1
|
Nakagawa I, Hirano M, Kishimoto R, Kayama A, Fujino T, Miyazaki Y, Suenaga A, Seto H, Ayabe T, Nagasaka K. Proposal for individual treatment by tubal occlusion factor based on the results of salpingoscopic salpingoplasty. J Obstet Gynaecol Res 2024; 50:1398-1401. [PMID: 38839109 DOI: 10.1111/jog.15993] [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: 02/07/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
AIM As a treatment for tubal infertility, falloposcopic tuboplasty (FT) is one of the options for patients who wish to conceive naturally. Based on the results of FT, we propose an appropriate time of transitioning to assisted reproductive technology (ART) for tubal infertility. OBJECTS AND METHODS We examined the outcomes of cases of tubal infertility during the period from June 1999 through March 2021 who were performed tuboplasty at our hospital using the FT catheter system under laparoscopy. RESULTS The number of treated cases was 828. There were 243 cases of endometriosis and 119 cases of genital chlamydial infection. By FT, 712 cases (86.0%) were successfully recanalized. Of the 712 cases, 189 conceived naturally (26.5%) and miscarriages were 23 cases (12.2%), ectopic pregnancies were 8 cases (4.2%). The mean duration from FT to pregnancy was 6.5 months in natural pregnancy group, 90% of them were pregnant within 14 months. In endometriosis cases, the pregnancy rate after FT did not change significantly among clinical stage. CONCLUSIONS Even when the fallopian tube was recanalized by FT, if the couple is unable to conceive naturally, they had better to consider switching to ART at about 14 months. When the couples with endometriosis consider switching to ART, we suggest deciding without considering the rASRM stage.
Collapse
Affiliation(s)
- Ippei Nakagawa
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mana Hirano
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Rintaro Kishimoto
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Akinori Kayama
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Fujino
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasundo Miyazaki
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Akihiko Suenaga
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Seto
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Takuya Ayabe
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazunori Nagasaka
- Department of Obstetrics and Gynecology, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Busnelli A, Di Simone N, Somigliana E, Greppi D, Cirillo F, Bulfoni A, Inversetti A, Levi-Setti PE. Untangling the independent effect of endometriosis, adenomyosis, and ART-related factors on maternal, placental, fetal, and neonatal adverse outcomes: results from a systematic review and meta-analysis. Hum Reprod Update 2024:dmae024. [PMID: 39049473 DOI: 10.1093/humupd/dmae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 05/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Women with endometriosis may constitute a group at a particularly increased risk of pregnancy-related complications. Furthermore, women selected for assisted reproductive technology (ART) are exposed to additional endocrinological and embryological factors that have been associated with adverse pregnancy outcomes. OBJECTIVE AND RATIONALE This study aimed to investigate the independent effect of endometriosis, adenomyosis, and various ART-related factors on adverse maternal, placental, fetal, and neonatal outcomes. SEARCH METHODS Published randomized controlled trials, cohort studies, and case-control studies were considered eligible. PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus were systematically searched up to 1 March 2024. This systematic review and meta-analysis was performed in line with the PRISMA and the MOOSE reporting guidelines. To thoroughly investigate the association between endometriosis/adenomyosis and adverse pregnancy outcomes, sub-analyses were conducted, whenever possible, according to: the method of conception (i.e. ART and non-ART conception), the endometriosis stage/phenotype, the coexistence of endometriosis and adenomyosis, any pre-pregnancy surgical treatment of endometriosis, and the form of adenomyosis. The odds ratio (OR) with 95% CI was used as effect measure. The quality of evidence was assessed using the GRADE approach. OUTCOMES We showed a higher risk of placenta previa in women with endometriosis compared to controls (34 studies, OR 2.84; 95% CI: 2.47, 3.26; I2 = 83%, moderate quality). The association was observed regardless of the method of conception and was particularly strong in the most severe forms of endometriosis (i.e. rASRM stage III-IV endometriosis and deep endometriosis (DE)) (OR 6.61; 95% CI: 2.08, 20.98; I2 = 66% and OR 14.54; 95% CI: 3.67, 57.67; I2 = 54%, respectively). We also showed an association, regardless of the method of conception, between endometriosis and: (i) preterm birth (PTB) (43 studies, OR 1.43; 95% CI: 1.32, 1.56; I2 = 89%, low quality) and (ii) cesarean section (29 studies, OR 1.52; 95% CI: 1.41, 1.63; I2 = 93%, low quality). The most severe forms of endometriosis were strongly associated with PTB. Two outcomes were associated with adenomyosis both in the main analysis and in the sub-analysis that included only ART pregnancies: (i) miscarriage (14 studies, OR 1.83; 95% CI: 1.53, 2.18; I2 = 72%, low quality) and (ii) pre-eclampsia (7 studies, OR 1.70; 95% CI: 1.16, 2.48; I2 = 77%, low quality). Regarding ART-related factors, the following associations were observed in the main analysis and confirmed in all sub-analyses conducted by pooling only risk estimates adjusted for covariates: (i) blastocyst stage embryo transfer (ET) and monozygotic twinning (28 studies, OR 2.05; 95% CI, 1.72, 2.45; I2 = 72%, low quality), (ii) frozen embryo transfer (FET) and (reduced risk of) small for gestational age (21 studies, OR 0.59; 95% CI, 0.57, 0.61; P < 0.00001; I2 = 17%, very low quality) and (increased risk of) large for gestational age (16 studies, OR 1.70; 95% CI, 1.60, 1.80; P < 0.00001; I2 = 55%, very low quality), (iii) artificial cycle (AC)-FET and pre-eclampsia (12 studies, OR 2.14; 95% CI: 1.91-2.39; I2 = 9%, low quality), PTB (21 studies, OR 1.24; 95% CI 1.15, 1.34; P < 0.0001; I2 = 50%, low quality), cesarean section (15 studies, OR 1.59; 95% CI 1.49, 1.70; P < 0.00001; I2 = 67%, very low quality) and post-partum hemorrhage (6 studies, OR 2.43; 95% CI 2.11, 2.81; P < 0.00001; I2 = 15%, very low quality). WIDER IMPLICATIONS Severe endometriosis (i.e. rASRM stage III-IV endometriosis, DE) constitutes a considerable risk factor for placenta previa and PTB. Herein, we recommend against superimposing on this condition other exposure factors that have a strong association with the same obstetric adverse outcome or with different outcomes which, if coexisting, could determine the onset of an ominous obstetric syndrome. Specifically, we strongly discourage the use of AC regimens for FET in ovulatory women with rASRM stage III-IV endometriosis or DE. We also recommend single ET at the blastocyst stage in this high-risk population. REGISTRATION NUMBER CRD42023401428.
Collapse
Affiliation(s)
- Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi, Milano, Italy
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Dalia Greppi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Federico Cirillo
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandro Bulfoni
- Division of Obstetrics and Gynecology, Humanitas S. Pio X Hospital, Milan, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Obstetrics and Gynecology, Humanitas S. Pio X Hospital, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| |
Collapse
|
3
|
Dai Y, Luo H, Zhu L, Yang W, Xiang H, Shi Q, Jin P. Dysmenorrhea pattern in adolescences informing adult endometriosis. BMC Public Health 2024; 24:373. [PMID: 38317119 PMCID: PMC10840152 DOI: 10.1186/s12889-024-17825-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Endometriosis (EMs) is a chronic and progressive disease that, if diagnosed late, can lead to infertility and deep infiltrating endometriosis (DIE). Dysmenorrhea is the most prominent symptom of EMs. However, limited research exists on the specific correlation between dysmenorrhea patterns and EMs. Early prevention of EMs is essential to effectively manage the progression of the disease, and is best detected during adolescence. Our objective was to associate the development of EMs with dysmenorrhea patterns during adolescence and quantify the risk of adult EMs for adolescent girls, with the aim of supporting primary intervention strategy planning. METHODS This case-control study examined predictors for adult EMs based on dysmenorrhea patterns in adolescents. We collected 1,287 cases of 641 EMs and 646 healthy females regarding their basic demographic information, adolescent menstrual characteristics, adolescent dysmenorrheal patterns, and adolescent lifestyles. Age-matching (1-to-1) was employed to control for the confounding effect of age between the groups. Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression models were utilized to identify predictors for adult EMs. The predictive value of the model was evaluated using the area under the receiver operating characteristic curve (AUC) and the C-index, while Hosmer-Lemeshow Test assessed the goodness of fit of the model. Data from one additional cohort in Shenzhen hospitalized with EMs were used to external validation were analyzed. RESULTS Individuals who always experienced dysmenorrhea had a risk of adult endometriosis 18.874 (OR = 18.874; 95%CI = 10.309-34.555) times higher than those occasional dysmenorrhea, The risk of developing EMs was 5.257 times higher in those who experienced dysmenorrhea more than 12 months after menarche than in those who experienced dysmenorrhea less than 6 months after menarche (OR = 5.257, 95% CI = 3.343-8.266), AUC in the external validation cohort was 0.794(95%CI: 0.741-0.847). We further found that high-intensity physical activity and sun-sensitive skin of burning were influential factors in high-frequency dysmenorrhea. The AUC value for the internal evaluation of the model was 0.812 and the AUC value for the external validation was 0.794. CONCLUSION Our findings revealed that the frequency of dysmenorrhea during adolescence contributed to the development of adult endometriosis. The frequency and onset of dysmenorrhea in adolescence were promising predictors for adult EMs. Both internal and external validation proved the model's good predictive ability. TRIAL REGISTRATION http://www.chictr.org.cn/ , TRN: ChicTR2200060429, date of registration: 2022/06/01, retrospectively registered.
