1
|
Ferrari F, Epis M, Casarin J, Bordi G, Gisone EB, Cattelan C, Rossetti DO, Ciravolo G, Gozzini E, Conforti J, Cromi A, Laganà AS, Ghezzi F, Odicino F. Long-term therapy with dienogest or other oral cyclic estrogen-progestogen can reduce the need for ovarian endometrioma surgery. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241252573. [PMID: 38738634 PMCID: PMC11092536 DOI: 10.1177/17455057241252573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Almost 10% of women in reproductive age are diagnosed with ovarian endometriomas and can experience symptoms and infertility disorders. Ovarian endometriomas can be treated with medical or surgical therapy. OBJECTIVE To assess whether long-term therapy with dienogest or oral cyclic estrogen-progestogens is effective in reducing the size of ovarian endometriomas, alleviating associated symptoms, and reducing the requirement for surgery. DESIGN Prospective non-interventional cohort study. METHODS We enrolled childbearing women diagnosed with ovarian endometriomas. We collected demographic, clinical, and surgical data, including the evaluation of ovarian endometrioma-associated symptoms and pain using the visual analog scale. We grouped the women according to treatment regimen into dienogest, estrogen-progestogens, and no-treatment. Patient's assessment was performed at baseline and after 12 months evaluating the largest ovarian endometrioma diameter (in millimeters) and the associated symptoms. Furthermore, we analyzed the impact of hormonal treatment in a sub-group of women fulfilling at baseline the criteria for a first-line surgical approach (ovarian endometrioma > 30 mm with visual analog scale > 8 or ovarian endometrioma > 40 mm before assisted reproductive treatments or any ovarian endometrioma(s) > 60 mm). RESULTS We enrolled 142 patients: 62, 38, and 42 in dienogest, estrogen-progestogens, and no-treatment groups, respectively. No significant differences were found regarding baseline characteristics. After 12 months, the mean largest ovarian endometrioma diameter increased in the no-treatment group (31.1 versus 33.8; p < 0.01), while a significant reduction was registered in the dienogest (35.1 versus 25.8; p < 0.01) and estrogen-progestogens (28.4 versus 16.7; p < 0.01) groups; no significant difference in ovarian endometrioma diameter reduction between these two latter groups was noted (p = 0.18). Ovarian endometrioma-associated symptoms and pain improved in dienogest and estrogen-progestogens groups, with a significantly greater effect for dienogest than for estrogen-progestogens for dysmenorrhea (74% versus 59%; p < 0.01). In the sub-group of women eligible for first-line surgery at baseline, long-term treatment with dienogest and estrogen-progestogens reduced surgical eligibility by 30%. CONCLUSIONS Decreased mean largest ovarian endometriomas'diameter after 12 months and reduction of the need for surgical treatment by 30% were observed in dienogest and estrogen-progestogens groups. Long-term treatment with dienogest had a greater effect in alleviating dysmenorrhea and pain.
Collapse
Affiliation(s)
- Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- S.C. Ginecologia e Ostetricia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Matteo Epis
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Giulia Bordi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Emanuele Baldo Gisone
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Chiara Cattelan
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | | | - Giuseppe Ciravolo
- S.C. Ginecologia e Ostetricia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elisa Gozzini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- S.C. Ginecologia e Ostetricia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Jacopo Conforti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- S.C. Ginecologia e Ostetricia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Palermo, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- S.C. Ginecologia e Ostetricia, ASST Spedali Civili di Brescia, Brescia, Italy
| |
Collapse
|
2
|
Ronsini C, Iavarone I, Braca E, Vastarella MG, De Franciscis P, Torella M. The Efficiency of Sclerotherapy for the Management of Endometrioma: A Systematic Review and Meta-Analysis of Clinical and Fertility Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1643. [PMID: 37763762 PMCID: PMC10535205 DOI: 10.3390/medicina59091643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The most common sites of implantation of endometriotic tissue are the ovaries. Endometriomas are present in most cases of endometriosis (up to 45%). Although laparoscopic cystectomy is the standard of care in endometrioma, new strategies have been set up to minimize iatrogenic injuries to ovarian tissue. Sclerotherapy consists of injecting alcohol into the endometrioma to denature the amino acidic components of its pseudocapsule. The aim of this systematic review and meta-analysis is to compare clinical and pregnancy