confidence with the techniques of oocyte and ovarian cortex freezing has prompted their potential use for patient categories other than those at risk of early menopause due to cancer treatments. Women affected by every iatrogenic or pathologic condition known to compromise ovarian function severely have been considered as potential candidates for fertility preservation. Among them, women with endometriosis may represent a particularly suitable group since they are at increased risk of premature ovarian exhaustion and about half of them will experience infertility. Based on the currently available notions on the intricate relationships between endometriosis, infertility and damage to the ovarian reserve, we speculate that fertility preservation may be of interest for women with endometriosis, in particular for those with bilateral unoperated endometriomas and for those who previously had excision of unilateral endometriomas and require surgery for a contralateral recurrence. Young age at diagnosis may be an independent but pivotal additional factor to be taken into consideration in the balance of the pros and cons of fertility preservation. On the other hand, we argue against the introduction of fertility preservation for endometriosis in routine clinical practice. To date, only few cases have been reported and there are insufficient data for robust cost-utility analyses. It is noteworthy that endometriosis is a relatively common disease and systematically including affected women in a fertility preservation program would have profound clinical, logistic and financial effects. More clinical data and in-depth economic analysis are imperative prior to recommending its routine use.
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Affiliation(s)
- Edgardo Somigliana
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Viganò
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Filippi
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Papaleo
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Laura Benaglia
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Candiani
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Vercellini
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy Università degli Studi di Milano, Milan, Italy
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20
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Somigliana E, Benaglia L, Paffoni A, Busnelli A, Vigano P, Vercellini P. Risks of conservative management in women with ovarian endometriomas undergoing IVF. Hum Reprod Update 2015; 21:486-99. [DOI: 10.1093/humupd/dmv012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/16/2015] [Indexed: 12/14/2022] Open
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