Collapse
Affiliation(s)
- Yu Dai
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Huangjin Luo
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, People's Republic of China
| | - Litong Zhu
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Weichun Yang
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Haishan Xiang
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China.
| | - Ping Jin
- Department of Gynecology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, Guangdong, People's Republic of China.
| |
Collapse
|
4
|
Nezhat C, Khoyloo F, Tsuei A, Armani E, Page B, Rduch T, Nezhat C. The Prevalence of Endometriosis in Patients with Unexplained Infertility. J Clin Med 2024; 13:444. [PMID: 38256580 PMCID: PMC11326441 DOI: 10.3390/jcm13020444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.
Collapse
Affiliation(s)
- Camran Nezhat
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Farrah Khoyloo
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Angie Tsuei
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Ellie Armani
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Barbara Page
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Thomas Rduch
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), CH-9014 St. Gallen, Switzerland
- Department of Gynecology and Obstetrics, Cantonal Hospital St. Gallen (KSSG), CH-9007 St. Gallen, Switzerland
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
| |
Collapse
|
5
|
Wu L, Huang X, Wang R, Li Y, Zhu H, Ouyang Y, Huang W. Increased Expression of TGF-β1 Contributes to the Downregulation of Progesterone Receptor Expression in the Eutopic Endometrium of Infertile Women with Minimal/Mild Endometriosis. Reprod Sci 2023; 30:3578-3589. [PMID: 37531067 DOI: 10.1007/s43032-023-01315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023]
Abstract
Endometriosis is a hormone-dependent disease associated with impaired immunoregulation. In our recent study, we have characterized the trascriptomic transformation of eutopic endometrium from patients with minimal/mild endometriosis and controls across the menstrual cycle. However, the regulatory mechanism of altered immune microenvironment in eutopic endometrial stromal cells (ESCs) remains unclear. Here, we want to explore the regulation of immune cell to progesterone resistance and endometrial receptivity in the eutopic ESCs by cytokine (TGF-β1), and to understand the effect of TGF-β1 on the decidualization of the eutopic ESCs. Primary culture of eutopic ESCs was performed to explore the effects of TGF-β1 on the expression of Smad and progesterone receptor (PR) and the in vitro decidualization. Additionally, co-immunoprecipitation (Co-IP) was used to explore the direct interaction between Smad and PR. We found an attenuate expression of PRB protein (p=0.026) after using TGF-β1 in eutopic ESCs, although the difference of PRA before and after treatment was not significant (p=0.678). Similarly, the results of qRT-PCR showed that the mRNA level of PR (p<0.001), PRB (p=0.003) and HOXA10 (p<0.001) decreased significantly after TGF-β1 treatment, but that increased (p<0.023, for all) after SB431542 treatment in the eutopic ESCs. Moreover, TGF-β1 has a negative effect on the in vitro decidualization of eutopic ESCs (p=0.003). And the group with treatment of both TGF-β1 and SB435142 in eutopic ESCs showed significant decidual-like changes with increased prolactin level (p=0.01). We did not observe any physical interaction between the PR and p-Smad3/Smad3 proteins by using Co-IP. By activating TGF-β/Smad signaling in eutopic ESCs, elevated TGF-β1 from CD45+ immune cells could attenuate expression of PR, and further decrease endometrial receptivity.
Collapse
Affiliation(s)
- Lukanxuan Wu
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xin Huang
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruiying Wang
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yujing Li
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huili Zhu
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yunwei Ouyang
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Wei Huang
- Department of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, 610041, Sichuan, China.
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
6
|
Sachs MK, Makieva S, Dedes I, Kalaitzopoulos DR, El-Hadad S, Xie M, Velasco A, Stiller R, Leeners B. Higher miscarriage rate in subfertile women with endometriosis receiving unbiopsied frozen-warmed single blastocyst transfers. Front Cell Dev Biol 2023; 11:1092994. [PMID: 37123402 PMCID: PMC10140404 DOI: 10.3389/fcell.2023.1092994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/07/2023] [Indexed: 05/02/2023] Open
Abstract
Background: Assisted reproductive technology treatment is recommended to overcome endometriosis-associated infertility but current evidence is controversial. Endometriosis is associated with lower antral follicle count (AFC) and oocyte yield but similar clinical outcomes compared to controls. Unaffected ovarian stimulation response and embryological outcomes but lower clinical pregnancy and live birth rates and higher miscarriage rates have been reported, implying direct impact on endometrial receptivity. With evidence emerging on the benefit of frozen-warmed and blastocyst stage transfer, we investigated ART outcomes in endometriosis using homogeneous case-control groups. Methods: This is a retrospective observational case-control study including n = 66 frozen-warmed unbiopsied single blastocyst transfers of patients with endometriosis and n = 96 of women exhibiting idiopathic sterility. All frozen-warmed transfers followed artificial endometrial preparation. Results: In control women, the mean number of oocytes recovered at oocyte pick up was higher compared to women with endometriosis (15.3 ± 7.1 vs. 12.7 ± 5.2, p = 0.025) but oocyte maturation index (mature oocytes/total oocytes at oocyte pick up) was significantly higher for endometriosis (48.2% vs. 34.0%, p = 0.005). The same was shown for the subgroup of 44 endometriosis patients after endometrioma surgery when compared with controls (49.1% vs. 34.0%, p = 0.014). Clinical pregnancy rate was not higher in endometriosis but was close to significance (47.0% vs. 32.3%, p = 0.059) while live birth rate was comparable (27.3% vs. 32.3%, p = 0.746). Miscarriage rate was higher in the endometriosis group (19.7% vs. 7.3%, p = 0.018). A significantly higher AFC was observed in the control group in comparison with the endometriosis group (16.3 ± 7.6 vs. 13.4 ± 7.0, p = 0.014). Live birth rate did not differ when comparing all endometriosis cases (p = 0.746), ASRM Stage I/II and Stage III/IV (p = 0.348 and p = 0.888) with the control group but the overall pregnancy rate was higher in ASRM Stage I/II (p = 0.034) and miscarriage rate was higher in ASRM Stage III/IV (p = 0.030) versus control. Conclusion: Blastocyst transfers in women with endometriosis originate from cycles with lower AFC but higher share of mature oocytes than in control women, suggesting that endometriosis might impair ovarian reserve but not stimulation response. A higher miscarriage rate, independent of blastocyst quality may be attributed to an impact of endometriosis on the endometrium beyond the timing of implantation.
Collapse
Affiliation(s)
- M. K. Sachs
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: M. K. Sachs,
| | - S. Makieva
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - I. Dedes
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - D. R. Kalaitzopoulos
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - S. El-Hadad
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - M. Xie
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - A. Velasco
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - R. Stiller
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - B. Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
7
|
Schliep KC, Farland LV, Pollack AZ, Buck Louis G, Stanford JB, Allen-Brady K, Varner MW, Kah K, Peterson CM. Endometriosis diagnosis, staging and typology and adverse pregnancy outcome history. Paediatr Perinat Epidemiol 2022; 36:771-781. [PMID: 35570746 PMCID: PMC9588543 DOI: 10.1111/ppe.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity. OBJECTIVES We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women. METHODS Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors. RESULTS Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes. CONCLUSIONS While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.