outcomes in surgery and sclerotherapy. Materials and Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched PubMed, EMBASE, Scopus, Google Scholar, Clinical-trials.gov, and the Cochrane Central Register of Controlled Trials databases in January 2023, adopting the string "Endometriosis and sclerotherapy". We made no limitations on the country and year of publication. We included the studies containing Success Rate (SR), Recurrence Rate (RR), Pregnancy Rate (PR) before and after the procedure. We used comparative studies for meta-analysis. Results: A total of 29 studies fulfilled inclusion criteria, 7 retrospective observational studies and 22 prospective studies. Eight comparative studies were enrolled in meta-analysis. Patients were analyzed concerning the number of recurrences and pregnancies in surgery, and compared with sclerotherapy. Four studies showed SR > 80.0%, and only two had SR < 80.0%, of which one consisted of tetracycline instillation. Only 1 study had 100% PR, the other 14 reported PR > 30.0%, whereas six had PR < 30.0%, of which one showed 0.0% PR with ethanol injection at two-thirds of the cyst fluid volume. Meta-analysis highlighted a non-significant lower incidence of recurrence in the surgery group compared to the sclerotherapy group (p = 0.87). In parallel, the surgery group showed a non-significant better PR than the sclerotherapy group (p = 0.08). Conclusions: Despite sclerotherapy having a minor incidence of postoperative complications compared to surgery, the latter is associated with a lower RR and better PR. However, those data assert the importance of a targeted therapy according to preoperative conditions and reproductive potential.
Collapse
Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Eleonora Braca
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Maria Giovanna Vastarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| |
Collapse
|
3
|
Asoglu MR, Celik C, Bahceci M. Frozen blastocyst transfer improves the chance of live birth in women with endometrioma. Gynecol Endocrinol 2020; 36:902-906. [PMID: 32568558 DOI: 10.1080/09513590.2020.1781082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: The existing literature is scarce regarding outcomes of fresh vs frozen embryo blastocyst transfers in women with endometrioma. The goal of the study was to compare outcomes between fresh and frozen blastocyst transfers (fresh-BT vs. frozen-BT) in endometrioma-affected women. Materials and methods: This study included 315 endometrioma-affected women aged between 20 and 39 years who underwent blastocyst transfer. Primary outcome was live birth rate (an alive birth after 24 completed weeks gestation). Results: The study groups did not differ in terms of patient characteristics and treatment variables. The live birth rate was 40.7% in fresh-BT group and 56.1% in frozen-BT group (OR:1.86, 95% CI:1.18-2.92 p = .007). The approach of frozen embryo transfer was an independent factor of live birth (adjusted OR:1.83, 95% CI:1.16-2.90, p = .009). Conclusion: The approach of frozen blastocyst transfer increases the chance of live birth in endometrioma-affected patients compared with fresh blastocyst transfer. Thus, a frozen embryo transfer may be the choice of strategy in these patients.
Collapse
Affiliation(s)
| | - Cem Celik
- Bahceci Umut Assisted Reproduction Center, Istanbul, Turkey
- Department of Obstetrics and Gynecology, School of Medicine, Uskudar University, Istanbul, Turkey
| | - Mustafa Bahceci
- Bahceci Fulya Assisted Reproduction Center, Istanbul, Turkey
| |
Collapse
|
4
|
Cecchino GN, Cozzolino M, Roque M, García-Velasco JA. Endometrioma and reproductive issues: a well-informed patient may be the driver for change. ACTA ACUST UNITED AC 2020; 72:149-156. [PMID: 33000615 DOI: 10.23736/s0026-4784.20.04595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Endometriosis affects a great proportion of women during their reproductive years and may impair female fertility in several ways. Ovarian endometrioma (OE) is the most frequent phenotype and growing evidence suggest an endometrioma-mediated damage to the ovary, ovarian reserve and oocyte quality. Traditionally, surgery has been the first-line treatment in cases of OE. Great advances in assisted reproduction and fertility preservation techniques opened new possibilities towards a more conservative approach. Herein we discuss multiple mechanisms responsible for the deterioration of the reproductive capacity in cases of OE as well as the pros and cons of different treatment options. The management of endometrioma-related subfertility remains controversial and it will depend on patient's intentions and priorities. In the "internet era" patients tend to be hyper-informed and more participative, but they are often misguided and misinformed. Thus, doctors should be able to convert these individuals into well-informed patients in order to facilitate the process of shared decision making, which is extremely relevant in the context of OEs.
