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Bila J, Dotlic J, Radjenovic SS, Vidakovic S, Tulic L, Micic J, Stojnic J, Babovic I, Dmitrovic A, Chiantera V, Laganà AS, Terzic M. Predictive Value of Basal Serum Progesterone for Successful IVF in Endometriosis Patients: The Need for a Personalized Approach. J Pers Med 2022; 12:jpm12101639. [PMID: 36294778 PMCID: PMC9605137 DOI: 10.3390/jpm12101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/02/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
The data regarding the role of progesterone (P4) in reproductive events of endometriosis patients are limited. This prospective study aimed to examine the predictive value of basal P4 serum levels for successful in vitro fertilization (IVF) in patients with primary infertility and endometriosis. The study included 73 patients divided according to endometriosis treatment (surgery vs. control—no treatment). The general data, basal hormonal status, and pregnancy rates were determined for every patient. Clinical pregnancy was achieved in 40.3% of patients, and more often in patients treated for endometriosis before IVF. The regression analysis showed that higher basal P4 serum levels were associated with achieving pregnancy through IVF. When regression was adjusted for the patient and IVF characteristics, higher basal P4 serum levels were associated with pregnancy achievement in both groups of women, along with the basal serum levels of FSH, LH, and AMH; EFI score; and stimulation protocol. The ROC analysis showed that the basal P4 serum level for successful IVF should be ≥0.7ng/mL. The basal P4 serum level cut-off for IVF success in endometriosis patients was determined for the first time. Constructed models for IVF success prediction emphasize the importance of determining the basal P4 serum levels for the personalized treatment of endometriosis-related infertility.
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Affiliation(s)
- Jovan Bila
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-361-5592; Fax: +381-11-361-5603
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Svetlana Spremovic Radjenovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Snezana Vidakovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Lidija Tulic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Jelena Micic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Jelena Stojnic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Ivana Babovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Aleksandar Dmitrovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Nur-Sultan 010000, Kazakhstan or
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, Corporate Fund “University Medical Center”, Turan Ave. 32, Nur-Sultan 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
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Zhao Y, Peng L, Li X, Zhang Y. Expression of somatostatin and its receptor 1-5 in endometriotic tissues and cells. Exp Ther Med 2018; 16:3777-3784. [PMID: 30405748 PMCID: PMC6201141 DOI: 10.3892/etm.2018.6730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/09/2018] [Indexed: 12/23/2022] Open
Abstract
The present study aimed to detect the expression of somatostatin (SS) and SS receptor (SSTR)1-5 in tissues from patients with endometriosis (EMS). Reverse transcription-quantitative polymerase chain reaction analysis was applied to examine the expression of somatostatin gene in ectopic endometrial cells (EECs). The expression of somatostatin receptor 1–5 in the ectopic endometrium (EE), eutopic endometrium and normal endometrium and their association with EMS staging were determined by immunohistochemistry. The results indicated that the expression of SS in EECs was significantly higher compared with that in the control group. SSTR1-5 were expressed in the EE tissues from 30 patients with EMS, and the positive rates were 43.3, 70.0, 53.3, 50.0 and 96.7%, respectively, which were closely associated with EMS staging of the patients. The positive rates of SSTR1-5 expression in the eutopic endometrium from 12 patients with EMS were 33.3, 41.7, 58.3, 58.3 and 83.3%, respectively, while the positive rates of SSTR1-5 expression in the normal endometrium from 14 women without EMS were 7.1, 7.1, 21.4, 28.6 and 64.3%, which were lower than the positive rates of SSTR1-5 in the EE (43.3, 70, 53.3, 50 and 96.7%) and eutopic endometrial cells (33.3, 41.7, 58.3, 58.3 and 83.3%). In conclusion, SS was highly expressed in EECs. SSTR1-5 were expressed in the ectopic as well as eutopic endometrium, and low or moderate expression of SSTR1-4 and high expression of SSTR5 were detected in the ectopic and eutopic endometrial tissues, while low expression of SSTR1-4 and partial expression of SSTR5 were detected in normal endometrium. The positive rates of expression of SSTR1-5 in the EE cells and eutopic endometrium were higher than those in the normal endometrium. The expression of all the subtypes of SSTR in the EE tissues was closely associated with EMS staging.