Collapse
Affiliation(s)
- Karen C. Schliep
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Anna Z. Pollack
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Germaine Buck Louis
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Kristina Allen-Brady
- Department of Internal Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Michael W. Varner
- Department of Obstetrics and Gynecology University of Utah Health, Salt Lake City, Utah, USA
| | - Kebba Kah
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - C. Matthew Peterson
- Department of Obstetrics and Gynecology University of Utah Health, Salt Lake City, Utah, USA
| |
Collapse
|
8
|
Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N. ESHRE guideline: endometriosis. Hum Reprod Open 2022; 2022:hoac009. [PMID: 35350465 PMCID: PMC8951218 DOI: 10.1093/hropen/hoac009] [Citation(s) in RCA: 417] [Impact Index Per Article: 208.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION How should endometriosis be diagnosed and managed based on the best available evidence from published literature? SUMMARY ANSWER The current guideline provides 109 recommendations on diagnosis, treatments for pain and infertility, management of disease recurrence, asymptomatic or extrapelvic disease, endometriosis in adolescents and postmenopausal women, prevention and the association with cancer. WHAT IS KNOWN ALREADY Endometriosis is a chronic condition with a plethora of presentations in terms of not only the occurrence of lesions, but also the presence of signs and symptoms. The most important symptoms include pain and infertility. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for development of ESHRE guidelines. After formulation of key questions by a group of experts, literature searches and assessments were performed. Papers published up to 1 December 2020 and written in English were included in the literature review. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed within specialist subgroups and then presented to the core guideline development group (GDG) until consensus was reached. A stakeholder review was organized after finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help clinicians to apply best care for women with endometriosis. Although studies mostly focus on women of reproductive age, the guideline also addresses endometriosis in adolescents and postmenopausal women. The guideline outlines the diagnostic process for endometriosis, which challenges laparoscopy and histology as gold standard diagnostic tests. The options for treatment of endometriosis-associated pain symptoms include analgesics, medical treatments and surgery. Non-pharmacological treatments are also discussed. For management of endometriosis-associated infertility, surgical treatment and/or medically assisted reproduction are feasible. While most of the more recent studies confirm previous ESHRE recommendations, there are five topics in which significant changes to recommendations were required and changes in clinical practice are to be expected. LIMITATIONS REASONS FOR CAUTION The guideline describes different management options but, based on existing evidence, no firm recommendations could be formulated on the most appropriate treatments. Also, for specific clinical issues, such as asymptomatic endometriosis or extrapelvic endometriosis, the evidence is too scarce to make evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in endometriosis care, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in endometriosis. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive payments. C.M.B. reports grants from Bayer Healthcare and the European Commission; Participation on a Data Safety Monitoring Board or Advisory Board with ObsEva (Data Safety Monitoring Group) and Myovant (Scientific Advisory Group). A.B. reports grants from FEMaLE executive board member and European Commission Horizon 2020 grant; consulting fees from Ethicon Endo Surgery, Medtronic; honoraria for lectures from Ethicon; and support for meeting attendance from Gedeon Richter; A.H. reports grants from MRC, NIHR, CSO, Roche Diagnostics, Astra Zeneca, Ferring; Consulting fees from Roche Diagnostics, Nordic Pharma, Chugai and Benevolent Al Bio Limited all paid to the institution; a pending patent on Serum endometriosis biomarker; he is also Chair of TSC for STOP-OHSS and CERM trials. O.H. reports consulting fees and speaker's fees from Gedeon Richter and Bayer AG; support for attending meetings from Gedeon-Richter, and leadership roles at the Finnish Society for Obstetrics and Gynecology and the Nordic federation of the societies of obstetrics and gynecology. L.K. reports consulting fees from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; honoraria for lectures from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; support for attending meetings from Gedeon Richter, AstraZeneca, Novartis, Dr KADE/Besins, Palleos Healthcare, Roche, Mithra; he also has a leadership role in the German Society of Gynecological Endocrinology (DGGEF). M.K. reports grants from French Foundation for Medical Research (FRM), Australian Ministry of Health, Medical Research Future Fund and French National Cancer Institute; support for meeting attendance from European Society for Gynaecological Endoscopy (ESGE), European Congress on Endometriosis (EEC) and ESHRE; She is an advisory Board Member, FEMaLe Project (Finding Endometriosis Using Machine Learning), Scientific Committee Chair for the French Foundation for Research on Endometriosis and Scientific Committee Chair for the ComPaRe-Endometriosis cohort. A.N. reports grants from Merck SA and Ferring; speaker fees from Merck SA and Ferring; support for meeting attendance from Merck SA; Participation on a Data Safety Monitoring Board or Advisory Board with Nordic Pharma and Merck SA; she also is a board member of medical advisory board, Endometriosis Society, the Netherlands (patients advocacy group) and an executive board member of the World Endometriosis Society. E.S. reports grants from National Institute for Health Research UK, Rosetrees Trust, Barts and the London Charity; Royalties from De Gruyter (book editor); consulting fees from Hologic; speakers fees from Hologic, Johnson & Johnson, Medtronic, Intuitive, Olympus and Karl Storz; Participation in the Medicines for Women's Health Expert Advisory Group with Medicines and Healthcare Products Regulatory Agency (MHRA); he is also Ambassador for the World Endometriosis Society. C.T. reports grants from Merck SA; Consulting fees from Gedeon Richter, Nordic Pharma and Merck SA; speaker fees from Merck SA, all paid to the institution; and support for meeting attendance from Ferring, Gedeon Richter and Merck SA. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (Full disclaimer available at www.eshre.eu/guidelines.).
Collapse
Affiliation(s)
- Christian M Becker
- Nuffield Department of Women’s and Reproductive Health, Endometriosis CaRe
Centre, University of Oxford, Oxford, UK
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Semmelweis University,
Budapest, Hungary
| | - Oskari Heikinheimo
- Department of Obstetrics & Gynecology, University of Helsinki and Helsinki
University Hospital, Helsinki, Finland
| | - Andrew Horne
- EXPPECT Centre for Endometriosis and Pelvic Pain, MRC Centre for Reproductive
Health, University of Edinburgh, Edinburgh, UK
| | - Femke Jansen
- EndoHome—Endometriosis Association Belgium, Belgium
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University Hospital
Muenster, Muenster, Germany
| | | | - Marina Kvaskoff
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy,
“Exposome and Heredity” Team, CESP, Villejuif, France
| | - Annemiek Nap
- Department of Gynaecology and Obstetrics, Radboudumc, Nijmegen,
The Netherlands
| | | | - Ertan Saridogan
- Department of Obstetrics and Gynaecology, University College London
Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women’s Health, University College
London, London, UK
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center,
University Hospitals Leuven, Leuven, Belgium
- Faculty of Medicine, Department of Development and Regeneration, LEERM (Lab of
Endometrium, Endometriosis and Reproductive Medicine), KU Leuven, Leuven,
Belgium
| | - Nehalennia van Hanegem
- Department of Reproductive Medicine and Gynecology, University Medical Center
Utrecht, Utrecht, The Netherlands
| | - Nicolas Vulliemoz
- Department of Woman Mother Child, Fertility Medicine and Gynaecological
Endocrinology, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology,
Strombeek-Bever, Belgium
| | | |
Collapse
|
9
|
Leuenberger J, Kohl Schwartz A, Geraedts K, Haeberlin F, Eberhard M, von Orelli S, Imesch P, Leeners B. Living with endometriosis: Comorbid pain disorders, characteristics of pain, and relevance for daily life. Eur J Pain 2022; 26:1021-1038. [PMID: 35184363 PMCID: PMC9306988 DOI: 10.1002/ejp.1926] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Methods Results Conclusions Significance
Collapse
Affiliation(s)
- J. Leuenberger
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - A.S. Kohl Schwartz
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - K. Geraedts
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - F. Haeberlin
- Cantonal Hospital St Gallen, Department of Gynecology and Obstetrics, St. Gallen, Rorschacherstrasse 501 9007 St. Gallen Switzerland
| | - M. Eberhard
- Cantonal Hospital Schaffhausen Department of Gynecology and Obstetrics Geissbergstrasse 81 8208 Schaffhausen Switzerland
| | - S. von Orelli
- Triemli Hospital Department of Gynecology and Obstetrics Birmensdorferstrasse 497 8063 Zürich Switzerland
| | - P. Imesch
- University Hospital Zurich Department of Gynecology Frauenklinikstrasse 10 8910 Zurich Switzerland
| | - B. Leeners
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| |
Collapse
|
10
|
Behbehani S, Suárez-Salvador E, Yi J, Buras M, Kosiorek H, Magrina J. Pregnancy Rates After Surgical Resection of Deep Infiltrating Endometriosis in Patients with Infertility: A Systematic Review and Meta-Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sadikah Behbehani
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Department of Obstetrics and Gynecology, University of California, Riverside, California, USA
| | - Elena Suárez-Salvador
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Hospital Valle de Hebron of the Universidad Autonoma Barcelona, Barcelona, Spain
| | - Johnny Yi
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Matthew Buras
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Heidi Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Javier Magrina
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| |
Collapse
|
11
|
Chen X, Zhou Y, Wu D, Shu C, Wu R, Li S, Huang Q, Shu J. Iron overload compromises preimplantation mouse embryo development. Reprod Toxicol 2021; 105:156-165. [PMID: 34481919 DOI: 10.1016/j.reprotox.2021.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
We and others have previously shown that abnormal pelvic environment plays an important role in the unexplained infertility of endometriosis. However, whether iron overload caused by ectopic periodic bleeding found in patients with endometriosis participates in endometriosis-associated reproductive failure is unknown. This study aimed to investigate effects of iron at level relevant to pelvic iron overload on the development of preimplantation mouse embryo. Two-cell embryos were collected, and cultured to blastocysts in G1/G2 medium supplemented with iron alone or in combination with iron chelator. The development rates, ATP level, mitochondrial membrane potential (MMP), reactive oxygen species level (ROS), and apoptotic and ferroptotic indices were compared between control and iron treatments across each specific developmental stage. Prolonged exposure to iron remarkably impaired early embryo development in vitro by hampering blastocyst formation (P < 0.001), which could be partly restored by iron chelator (P < 0.001). The arrest of embryo development was linked with iron-initiated mitochondrial dysfunction with reduction of ATP generation and MMP (P < 0.05 and P < 0.001, respectively). Impaired mitochondria altered ROS accumulation post-iron exposure at morula stage and blastocyst stage (P < 0.05). Moreover, Iron-exposed blastocyst stage embryos showed higher apoptotic and ferroptotic rates (P < 0.001 and P < 0.05, respectively). Our results highlight that pathologically relevant level of iron compromises preimplantation mouse embryo development by disrupting mitochondrial function and triggering both apoptosis and ferroptosis, which implicates that excess iron found in peritoneal fluid of women with endometriosis likely participates in endometriosis-associated reproductive failure.