Collapse
Affiliation(s)
- Gustavo N Cecchino
- Department of Gynecology, Federal University of São Paulo, São Paulo, Brazil - .,Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain - .,Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil -
| | - Mauro Cozzolino
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,IVIRMA, IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Juan A García-Velasco
- Department of Gynecology and Obstetrics, Rey Juan Carlos University, Madrid, Spain.,Department of Reproductive Medicine and Infertility, IVIRMA Madrid, Madrid, Spain
| |
Collapse
|
5
|
Xholli A, Filip G, Previtera F, Cagnacci A. Modification of endometrioma size during hormone therapy containing dienogest. Gynecol Endocrinol 2020; 36:545-549. [PMID: 31842632 DOI: 10.1080/09513590.2019.1703942] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study was to evaluate whether hormone therapy containing dienogest is effective in reducing endometrioma size. A retrospective observational study was conducted on 116 women with endometrioma which was evaluated after 6 and 12 months of either no treatment (n = 46), or hormonal therapy containing dienogest (n = 70), without (DNG; n = 34) or with ethinylestradiol (DNG/EE; n = 36). Median (interquartile range) cyst diameter (23.0 mm (21.0 mm)) and volume (9941.2 mm3 (14240.1 mm3)) of untreated were similar to cyst diameter (25.0 mm (14.5 mm) and volume (7587.7 mm3 (13806.2 mm3)) of treated women. After 12 months, endometrioma volume did not vary in untreated women (-34.0 mm3 (55595.0 mm3); -0.77% (93.9%)) while it significantly decreased (-5400 mm3 (15378.7 mm3); -100.0% (27.7%); p<.0001) during hormone therapy. Volume decrease was linearly related to endometrioma volume ([Formula: see text] R2 = 0.899, p<.0001). The effect tended to be greater during DNG alone than DNG/EE (-100.0% (0.0%) vs. -87.9% (47.7%); p<.0004). Cyst disappearance was observed in 4.4% of untreated cases and in 57.1% of cases on hormone therapy (p<.0001) (38.9% with DNG/EE and 76.5% with DNG; p<.03). The early diagnosis and treatment of endometrioma with dienogest-based hormone therapy may be effective in controlling cyst growth and in reducing the need for surgery.
Collapse
Affiliation(s)
- Anjeza Xholli
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Gabriele Filip
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Francesca Previtera
- Department of Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Unit, University of Udine, Udine, Italy
| | - Angelo Cagnacci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Obstetrics Gynaecology and Paediatrics, Obstetrics and Gynecology Clinic, Hospital San Martino-IRCCS, University of Genova, Genova, Italy
| |
Collapse
|
6
|
Endometrioma, fertility, and assisted reproductive treatments: connecting the dots. Curr Opin Obstet Gynecol 2019; 30:223-228. [PMID: 29847457 DOI: 10.1097/gco.0000000000000464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. RECENT FINDINGS The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms. SUMMARY Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.
Collapse
|
7
|
Gomez R, Schorsch M, Gerhold-Ay A, Hasenburg A, Seufert R, Skala C. Fertility After Ovarian Cystectomy: How Does Surgery Affect IVF/ICSI Outcomes? Geburtshilfe Frauenheilkd 2019; 79:72-78. [PMID: 30686836 PMCID: PMC6336490 DOI: 10.1055/a-0767-6722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 09/20/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction
For patients considering undergoing assisted reproductive techniques (ART), many concerns arise when persistent ovarian cysts are found. This large study aimed to determine how ovarian cyst removal affects success rates of IVF/ICSI therapies.
Methods
550 patients who underwent an IVF/ICSI treatment between 2002 and 2011 with a persistent ovarian cyst ≤ 5 cm before treatment were analyzed retrospectively. 328 patientsʼ preference was to undergo a laparoscopic cystectomy and 222 patients opted for a conservative management. Control subjects included 13 552 patients undergoing IVF/ICSI at the same period of time without an ovarian cyst.
Results
After adjusting for age, patients with ovarian cysts without surgery needed a significant higher stimulation dose than the control group (2576.4 vs. 2207.5 IU, p < 0.001). However, on average, they had 1.13 (− 0.25 – 2.01) higher oocyte number retrieved compared to the operated patients (9.0 ± 5.5 vs. 8.2 ± 5.0) (p = 0.012). Patients after surgical cyst removal had a significant lower number of oocytes retrieved (MNOR) in comparison to the control group (8.2 ± 5.0 vs. 9.5 ± 5.4) (p = 0.00). Compared to controls, operated patients had similar clinical pregnancy rate (CPR) (34.2 vs. 33.5%) OR 1.031 (95% CI 0.817 – 1.302) (p = 0.815). Compared to controls, patients without surgery showed significant lower pregnancy rate (34.2 vs. 25,7%) OR 1.428 (95% CI 1.054 – 1.936) (p = 0.002) and lower live birth rate (LBR) (21.9 vs. 13.5%) OR 1.685 (95% CI 1.143 – 2.485) (p = 0.008).
Conclusions
Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls.
Collapse
Affiliation(s)
- Ruth Gomez
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | | | - Aslihan Gerhold-Ay
- IMBEI-Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Annette Hasenburg
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Rudolf Seufert
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| | - Christine Skala
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Germany
| |
Collapse
|
8
|
Ovarian endometriosis and infertility: in vitro fertilization (IVF) or surgery as the first approach? Fertil Steril 2018; 110:1218-1226. [DOI: 10.1016/j.fertnstert.2018.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023]
|
9
|
Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
|
10
|
Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril 2017; 108:117-124.e5. [DOI: 10.1016/j.fertnstert.2017.05.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 11/23/2022]
|
11
|
Ferrero S, Scala C, Tafi E, Racca A, Venturini PL, Leone Roberti Maggiore U. Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2017; 213:17-21. [DOI: 10.1016/j.ejogrb.2017.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/26/2016] [Accepted: 04/01/2017] [Indexed: 12/20/2022]
|
12
|
Strategies to Preserve and Optimize Fertility for Patients with Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endometriosis is commonly associated with dysmenorrhea, chronic pelvic pain, and infertility. When medical therapy fails, surgery is often recommended; unfortunately, endometriosis surgery can adversely impact fertility and ovarian reserve in women desiring future childbearing. This review will focus on mechanisms of infertility in endometriosis patients as well as strategies for optimizing fertility in endometriosis patients when surgery is indicated. In addition, fertility preserving techniques such as oocyte and ovarian tissue cryopreservation as well as issues relevant to in vitro fertilization for patients with endometriosis are discussed.
Collapse
|
13
|
Salihoğlu KN, Dilbaz B, Cırık DA, Ozelci R, Ozkaya E, Mollamahmutoğlu L. Short-Term Impact of Laparoscopic Cystectomy on Ovarian Reserve Tests in Bilateral and Unilateral Endometriotic and Nonendometriotic Cysts. J Minim Invasive Gynecol 2016; 23:719-25. [DOI: 10.1016/j.jmig.2016.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 01/07/2023]
|
14
|
Kang JH, Kim YS, Lee SH, Kim WY. Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy. Eur J Obstet Gynecol Reprod Biol 2015; 194:64-7. [DOI: 10.1016/j.ejogrb.2015.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/13/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
|
15
|
Reduction in Endometrioma Size with Three Months of Aromatase Inhibition and Progestin Add-Back. BIOMED RESEARCH INTERNATIONAL 2015; 2015:878517. [PMID: 26247030 PMCID: PMC4515259 DOI: 10.1155/2015/878517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/07/2014] [Indexed: 12/05/2022]
Abstract
The purpose of this study was to assess the impact of 3 months of aromatase inhibition together with progestin add-back on ovarian endometrioma size. This prospective cohort study was performed at University Medical Center (UC San Diego). Women trying to conceive were excluded. After informed consent, all women were treated with the aromatase inhibitor letrozole (5 mg/d) with norethindrone acetate (5 mg/d) add-back for 3 months. Pre- and posttreatment assessments of endometrioma sizes were performed by ultrasound. The impact of treatment on pain was determined using the patient assessed endpoints of the Biberoglu and Behrman scale. These included assessing dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain each on a scale from 0 to 3. The primary endpoint of this study was the change in ultrasound documented endometrioma size. Fourteen endometriomas in 8 consecutive women were treated for 3 m. Mean endometrioma diameter decreased 50% from 4.6 ± 1.6 cm to 2.3 ± 1.6 cm (mean ± SD). This represents a 75% decrease in endometrioma volume. Endometriosis symptoms of dysmenorrhea, dyspareunia, and nonmenstrual pelvic pain also improved with treatment. In conclusion, a 3-month course of high dose aromatase inhibition with progestin add-back significantly reduces ovarian endometrioma size and warrants further investigation.