Collapse
Affiliation(s)
- Xiaopan Chen
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China; Department of Genetic and Genomic Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China.
| | - Yier Zhou
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China
| | - Dandan Wu
- Department of Obstetrics, Zhejiang Hospital, Hangzhou 310012, China
| | - Chongyi Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China
| | - Ruifang Wu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China
| | - Shishi Li
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China
| | - Qiongxiao Huang
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China
| | - Jing Shu
- Reproductive Medicine Center, Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou 310058, China.
| |
Collapse
|
12
|
Che D, Fang Z, Mai H, Xu Y, Fu L, Zhou H, Zhang L, Pi L, Gu X. The lncRNA ANRIL Gene rs2151280 GG Genotype is Associated with Increased Susceptibility to Recurrent Miscarriage in a Southern Chinese Population. J Inflamm Res 2021; 14:2865-2872. [PMID: 34234511 PMCID: PMC8256094 DOI: 10.2147/jir.s304801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022] Open
Abstract
Background Genetic factors may play an important role in susceptibility to recurrent miscarriage. Some cardiovascular disease-related candidate genes have been shown to be associated with recurrent miscarriage. Long noncoding RNA ANRIL has been confirmed to be associated with susceptibility to various diseases, such as cardiovascular disease. However, it remains unclear whether the ANRIL gene polymorphism is related to recurrent miscarriage susceptibility. Methods Three ANRIL gene polymorphisms (rs2151280, rs1063192 and rs564398) were genotyped in 819 controls and 610 recurrent miscarriage patients through TaqMan real-time polymerase chain reaction. The odds ratios and 95% confidence intervals (CIs) were used to assess the strength of each association. Results Our results showed that the ANRIL rs2151280 GG genotype was associated with increased susceptibility to recurrent miscarriage (GG vs AA: adjusted OR=1.527, 95% CI=1.051–2.218, p=0.0262; GG vs AG/AA adjusted OR=1.460, 95% CI=1.021–2.089, p=0.0381). By combining the analysis of the risk genotypes in the three SNPs, we found that individuals with 2–3 risk genotypes had a significantly increased risk of recurrent miscarriage compared with those with a 0–1 risk genotype (adjusted OR=1.728, 95% CI=1.112–2.683, p=0.0149). This risk was more significant in subgroups of women less than 35–40 years of age and women with 2–3 miscarriages. Conclusion These results suggested that a specific SNP in the ANRIL gene may be associated with increased susceptibility to recurrent miscarriage in a southern Chinese population.
Collapse
Affiliation(s)
- Di Che
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhenzhen Fang
- Program of Molecular Medicine, Guangzhou Women and Children's Hospital, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hanran Mai
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yufen Xu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - LanYan Fu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Huazhong Zhou
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Linyuan Zhang
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lei Pi
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaoqiong Gu
- Department of Clinical Biological Resource Bank, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
13
|
Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4381346. [PMID: 33490243 PMCID: PMC7787757 DOI: 10.1155/2020/4381346] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022]
Abstract
Background In the past several years, there has been an increasing concern on miscarriage caused by endometriosis or adenomyosis. However, the results reported by different studies remain controversial. The present study is aimed at assessing the impact of endometriosis and adenomyosis on miscarriage. Materials and Methods Searches were carried out in PubMed, Embase, and the Cochrane library for studies published from inception until February 29, 2020. The investigators included studies that evaluated miscarriage risk in pregnant women with endometriosis or adenomyosis by assisted reproductive technology (ART), or with spontaneous conception (SC). Miscarriage (<28 weeks) was the primary outcome. The secondary outcomes were antepartum hemorrhage (APH), postpartum hemorrhage (PPH), preterm birth, low birthweight, placenta praevia, placental abruption, ectopic pregnancy, stillbirth, gestational diabetes, preeclampsia, and intrauterine growth restriction (IUGR). Endnote was used for the study collection, and the data analyses were carried out by two authors using Review Manager version 5.2. Results Thirty-nine studies, which is comprised of 697,984 women, were included in the present study. Miscarriage risk increased in women with endometriosis in SC (OR: 1.81, 95% CI: 1.44-2.28, I2 = 96%) compared with those without endometriosis, while women with endometriosis who underwent ART had a similar miscarriage risk, when compared to those with tubal infertility (OR: 1.03, 95% CI: 0.92-1.14, I2 = 0%). Compared with those without adenomyosis, women with adenomyosis had an augmented miscarriage risk in ART (OR: 2.81, 95% CI: 1.44-5.47, I2 = 64%). Compared with those without endometriosis, women with endometriosis had higher odds of APH, PPH, preterm birth, stillbirth, and placenta praevia. No difference was observed in the incidence of ectopic pregnancy, placental abruption, pre-eclampsia, gestational diabetes, low birthweight, and IUGR. Conclusion Women with endometriosis had an augmented miscarriage risk in SC and a similar miscarriage risk during ART. Adenomyosis was associated with miscarriage in pregnant women using ART.
Collapse
|
14
|
Borisova AV, Konnon SRD, Tosto V, Gerli S, Radzinsky VE. Obstetrical complications and outcome in patients with endometriosis. J Matern Fetal Neonatal Med 2020; 35:2663-2677. [PMID: 32674641 DOI: 10.1080/14767058.2020.1793326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endometriosis is a disease that has a profound impact on the quality of life of women, due to the associated chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. However, even getting long-awaited pregnancy (often after assisted reproductive technologies), patients with endometriosis have a high risk of obstetric complications, such as miscarriage, preterm birth, preeclampsia, placental abnormalities, hemorrhage in labor, birth of small for gestational age infants, stillbirth and higher cesarean section rate. In addition, during pregnancy acute complications of endometriosis may occur, such as spontaneous hemoperitoneum, which is rare but life-threatening conditions that in most cases require surgical intervention. The mechanisms of the observed complications in pregnant women with endometriosis are not fully understood. This review presents literature data and personal considerations on the effect of endometriosis on pregnancy outcome and the occurrence of complications, as well as their possible underlined mechanisms. Based on this, we proposed ways to reduce the risk of obstetric complications in pregnant women with a history of endometriosis.