Collapse
|
16
|
Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles. J Assist Reprod Genet 2015; 32:685-9. [PMID: 25758989 DOI: 10.1007/s10815-015-0457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function. METHODS A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (E-Ov) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles. RESULTS Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2 ± 2.0 vs. 5.1 ± 3.3, P = 0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6% vs. 69.5%, P = 0.43) and the rate of top-quality embryos (40.0% vs. 49.0%, P = 0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0% vs. 25.0%, P = 0.39 and 20.0% vs. 20.8%, P = 0.96). CONCLUSIONS The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.
Collapse
|
17
|
|
18
|
Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod 2014; 29:2190-8. [DOI: 10.1093/humrep/deu199] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
19
|
Fadhlaoui A, Bouquet de la Jolinière J, Feki A. Endometriosis and infertility: how and when to treat? Front Surg 2014; 1:24. [PMID: 25593948 PMCID: PMC4286960 DOI: 10.3389/fsurg.2014.00024] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/15/2014] [Indexed: 01/24/2023] Open
Abstract
Endometriosis is defined as the presence of endometrial-like tissue (glands or stroma) outside the uterus, which induces a chronic inflammatory reaction. Although endometriosis impairs fertility, it does not usually completely prevent conception. The question of evidence based-medicine guidelines in endometriosis-associated infertility is weak in many situations. Therefore, we will highlight in this issue where the challenges are.
Collapse
Affiliation(s)
- Anis Fadhlaoui
- Service de gynécologie obstétrique, HFR Fribourg – Hôpital Cantonal, Fribourg, Switzerland
| | | | - Anis Feki
- Service de gynécologie obstétrique, HFR Fribourg – Hôpital Cantonal, Fribourg, Switzerland
| |
Collapse
|
20
|
Song T, Lee SH, Kim WY. Additional benefit of hemostatic sealant in preservation of ovarian reserve during laparoscopic ovarian cystectomy: a multi-center, randomized controlled trial. Hum Reprod 2014; 29:1659-65. [DOI: 10.1093/humrep/deu125] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
|
21
|
Ferrero S, Remorgida V, Venturini PL, Leone Roberti Maggiore U. Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study. Eur J Obstet Gynecol Reprod Biol 2014; 174:117-22. [DOI: 10.1016/j.ejogrb.2013.11.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/12/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
|
22
|
Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst. Fertil Steril 2013; 100:464-9. [DOI: 10.1016/j.fertnstert.2013.03.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 11/17/2022]
|
23
|
Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro
fertilization. J Obstet Gynaecol Res 2013; 39:1246-52. [DOI: 10.1111/jog.12056] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/18/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Akiko Takashima
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Kiwamu Otaka
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| | - Toshihiko Kinoshita
- Department of Obstetrics and Gynecology; Toho University Medical Center Sakura Hospital; Chiba Japan
| |
Collapse
|
24
|
Tulandi T, Akkour K. Role of reproductive surgery in the era of assisted reproductive technology. Best Pract Res Clin Obstet Gynaecol 2012; 26:747-55. [DOI: 10.1016/j.bpobgyn.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/11/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
|
25
|
Hemostasis by Bipolar Coagulation Versus Suture After Surgical Stripping of Bilateral Ovarian Endometriomas: A Randomized Controlled Trial. J Minim Invasive Gynecol 2012; 19:722-30. [DOI: 10.1016/j.jmig.2012.08.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 07/29/2012] [Accepted: 08/02/2012] [Indexed: 11/23/2022]
|
26
|
Koch J, Rowan K, Rombauts L, Yazdani A, Chapman M, Johnson N. Endometriosis and Infertility - a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence). Aust N Z J Obstet Gynaecol 2012; 52:513-22. [DOI: 10.1111/j.1479-828x.2012.01480.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 08/02/2012] [Indexed: 12/29/2022]
Affiliation(s)
- Juliette Koch
- IVF Australia; Bondi Junction; New South Wales; Australia
| | | | - Luk Rombauts
- Department of O&G; Monash University; Clayton; Victoria; Australia
| | - Anusch Yazdani
- QFG Research Foundation; University of Queensland; St Lucia; Queensland; Australia
| | - Michael Chapman
- Department of O&G; University of New South Wales; Randwick; New South Wales; Australia
| | | |
Collapse
|
27
|
Yazbeck C, Koskas M, Cohen Scali S, Kahn V, Luton D, Madelenat P. [How I do... ethanol sclerotherapy for ovarian endometriomas]. ACTA ACUST UNITED AC 2012; 40:620-2. [PMID: 22959083 DOI: 10.1016/j.gyobfe.2012.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Affiliation(s)
- C Yazbeck
- Service de gynécologie obstétrique et médecine de reproduction, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | | | | | | | | | | |
Collapse
|
28
|
Siristatidis C, Chrelias C, Sioulas VD, Stathopoulou VA, Makris GMC, Koliopoulos G, Kassanos D. Controversies in the management of endometriomas in patients undergoing assisted reproduction. Arch Gynecol Obstet 2012; 286:1563-9. [DOI: 10.1007/s00404-012-2538-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 08/16/2012] [Indexed: 10/27/2022]
|
29
|
Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97:3146-54. [PMID: 22723324 DOI: 10.1210/jc.2012-1558] [Citation(s) in RCA: 312] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Endometriomas are mainly treated surgically. However, there has been concern over the potential damaging effect of this surgery on ovarian reserve. OBJECTIVE The aim of this meta-analysis was to investigate the impact of surgery for endometriomas on ovarian reserve as determined by serum anti-müllerian hormone (AMH). DATA SOURCES MEDLINE, PubMed, and Embase were searched electronically. STUDY SELECTION All prospective cohort studies that analyzed changes of serum AMH concentrations after surgical treatment of endometriomas were eligible. Twenty-one studies were identified, of which eight were selected for meta-analysis. DATA EXTRACTION Two reviewers performed the data extraction independently. DATA SYNTHESIS Pooled analysis of 237 patients showed a statistically significant decrease in serum AMH concentration after ovarian cystectomy (weighted mean difference -1.13 ng/ml; 95% confidence interval -0.37 to -1.88), although heterogeneity was high. Sensitivity analysis for studies with a preoperative serum AMH level of 3.1 ng/ml or greater improved heterogeneity but also still showed a significant postoperative fall in serum AMH (weighted mean difference -1.52 ng/ml, 95% confidence interval -1.04 to -2). CONCLUSION The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH.
Collapse
Affiliation(s)
- Francesca Raffi
- University of Nottingham, Medical School, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom.
| | | | | |
Collapse
|
30
|
National survey of the current management of endometriomas in women undergoing assisted reproductive treatment. Hum Reprod 2012; 27:2712-9. [DOI: 10.1093/humrep/des195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
31
|
Benaglia L, Bermejo A, Somigliana E, Scarduelli C, Ragni G, Fedele L, Garcia-Velasco JA. Pregnancy outcome in women with endometriomas achieving pregnancy through IVF. Hum Reprod 2012; 27:1663-7. [DOI: 10.1093/humrep/des054] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Tulandi T, Marzal A. Redefining reproductive surgery. J Minim Invasive Gynecol 2012; 19:296-306. [PMID: 22348901 DOI: 10.1016/j.jmig.2012.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 11/17/2022]
Abstract
With the availability of and improvements in in vitro fertilization (IVF), the role of reproductive surgery has been questioned. Yet, the scope of reproductive surgery today is much larger than in the past. Hysteroscopic correction of intrauterine disease is an important endoscopic procedure in women with infertility. Evidence suggests that correction of intrauterine disease is often followed by spontaneous pregnancy and improved IVF outcome. Hysteroscopic examination should be considered after 1 failed IVF. Today, it is clear that removal of the hydrosalpinx leads to a higher IVF-related live birth rate. The procedure should be performed thoroughly without compromising the ovarian blood supply. The IVF pregnancy rate is not affected by the presence of ovarian endometriomas, and small endometriomas need not be removed; however, large and symptomatic endometriomas that interfere with oocyte retrieval should be excised. When excision of the cyst wall is difficult, fenestration and ablation should be considered. This might lead to an increased recurrence rate, but is associated with less interference of the ovarian reserve. Although the role of reproductive surgery as primary treatment for tuboperitoneal infertility is limited, it has an important role in enhancing the outcome of IVF treatment and in preservation of fertility. Surgical preservation of fertility consists of ovarian suspension, ovarian excision for cryopreservation, and ovarian tissue transplantation.