Collapse
Affiliation(s)
- Anna V Borisova
- Department of Obstetrics and Gynecology with the Course of Perinatology, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Setonde Romeo D Konnon
- Department of Obstetrics and Gynecology with the Course of Perinatology, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Valentina Tosto
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Sandro Gerli
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Viktor E Radzinsky
- Department of Obstetrics and Gynecology with the Course of Perinatology, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| |
Collapse
|
15
|
Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:592-632. [PMID: 31318420 DOI: 10.1093/humupd/dmz012] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The reproductive impact of adenomyosis and endometriosis is widely researched but the extent of these impacts remains elusive. It has been demonstrated that endometriosis, in particular, is known to result in subfertility but endometriosis and adenomyosis are increasingly linked to late pregnancy complications such as those caused by placental insufficiency. At the molecular level, the presence of ectopic endometrium perturbs the endometrial hormonal, cellular, and immunological milieu, negatively influencing decidualization, placentation, and developmental programming of the embryo. It is unclear if and how such early aberrant reproductive development relates to pregnancy outcomes in endometriosis and adenomyosis. OBJECTIVE AND RATIONALE The aims of this systematic review and meta-analysis were to (i) investigate the association of adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes of women through both assisted reproduction and natural conception and (ii) determine whether endometriosis disease subtypes have specific impacts on different stages of the reproductive process. SEARCH METHODS A systematic literature review of NHS evidence electronic databases and the Cochrane database identified all comparative and observational studies between 1980 and December 2018 in any language on adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes (23 search terms used). A total of 104 papers were selected for data extraction and meta-analysis, with use of Downs and Black standardized checklist to evaluate quality and bias. OUTCOMES We found that endometriosis consistently leads to reduced oocyte yield and a reduced fertilization rate (FR), in line with current evidence. Milder forms of endometriosis were most likely to affect the fertilization (FR OR 0.77, CI 0.63-0.93) and earlier implantation processes (implantation rate OR 0.76, CI 0.62-0.93). The more severe disease by American Society for Reproductive Medicine staging (ASRM III and IV) influenced all stages of reproduction. Ovarian endometriosis negatively affects the oocyte yield (MD -1.22, CI -1.96, -0.49) and number of mature oocytes (MD -2.24, CI -3.4, -1.09). We found an increased risk of miscarriage in both adenomyosis and endometriosis (OR 3.40, CI 1.41-8.65 and OR 1.30, CI 1.25-1.35, respectively), and endometriosis can be associated with a range of obstetric and fetal complications including preterm delivery (OR 1.38, CI 1.01-1.89), caesarean section delivery (OR 1.98 CI 1.64-2.38), and neonatal unit admission following delivery (OR 1.29, CI 1.07-1.55). WIDER IMPLICATIONS Adenomyosis and the subtypes of endometriosis may have specific complication profiles though further evidence is needed to be able to draw conclusions. Several known pregnancy complications are likely to be associated with these conditions. The complications are possibly caused by dysfunctional uterine changes leading to implantation and placentation issues and therefore could potentially have far-reaching consequences as suggested by Barker's hypothesis. Our findings would suggest that women with these conditions should ideally receive pre-natal counselling and should be considered higher risk in pregnancy and at delivery, until evidence to the contrary is available. In order to expand our knowledge of these conditions and better advise on future management of these patients in reproductive and maternal medicine, a more unified approach to studying fertility and reproductive outcomes with longer term follow-up of the offspring and attention to the subtype of disease is necessary.
Collapse
Affiliation(s)
- Joanne Horton
- University of Southampton, Human Development and Health, Southampton, UK.,University of Southampton, Complete Fertility, Princess Anne Hospital, Southampton, UK
| | - Monique Sterrenburg
- University of Sheffield, Academic Unit of Medical, Sheffield, UK.,University of Sheffield, Sheffield Teaching Hospitals NHS Foundation Trust, Obstetrics and Gynaecology, Sheffield, UK
| | - Simon Lane
- University of Southampton, Institute for Life Sciences, Southampton, UK
| | - Abha Maheshwari
- University of Aberdeen, Obstetrics and Gynaecology, Aberdeen, UK
| | - Tin Chiu Li
- Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Shatin, Hong Kong
| | - Ying Cheong
- University of Southampton, Human Development and Health, Southampton, UK.,University of Southampton, Complete Fertility, Princess Anne Hospital, Southampton, UK
| |
Collapse
|
16
|
Álvarez-Salvago F, Lara-Ramos A, Cantarero-Villanueva I, Mazheika M, Mundo-López A, Galiano-Castillo N, Fernández-Lao C, Arroyo-Morales M, Ocón-Hernández O, Artacho-Cordón F. Chronic Fatigue, Physical Impairments and Quality of Life in Women with Endometriosis: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3610. [PMID: 32455618 PMCID: PMC7277433 DOI: 10.3390/ijerph17103610] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/29/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022]
Abstract
AIM To explore endometriosis-related fatigue (ERF), health-related fitness, sleep quality, and health-related quality of life (HRQoL) in women with endometriosis in comparison with matched controls. METHODS Twenty-five affected women and twenty-five age and height-matched women without endometriosis were included. ERF was assessed through the Piper Fatigue Scale; health-related fitness was assessed through the Schöber, flamingo, and 6-min walking tests and dynamometry; and body composition was assessed through impedanciometry. Self-perceived physical fitness, sleep quality, and HRQoL were assessed through the International Fitness Scale, the Pittsburgh Sleep Quality Index, and the 12-item Short Form Health Survey, respectively. RESULTS Affected women exhibited higher levels of ERF than controls, increased fat mass, and physical deconditioning (reduced back strength, lumbar flexibility, body balance, and functional capacity, p-values < 0.050). Moreover, cases also had poorer perceived physical fitness, sleep quality, and HRQoL (p-value < 0.050). Finally, we observed deteriorated health-related fitness, sleep quality, and HRQoL in those women with endometriosis with higher levels of ERF. CONCLUSIONS This study constitutes the first evidence that women with endometriosis describe a generalized physical deconditioning, even more pronounced in affected women with higher levels of ERF. Further studies assessing the efficacy of rehabilitation interventions to face these physical impairments in women with endometriosis are warranted.
Collapse
Affiliation(s)
- Francisco Álvarez-Salvago
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Department of Physiotherapy, University of Granada, E-18016 Granada, Spain
| | - Ana Lara-Ramos
- Gynaecology and Obstetrics Unit, “Virgen de las Nieves” University Hospital, E-18014 Granada, Spain;
| | - Irene Cantarero-Villanueva
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Department of Physiotherapy, University of Granada, E-18016 Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
| | - Maryna Mazheika
- Department of Obstetrics and Gynaecology, University of Granada, E-18016 Granada, Spain;
| | | | - Noelia Galiano-Castillo
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Department of Physiotherapy, University of Granada, E-18016 Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
| | - Carolina Fernández-Lao
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Department of Physiotherapy, University of Granada, E-18016 Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
| | - Manuel Arroyo-Morales
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Department of Physiotherapy, University of Granada, E-18016 Granada, Spain
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
| | - Olga Ocón-Hernández
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
- Gynaecology and Obstetrics Unit, “San Cecilio” University Hospital, E-18016 Granada, Spain
| | - Francisco Artacho-Cordón
- “Cuídate” Support Unit for Oncology Patients (UAPO), Sport and Health University Research Institute (iMUDS), University of Granada, E-18016 Granada, Spain; (F.A.-S.); (I.C.-V.); (N.G.-C.); (C.F.-L.); (M.A.-M.)
- Biohealth Research Institute in Granada (ibs.GRANADA), E-18016 Granada, Spain;
- Department of Radiology and Physical Medicine, University of Granada, E-18016 Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28015 Madrid, Spain
| |
Collapse
|
17
|
Shared Molecular Features Linking Endometriosis and Obstetric Complications. Reprod Sci 2020; 27:1089-1096. [PMID: 32046439 DOI: 10.1007/s43032-019-00119-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
Recent epidemiological research has shown the increased risk of adverse pregnancy outcomes in women with endometriosis compared with the general population. The aim of this review is to explore common pathophysiologic mechanisms between endometriosis and obstetric complications. A computerized literature search was performed to identify relevant studies. The search covered the period between January 2008 and October 2018. One of the potential mechanisms driving the initiation and progression of endometriosis is the accumulation of a variety of epigenetic changes in endometrial cells. Epigenetic control of gene expression which is considered to be responsible for the development of endometriosis is commonly seen in patients with preeclampsia, small for gestational age (SGA), or preterm birth. DLX5 and GATA3, paternally imprinted genes, and CDKN1C, a maternally imprinted gene, were aberrantly expressed in placenta tissues of the preeclampsia; CDKN1C, the growth inhibitor gene, was upregulated in human SGA placentas; and hypomethylation of PTGER2 would be associated with preterm birth. Preeclampsia, SGA, or preterm birth may share common epigenetic alterations with endometriosis, which raises the possibility that the occurrence of two conditions might be nonrandom. To date, however, there is a lack of evidence that links endometriosis and other obstetric complications, such as postpartum hemorrhage or placental abruption, at the epigenetic level. In conclusion, epigenetic changes may be a common hallmark of two conditions: endometriosis and obstetrical complications, such as preeclampsia, SGA, or preterm birth.
Collapse
|
18
|
Endometriosis and Pregnancy: A Single Institution Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020401. [PMID: 31936225 PMCID: PMC7014217 DOI: 10.3390/ijerph17020401] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 12/17/2022]
Abstract
Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.
Collapse
|
19
|
A Relationship Between Endometriosis and Obstetric Complications. Reprod Sci 2020; 27:771-778. [DOI: 10.1007/s43032-019-00118-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/11/2019] [Indexed: 12/29/2022]
|
20
|
Alan M, Anğın A, Gun I, Alan Y, Sakin Ö, Çıkman M, Pirio Z, Başak K, Kale A, Kaygın P, Oğuztüzün S. The Effects of Leukocyte- and Platelet-Rich Plasma (L-Prp) and Pure Platelet-Rich Plasma (P-Prp) in a Rat Endometriosis Model. TROPICAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2020. [DOI: 10.4103/tjog.tjog_110_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
21
|
Fox CW, Savaris RF, Jeong JW, Kim TH, Miller PB, Likes CE, Schammel DP, Young SL, Lessey BA. Unexplained recurrent pregnancy loss and unexplained infertility: twins in disguise. Hum Reprod Open 2019; 2020:hoz021. [PMID: 36694811 PMCID: PMC9869655 DOI: 10.1093/hropen/hoz021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/07/2019] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Is B-cell CLL/lymphoma 6 (BCL6) endometrial expression, a surrogate biomarker of endometriosis, elevated in women with unexplained recurrent pregnancy loss (uRPL) and unexplained infertility (UI) compared to fertile subjects? SUMMARY ANSWER Endometrial BCL6 expression is elevated to a similar degree in women with uRPL and UI compared to fertile controls. WHAT IS KNOWN ALREADY Endometriosis has been linked to the genesis of endometrial progesterone resistance and to specific nuclear proteins, including endometrial BCL6. BCL6 overexpression (immune histologic score > 1.4) has been strongly associated with poor reproductive outcomes in IVF cycles in women with UI. Our previous data have demonstrated an accuracy of 94% for diagnosing endometriosis, and BCL6 protein is elevated in the decidua of women with uRPL. STUDY DESIGN SIZE DURATION In this case-control study, at a tertiary university teaching hospital, 110 samples (control n = 28; uRPL n = 29; UI n = 53) from pathological archives were analyzed. Timed endometrial biopsies were obtained between 2 January 2002 and 31 December 2016. PARTICIPANTS/MATERIALS SETTING METHOD LH-timed endometrial biopsies were obtained from women with UI, uRPL (two or more consecutive losses) and normal fertile subjects during the mid-secretory phase of the menstrual cycle. Endometrial BCL6 protein levels were compared in women with UI and uRPL and fertile controls using western blot analysis and immunohistochemistry (HSCORE). MAIN RESULTS AND THE ROLE OF CHANCE The mean age of the uRPL group was significantly higher than the others [mean (SD)] control = 32.7 (2.6); uRPL = 35.8 (3.7); UI = 32.7 (4.4); P = 0.002, ANOVA]. Seventy-nine percent of women in both subfertile groups (uRPL and UI, 65 out of 82) displayed elevated BCL6 protein levels. From these, a subset of cases with abnormal BCL6 went to laparoscopy and endometriosis was found in 9 out of 11 cases of uRPL and in 20 out of 21 cases of UI. Median BCL6 HSCORE for controls versus uRPL and UI was significantly different [median (interquartile); control = 0.3 (0.02 to 0.5); uRPL = 3 (1.9 to 3.6); UI = 2.9 (1.6 to 3.1); P < 0.0001, Kruskal-Wallis]. A significant trend in the association between the degree of infertility (fertile, uRPL and UI) and the HSCORE level (negative, medium and high) was found (P < 0.001; x 2 for trend). Western blot of representative samples from each group demonstrated similar findings based on protein levels in the whole endometrium. After running ANCOVA analysis for age difference, the BCL6 difference among groups was still significant (P-value < 0.0001). LIMITATIONS REASONS FOR CAUTION We studied subjects with two consecutive pregnancy losses rather than the definition adopted in Europe of three losses. The findings may lack external validity in other clinical settings (e.g. low prevalence of endometriosis). WIDER IMPLICATIONS OF THE FINDINGS Based on the data presented here, we postulate that the degree of BCL6 expression may represent a continuum of progesterone resistance and response to inflammation that occurs in women with endometriosis, yielding different degrees of infertility, from uRPL to UI. STUDY FUNDING/COMPETING INTERESTS This study was supported by NICHD/NIH R01 HD067721 (SLY and BAL), by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior: Grant 99999.003035/2015-08 (BAL) and by CAPES/PROAP (RFS). Two authors (BAL, SLY) have licensed intellectual property for the detection of endometriosis. Dr Bruce Lessey is an unpaid scientific Advisor for CiceroDx. The other authors report no conflict of interest.
Collapse
Affiliation(s)
- Chelsea W Fox
- University of San Diego, Department of Obstetrics and Gynecology, San Diego, CA, USA
| | - Ricardo F Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
| | - Jae-Wook Jeong
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Tae Hoon Kim
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI 49503, USA
| | - Paul B Miller
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - Creighton E Likes
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC 29605, USA
| | - David P Schammel
- Pathology Associates, Greenville Health System, Greenville, SC, USA
| | - Steven L Young
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Bruce A Lessey
- Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wake Forest Health, Winston-Salem, NC 27157, USA
| |
Collapse
|
22
|
Küpker W, Aizpurua J, Felberbaum RE. Endometriose und Fertilitätsprotektion – sinnvoll oder nicht? GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-019-0248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Likes CE, Cooper LJ, Efird J, Forstein DA, Miller PB, Savaris R, Lessey BA. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet 2019; 36:483-490. [PMID: 30610661 PMCID: PMC6439015 DOI: 10.1007/s10815-018-1388-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. METHODS All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. RESULTS Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. CONCLUSIONS Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.
Collapse
Affiliation(s)
- Creighton E Likes
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Leah J Cooper
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - Jessica Efird
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - David A Forstein
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Paul B Miller
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Ricardo Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-903, Brazil
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA.
| |
Collapse
|
24
|
Yang P, Wang Y, Wu Z, Pan N, Yan L, Ma C. Risk of miscarriage in women with endometriosis undergoing IVF fresh cycles: a retrospective cohort study. Reprod Biol Endocrinol 2019; 17:21. [PMID: 30755216 PMCID: PMC6371538 DOI: 10.1186/s12958-019-0463-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/31/2019] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Endometriosis is thought to affect the effectiveness of ART by an increased risk of miscarriage. We aimed to investigate the impact of endometriosis in women achieving singleton pregnancies through IVF fresh cycles and risk of miscarriage. METHODS This retrospective cohort study included all women undergoing a first IVF cycle and achieving singleton pregnancies after fresh embryo transfer in a tertiary university hospital reproductive medical center between January 2008 and June 2016. Women with endometriosis were compared with women with no endometriosis. Women in the endometriosis group were all with a history of laparoscopy or laparotomy for endometriosis and/or with ovarian endometrioma. The control group was matched 1:2 according to age and study period. RESULTS Among the cohort, we identified 1006 women with endometriosis as study group and 2012 unaffected women matched in a 1:2 ratios as control group. The miscarriage rate between women with and without endometriosis was similar (22.4 and 20.1%, P = 0.085). The odds ratio after adjusting for the risk factors for miscarriage was 1.14 (95% confidence interval 0.95-1.37). In the study group, the women with and without endometrioma did not show a significant risk of miscarriage, (19.8 and 23.8%, P = 0.152, OR 0.79, 95% CI 0.58-1.09). The miscarriage rate in women with endometrioma ≥30 mm (37.3 ± 7.1 mm) and < 30 mm (19.3 ± 5.5 mm) was not significantly different, (24.7 and 18.5%, P = 0.229, OR 1.44, 95% CI 0.79-2.63). After adjustment for risk factors for miscarriage, the presence of endometrioma and the size of endometrioma, regression model confirmed no significant increase for the risk of miscarriage in the subgroup analyses. CONCLUSIONS The risk of miscarriage did not statistically increase in women with endometriosis who achieved pregnancy through IVF fresh cycles.