Collapse
Affiliation(s)
- Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
| | | |
Collapse
|
33
|
Opøien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, Oldereid N, Mellembakken JR, Tanbo T. In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril 2012; 97:912-8. [PMID: 22341637 DOI: 10.1016/j.fertnstert.2012.01.112] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/09/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess success rates of IVF and intracytoplasmic sperm injection in women with various stages of endometriosis. DESIGN Retrospective cohort study. SETTING Reproductive medicine unit in a university hospital. PATIENT(S) Infertile women (n = 2,245) with various stages of endometriosis or tubal factor infertility. INTERVENTION(S) IVF or intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Dose of FSH, number of oocytes retrieved, fertilization rate, implantation rate, pregnancy rate (PR), live birth/ongoing PR. RESULT(S) Women with endometriosis had similar pregnancy and live birth/ongoing PR as did women with tubal factor infertility, but the American Society for Reproductive Medicine (ASRM) stage I and II endometriosis patients had a lower fertilization rate, and stage III and IV patients required more FSH and had fewer oocytes retrieved. Splitting the stage III and IV groups into patients with and without endometriomas showed that the endometrioma group required more FSH and had a significantly lower pregnancy and live birth/ongoing PR. CONCLUSION(S) With the exception of patients with endometrioma, infertile women with various stages of endometriosis have the same success rates with IVF and intracytoplasmic sperm injection as patients with tubal factor. This contrasts with the systematic review on which the European Society of Human Reproduction and Embryology bases its recommendations.
Collapse
Affiliation(s)
- Hans Kristian Opøien
- Section for Reproductive Medicine, Department of Gynaecology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Esinler I, Bozdag G, Arikan I, Demir B, Yarali H. Endometrioma =3 cm in Diameter per se Does Not Affect Ovarian Reserve in Intracytoplasmic Sperm Injection Cycles. Gynecol Obstet Invest 2012; 74:261-4. [DOI: 10.1159/000339630] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/16/2012] [Indexed: 11/19/2022]
|
35
|
Lee DY, Young Kim N, Jae Kim M, Yoon BK, Choi D. Effects of laparoscopic surgery on serum anti-Müllerian hormone levels in reproductive-aged women with endometrioma. Gynecol Endocrinol 2011; 27:733-6. [PMID: 21158493 DOI: 10.3109/09513590.2010.538098] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A few studies have investigated the effects of laparoscopic cystectomy for endometrioma on ovarian reserve using serum anti-Müllerian hormone (AMH) levels and have shown inconsistent results. This prospective study was performed to estimate early changes in serum AMH after laparoscopic surgery for endometrioma. In 27 women aged 21-46 years who underwent laparoscopic unilateral cystectomy (n = 13) or oophorectomy (n = 14) for endometrioma, we measured pre- and postoperative serum AMH levels at baseline and 1 week, 1 month, and 3 months after surgery. Serial changes in serum AMH levels were analyzed according to the operation type using analysis of variance. Mean levels of serum AMH decreased significantly immediately after surgery and remained for up to 3 months in both operation types (P = 0.002 for cystectomy group and P <0.001 for oophorectomy group). In addition, the serum AMH levels showed similar patterns of change after cystectomy or oophorectomy. In conclusion, laparoscopic ovarian cystectomy for endometrioma appears to decrease serum AMH levels immediately after surgery.