Collapse
Affiliation(s)
- Puyu Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
| | - Yang Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Zhangxin Wu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Ningning Pan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian district, North garden road, No 49, Beijing, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
| |
Collapse
|
25
|
Sperschneider ML, Hengartner MP, Kohl-Schwartz A, Geraedts K, Rauchfuss M, Woelfler MM, Haeberlin F, von Orelli S, Eberhard M, Maurer F, Imthurn B, Imesch P, Leeners B. Does endometriosis affect professional life? A matched case-control study in Switzerland, Germany and Austria. BMJ Open 2019; 9:e019570. [PMID: 30782670 PMCID: PMC6340011 DOI: 10.1136/bmjopen-2017-019570] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Endometriosis is a gynaecological disease most commonly causing severe and chronic pelvic pain as well as an impaired quality of life. The aim of this study was to investigate if and how endometriosis affects choices regarding professional life as well as the quality of daily working life. DESIGN, SETTING AND PARTICIPANTS In the context of a multicentre case-control study, we collected data from 505 women with surgically/histologically confirmed diagnosis of endometriosis and 505 matched controls. Study participants were recruited prospectively in hospitals and doctors' practices in Switzerland, Germany and Austria. Using a detailed questionnaire, the study investigated work-life and career choices of study participants. MAIN OUTCOME MEASURES Associations between endometriosis/disease symptoms and limitations in career development as well as ability to work. RESULTS Women with endometriosis were less often able to work in their desired profession than women from the control group (adjusted OR=1.84, 95% CI: 1.15 to 2.94, R2=0.029, p=0.001) and they had to take health-related limitations into consideration in their career decisions to a significantly higher degree than women in the control group (OR=4.79, 95% CI: 2.30 to 9.96, R2=0.063, p<0.001). Among women with endometriosis, chronic pain was significantly associated with increased sick leave (OR=3.52, 95% CI: 2.02 to 6.13, R2=0.072, p<0.001) as well as with loss of productivity at work (OR=3.08, 95% CI: 2.11 to 4.50, R2=0.087, p<0.001). CONCLUSIONS Endometriosis is associated with impairment of professional life, in particular with regard to career choices. Further research to develop strategies to support endometriosis-affected women in realising professional opportunities is recommended. TRIAL REGISTRATION NUMBER NCT02511626; Pre-results.
Collapse
Affiliation(s)
- Marita Lina Sperschneider
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Department of Gynaecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Alexandra Kohl-Schwartz
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women’s Hospital, Bern, Switzerland
| | - Kirsten Geraedts
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | | | - Monika Martina Woelfler
- Department of Gynaecology, Endocrinology and Reproductive Medicine, Medical University Graz, Graz, Austria
| | - Felix Haeberlin
- Department of Gynaecology and Obstetrics, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Markus Eberhard
- Department of Gynaecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Franziska Maurer
- Department of Gynecology and Obstetrics, Canton Hospital Solothurn, Solothurn, UK
| | - Bruno Imthurn
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
26
|
Radzinsky VY, Orazov MR, Ivanov II, Khamoshina MB, Kostin IN, Kavteladze EV, Shustova VB. Implantation failures in women with infertility associated endometriosis. Gynecol Endocrinol 2019; 35:27-30. [PMID: 31532313 DOI: 10.1080/09513590.2019.1632089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Endometriosis is currently considered as one of the most common diseases associated with infertility. A controversial issue is whether endometriosis per se exerts a detrimental effect on IVF outcomes. Failure of implantation due to endometriosis-associated infertility is a contradictory and widely discussed burden nowadays. The purpose of the study is to assess the quality of embryos and implantation rate in women with infertility associated with endometriosis. The study included infertile reproductive aged women, between 26 and 40 years who underwent IVF and ICSI procedures. The patients were divided into two groups: group I (n = 70) involved 70 patients with recurrent unilateral endometriomas, II control group (n = 50) with tubal factor infertility. The quality of the retrieved embryos was assessed according to the generally accepted classification of Gardner, indicating the rate of implantation in each group. Embryo transfer was performed in case of high quality embryos. Assessing the ovarian reserve indicators, in the group I patients with recurrent unilateral endometriomas the serum level of AMH was significantly lower (2.1 ± 1.75 vs. 3.2 ± 1.4, p < .005), as well as the number of retrieved oocytes (8.1 ± 3.9 and 10.1 ± 6.8, p < .005). The analysis of the results demonstrated that the duration of stimulation in the group patients with recurrent unilateral endometriomas was significantly higher in comparison with the group II (12.2 ± 1.8 and 10.2 ± 1.6 days, p < .001). Nevertheless, the number of good quality embryos retrieved was comparable in both groups (2.2 ± 1.5 and 2.8 ± 1.8). In the group I patients with recurrent unilateral endometriomas, there was a statistically significant decrease of implantation rate (17.1% vs. 24% p < .005). The results of the study revealed no statistical difference in embryo quality in the study cohort. However, it is important to note that a statistically significant difference in implantation rate in the group of endometriosis-associated infertility compared was obtained 1.5 times lower than in the control group (15.8% vs. 24.0% p < .005). The achieved results demonstrated an adverse IVF outcome in infertile women with recurrent endometrioma compared to the control group.
Collapse
Affiliation(s)
- Victor Yevseyevich Radzinsky
- Department of Obstetrics and Gynecology with Course of Perinatology of the Medical Faculty, Medical Institute of the Russian University of Friendship of Peoples , Moscow , Russian Federation
| | - Mekan Rakhimberdievich Orazov
- Department of Obstetrics and Gynecology with Course of Perinatology of the Medical Faculty, Medical Institute of the Russian University of Friendship of Peoples , Moscow , Russian Federation
| | - Igor Isaakovich Ivanov
- Department of Obstetrics and Gynecology, Medical Academy Named S. I. Georgievskiy of Vernadsky Crimean Federal University , Simferopol , Republic of Crimea, Russian Federation
| | - Marina Borisovna Khamoshina
- Department of Obstetrics and Gynecology with Course of Perinatology of the Medical Faculty, Medical Institute of the Russian University of Friendship of Peoples , Moscow , Russian Federation
| | - Igor Nikolaevich Kostin
- Department of Obstetrics and Gynecology with Course of Perinatology of the Medical Faculty, Medical Institute of the Russian University of Friendship of Peoples , Moscow , Russian Federation
| | | | | |
Collapse
|
27
|
Schwartz ASK, Gross E, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Eberhard M, Imesch P, Imthurn B, Leeners B. The use of home remedies and complementary health approaches in endometriosis. Reprod Biomed Online 2018; 38:260-271. [PMID: 30612955 DOI: 10.1016/j.rbmo.2018.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 10/17/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
RESEARCH QUESTION Conventional treatments are often associated with adverse effects and endometriosis pain symptoms may reoccur despite treatment. Consequently, many women use complementary health approaches (CHA) and home remedies (HR) to relieve their pain. The aim of this study was to examine the frequency and the subjectively perceived efficacy of CHA/HR use by women affected by endometriosis. DESIGN Retrospective evaluation using medical charts and a questionnaire. Women recruited in hospitals and in self-help groups were asked about the use of 'topical heat', 'repose/relaxation', 'movement/massages', 'homeopathy/phytotherapy', 'acupuncture/traditional Chinese medicine (TCM)' and 'kinesiology/physiotherapy'. RESULTS From a total of 574 women with a confirmed diagnosis of endometriosis, 359 (62.5%) applied some form of CHA/HR. Women suffering from fatiguing disease symptoms more often selected alternative therapies (odds ratio [OR] 3.14, 95% confidence interval [CI] 1.39-7.11, P = 0.006) compared with women without these characteristics. Furthermore, women dissatisfied with healthcare provided by their treating physician, more frequently (OR 2.30, 95% CI 1.19-4.45, P = 0.013) chose the aforementioned alternative strategies. CONCLUSION As conventional therapies may not be sufficiently effective, women's needs should be closely examined, and individual treatment options should be discussed and initiated by clinicians to provide the best comprehensive treatment possible for endometriosis.
Collapse
Affiliation(s)
- Alexandra Sabrina Kohl Schwartz
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland; University Women's Hospital, Division of Gynecological Endocrinology and Reproductive Medicine, Bern 3010, Switzerland
| | - Elvira Gross
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Kirsten Geraedts
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, University Hospital, Department of Psychosomatics, Berlin 10117, Germany
| | - Monika Maria Wölfler
- University Hospital Graz, Department of Gynecology and Obstetrics, Graz 8036, Austria
| | - Felix Häberlin
- Canton Hospital St. Gallen, Department of Gynecology and Obstetrics, St. Gallen 9007, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zürich, Department of Gynecology and Obstetrics, Zürich 8036, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Department of Gynecology and Obstetrics, Schaffhausen 8208, Switzerland
| | - Patrick Imesch
- University Hospital Zürich, Department of Gynecology, Zürich 8910, Switzerland
| | - Bruno Imthurn
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland
| | - Brigitte Leeners
- University Hospital Zürich, Department of Reproductive Endocrinology, Zürich 8910, Switzerland.
| |
Collapse
|
28
|
Lukas I, Kohl-Schwartz A, Geraedts K, Rauchfuss M, Wölfler MM, Häberlin F, von Orelli S, Eberhard M, Imthurn B, Imesch P, Leeners B. Satisfaction with medical support in women with endometriosis. PLoS One 2018; 13:e0208023. [PMID: 30496315 PMCID: PMC6264517 DOI: 10.1371/journal.pone.0208023] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/11/2018] [Indexed: 12/17/2022] Open
Abstract
Endometriosis affects various aspects of women's lives. We searched for predictors for patient satisfaction with medical support (PSwMS) in women with endometriosis. The study was designed as a multi-centre retrospective cohort study. We approached women with histologically confirmed endometriosis from 2010 until 2016, comparing women satisfied to women dissatisfied with medical support. We analysed data on characteristics of endometriosis, PSwMS and the influence of disease characteristics on PSwMS. Information on satisfaction with medical support was collected through a standardized questionnaire. After exclusion of 73 women because of inchoately filled in questionnaires, data from 498 women was evaluated. Altogether, it was observed that 54.6% (n = 272) of the study participants were satisfied with medical support and 45.4% (n = 226) were not. Feeling adequately informed by the time of diagnosis (p < 0.001), taking women's mental troubles seriously (p < 0.001) and supporting women in handling their pain (p < 0.001) were significantly associated with satisfaction. We found adequate information to be the most distinctive indicator for PSwMS. Further, acknowledging psychological distress and supporting women in handling their symptoms rather than to alleviate them, positively affect PSwMS. To achieve PSwMS, healthcare providers have to give adequate information on endometriosis and its management.
Collapse
Affiliation(s)
- Ilona Lukas
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Kohl-Schwartz
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
- Division of Gynecological Endocrinology and Reproductive Medicines, University Women’s Hospital, Berne, Switzerland
| | - Kirsten Geraedts
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | | | - Monika M. Wölfler
- Department of Gynecology and Obstetrics, University Hospital Graz, Graz, Austria
| | - Felix Häberlin
- Department of Gynecology and Obstetrics, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Stephanie von Orelli
- Department of Gynecology and Obstetrics, Triemli Hospital Zurich, Zurich, Switzerland
| | - Markus Eberhard
- Department of Gynecology and Obstetrics, Canton Hospital Schaffhausen, Schaffhausen, Switzerland
| | - Bruno Imthurn
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Brigitte Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
29
|
Liebermann C, Kohl Schwartz AS, Charpidou T, Geraedts K, Rauchfuss M, Wölfler M, von Orelli S, Häberlin F, Eberhard M, Imesch P, Imthurn B, Leeners B. Maltreatment during childhood: a risk factor for the development of endometriosis? Hum Reprod 2018; 33:1449-1458. [DOI: 10.1093/humrep/dey111] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/15/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- C Liebermann
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - A S Kohl Schwartz
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
- Division of Gynaecologic Endocrinology and Reproductive Medicine, University Hospital Bern, Effingerstrasse 102, Bern, Switzerland
| | - T Charpidou
- Cantonal Hospital Baden, 5405 Baden, Im Ergel 1, Switzerland
| | - K Geraedts
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - M Rauchfuss
- Charité Berlin, University Hospital Berlin, Sauerbruchweg 5, Berlin, Germany
| | - M Wölfler
- Division of Gynaecological Endocrinology and Reproductive Medicine, Medical University of Graz, Auenbruggerplatz 1, Graz, Austria
| | - S von Orelli
- Triemli Hospital Zurich, Birmesdorferstrasse 497, Zurich, Switzerland
| | - F Häberlin
- Cantonal Hospital St. Gallen, Rorschacherstrasse 501, St. Gallen, Switzerland
| | - M Eberhard
- Cantonal Hospital Schaffhausen, Geissbergstrasse 81, Schaffhausen, Switzerland
| | - P Imesch
- Department of Gynaecology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - B Imthurn
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| | - B Leeners
- Department of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, Switzerland
| |
Collapse
|
30
|
Ramin-Wright A, Schwartz ASK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Imesch P, Fink D, Leeners B. Fatigue – a symptom in endometriosis. Hum Reprod 2018; 33:1459-1465. [DOI: 10.1093/humrep/dey115] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/20/2018] [Accepted: 05/13/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Annika Ramin-Wright
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Alexandra Sabrina Kohl Schwartz
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
- University Women’s Hospital, Division of Gynecological Endocrinology and Reproductive Medicines, Effingerstrasse 102, Bern, Switzerland
| | - Kirsten Geraedts
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, Dept of Psychosomatics, Sauerbruchweg 5, Berlin, Germany
| | - Monika Martina Wölfler
- University Hospital Graz, Dept of Gynecology and Obstetrics, Auenbruggerplatz 1, Graz, Austria
| | - Felix Haeberlin
- Canton Hospital St. Gallen, Dept of Gynecology and Obstetrics, St. Gallen, Rorschacherstrasse 501, St. Gallen, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zurich, Dept of Gynecology and Obstetrics, Birmesdorferstrasse 497, Zurich, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Dept of Gynecology and Obstetrics, Geissbergstrasse 81, Schaffhausen, Switzerland
| | - Bruno Imthurn
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Patrick Imesch
- University Hospital Zurich, Dept of Gynecology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Daniel Fink
- University Hospital Zurich, Dept of Gynecology, Frauenklinikstrasse 10, Zurich, Switzerland
| | - Brigitte Leeners
- University Hospital Zurich, Dept of Reproductive Endocrinology, Frauenklinikstrasse 10, Zurich, Switzerland
| |
Collapse
|
31
|
Hämmerli S, Kohl Schwartz AS, Geraedts K, Imesch P, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Leeners B. Does Endometriosis Affect Sexual Activity and Satisfaction of the Man Partner? A Comparison of Partners From Women Diagnosed With Endometriosis and Controls. J Sex Med 2018; 15:853-865. [DOI: 10.1016/j.jsxm.2018.03.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
|
32
|
Máté G, Bernstein LR, Török AL. Endometriosis Is a Cause of Infertility. Does Reactive Oxygen Damage to Gametes and Embryos Play a Key Role in the Pathogenesis of Infertility Caused by Endometriosis? Front Endocrinol (Lausanne) 2018; 9:725. [PMID: 30555421 PMCID: PMC6281964 DOI: 10.3389/fendo.2018.00725] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022] Open
Abstract
Approximately, 10-15% of women of reproductive age are affected by endometriosis, which often leads to infertility. Endometriosis often has an inherited component, and several causative predisposing factors are hypothesized to underlie the pathogenesis of endometriosis. One working hypothesis is the theory of retrograde menstruation. According to the theory of retrograde menstruation, components of refluxed blood, including apoptotic endometrial tissue, desquamated menstrual cells, lysed erythrocytes, and released iron, induce inflammation in the peritoneal cavity. This in turn activates macrophage release of reactive oxygen species (ROS), leading to oxidative stress via the respiratory burst. Refluxed blood promotes the Fenton reaction, terminating in the production of hydroxyl radical, the most potently destructive ROS. In this article, we review the papers that demonstrate decreased quantity and quality of oocytes and embryos retrieved from IVF/ICSI patients with endometriosis. We discuss literature data demonstrating that ROS are generated in endometriotic tissues that have physical proximity to gametes and embryos, and demonstrating adverse impacts on oocyte, sperm and embryo microtubule apparatus, chromosomes, and DNA. Data that addresses the notions that endometriosis causes oocyte and fetal aneuploidy and that these events are mediated by ROS species are also discussed. Literature data are also discussed that employ use of anti-oxidant molecules to evaluate the importance of ROS-mediated oxidative damage in the pathogenesis of endometriosis. Studies are discussed that have employed anti-oxidants compounds as therapeutics to improve oocyte and embryo quality in infertile subjects, and improve fertility in patients with endometriosis.
Collapse
Affiliation(s)
- Gábor Máté
- Pannon Reproduction Institute, Tapolca, Hungary
| | - Lori R. Bernstein
- Pregmama, LLC, Gaithersburg, MD, United States
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, United States
- Department of Veterinary Integrative Biosciences, Texas A&M College of Veterinary Medicine, College Station, TX, United States
| | - Attila L. Török
- Pannon Reproduction Institute, Tapolca, Hungary
- *Correspondence: Attila L. Török
| |
Collapse
|