Collapse
Affiliation(s)
- Dong-Yun Lee
- Department of Obstetrics & Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
36
|
|
37
|
Somigliana E, Benaglia L, Vigano’ P, Candiani M, Vercellini P, Fedele L. Surgical measures for endometriosis-related infertility: A plea for research. Placenta 2011; 32 Suppl 3:S238-42. [DOI: 10.1016/j.placenta.2011.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/18/2011] [Indexed: 01/19/2023]
|
38
|
Muzii L, Miller CE. The Singer, Not the Song. J Minim Invasive Gynecol 2011; 18:666-7. [DOI: 10.1016/j.jmig.2011.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/23/2011] [Indexed: 11/17/2022]
|
39
|
Reinblatt SL, Ishai L, Shehata F, Son WY, Tulandi T, Almog B. Effects of ovarian endometrioma on embryo quality. Fertil Steril 2011; 95:2700-2. [DOI: 10.1016/j.fertnstert.2011.03.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
|
40
|
Benaglia L, Pasin R, Somigliana E, Vercellini P, Ragni G, Fedele L. Unoperated ovarian endometriomas and responsiveness to hyperstimulation. Hum Reprod 2011; 26:1356-61. [PMID: 21478182 DOI: 10.1093/humrep/der097] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a growing consensus that ovarian reserve is reduced after surgical excision of ovarian endometriomas. However, it remains to be fully clarified whether this damage precedes or follows surgery. In order to further elucidate this aspect, we evaluated ovarian responsiveness to hyperstimulation in women selected for IVF with unilateral unoperated endometriomas. The main aim of this study was to compare the number of developing follicles in the affected ovary with that in the contralateral intact gonad as a control. METHODS Patients selected for IVF who were diagnosed with one or more monolateral endometriomas (diameter <4 cm) and who did not undergo previous ovarian surgery were retrospectively identified. We compared the number of follicles (diameter ≥ 11 mm) and the number of co-dominant follicles (diameter >15 mm) on the day of hCG administration in the affected and intact ovaries. RESULTS Among the 84 women selected, the median interquartile range (IQR) number of follicles ≥ 11 mm in the affected and intact ovaries was 5 (3-7) and 5 (3-8), respectively (P= 0.36). The median (IQR) number of co-dominant follicles in the affected and intact ovaries was 3 (2-4) and 3 (2-5), respectively (P= 0.48). The number of co-dominant follicles was lower in the affected ovary in 36 cases (43%, 95% confidence interval: 32-53%). We also failed to identify any statistically significant difference between the two ovaries when evaluating data according to the number of cysts, their dimension, the dose of gonadotrophins used or the number of oocytes retrieved. CONCLUSIONS In women selected for IVF, the presence of an endometrioma does not markedly affect responsiveness to hyperstimulation.
Collapse
Affiliation(s)
- Laura Benaglia
- Department of Obstetrics, Gynecology and Neonatology , Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy
| | | | | | | | | | | |
Collapse
|
41
|
Roman H, Pura I, Tarta O, Mokdad C, Auber M, Bourdel N, Marpeau L, Sabourin JC. Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study. Fertil Steril 2010; 95:1853-6.e1-4. [PMID: 21168130 DOI: 10.1016/j.fertnstert.2010.11.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/13/2010] [Accepted: 11/11/2010] [Indexed: 10/18/2022]
Abstract
In ten ovarian endometriomas of diameter exceeding 30 mm, managed by complete vaporization of the inner surface using plasma energy followed by cystectomy, we performed histologic evaluation of the depth of necrosis and the effectiveness of endometrial tissue ablation. We observed that plasma energy allows the ablation of endometrial tissue with minimal damage to the ovarian parenchyma, which suggests that this technique might be of particular interest for women with risk factors of postoperative ovarian reserve impairment, such as recurrent and bilateral endometriomas.
Collapse
Affiliation(s)
- Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Mokdad C, Rozsnayi F, Delaunay F, Gregorczyk V, Auber M, Puscasiu L, Marpeau L, Roman H. Prise en charge chirurgicale des abcès tubo-ovariens compliquant une endométriose profonde. ACTA ACUST UNITED AC 2010; 38:490-5. [DOI: 10.1016/j.gyobfe.2010.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Indexed: 11/24/2022]
|