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Affiliation(s)
- Yanhua Zhao
- Department of Obstetrics and Gynecology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Lin Peng
- Reproductive and Stem Cell Research Institute, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Xiang Li
- Department of Pathology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Yi Zhang
- Department of Obstetrics and Gynecology, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
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Allègre L, Aristizabal P, Nyangoh Timoh K, Thomassin-Naggara I, Kermarrec E, Bendifallah S, Darai E. Comparison of 3-Tesla to 1.5-Tesla Magnetic Resonance Enterography to assess multifocal and multicentric bowel endometriosis: Results in routine practice. Eur J Obstet Gynecol Reprod Biol 2018; 230:172-177. [DOI: 10.1016/j.ejogrb.2018.09.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 01/07/2023]
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Bertocchi E, Barugola G, Benini M, Bocus P, Rossini R, Ceccaroni M, Ruffo G. Colorectal Anastomotic Stenosis: Lessons Learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2018; 26:100-104. [PMID: 29678755 DOI: 10.1016/j.jmig.2018.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE). DESIGN Retrospective analysis of a prospective database (Canadian Task Force classification III). SETTING Public medical center. PATIENTS All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016. INTERVENTION All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed. MEASUREMENTS AND MAIN RESULTS A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23-44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21-64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p = .01) and previous pelvic surgery (p = .002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation. CONCLUSION The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication.
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Affiliation(s)
- Elisa Bertocchi
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy.
| | - Giuliano Barugola
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marco Benini
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Paolo Bocus
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Roberto Rossini
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Gynecology, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Giacomo Ruffo
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
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Nyangoh Timoh K, Stewart Z, Benjoar M, Beldjord S, Ballester M, Bazot M, Thomassin-Naggara I, Darai E. Magnetic Resonance Enterography to Assess Multifocal and Multicentric Bowel Endometriosis. J Minim Invasive Gynecol 2017; 25:697-705. [PMID: 29158158 DOI: 10.1016/j.jmig.2017.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 01/16/2023]
Abstract
STUDY OBJECTIVE To prospectively determine the accuracy of magnetic resonance enterography (MRE) compared with conventional magnetic resonance imaging (MRI) for multifocal (i.e., multiple lesions affecting the same digestive segment) and multicentric (i.e., multiple lesions affecting several digestive segments) bowel endometriosis. DESIGN A prospective study (Canadian Task Force classification II-2). SETTING Tenon University Hospital, Paris, France. PATIENTS Patients with MRI-suspected colorectal endometriosis scheduled for colorectal resection from April 2014 to February 2016 were included. INTERVENTIONS Patients underwent both 1.5-Tesla MRI and MRE as well as laparoscopically assisted and open colorectal resections. MEASUREMENTS AND MAIN RESULTS The diagnostic performance of MRI and MRE was evaluated for sensitivity, specificity, positive and negative predictive values, accuracy, and positive and negative likelihood ratios (LRs). The interobserver variability of the experienced and junior radiologists was quantified using weighted statistics. Forty-seven patients were included. Twenty-two (46.8%) patients had unifocal lesions, 14 (30%) had multifocal lesions, and 11 (23.4%) had multicentric lesions. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multifocal lesions were 0.29 (6/21), 1.00 (23/24), 15.36, and 0.71 for MRI and 0.57 (12/21), 0.89 (23/25), 4.95, and 0.58 for MRE. The sensitivity, specificity, positive LR, and negative LR for the diagnosis of multicentric lesions were 0.18 (1/11), 1.00 (1/1), 15, and 0.80 for MRI and 0.46 (5/11), 0.92 (33/36), 5.45, and 0.60 for MRE. Lower accuracies for MRI compared with MRE to diagnose multicentric (p = .01) and multifocal lesions (p = .004) were noted. The interobserver agreement for MRE was good for both multifocality (κ = 0.80) and multicentricity (κ = 0.61). CONCLUSION MRE has better accuracy for diagnosing multifocal and multicentric bowel endometriosis than conventional MRI.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France
| | - Zelda Stewart
- Department of Obstetrics and Gynecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France
| | - Mikhael Benjoar
- Department of Radiology, University Pierre et Marie Curie, Paris, France
| | - Selma Beldjord
- Department of Radiology, University Pierre et Marie Curie, Paris, France
| | - Marcos Ballester
- Department of Obstetrics and Gynecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique 6, Centre Expert En Endométriose, University Pierre et Marie Curie, Paris, France; Unité Médicale de Recherche S938, University Pierre et Marie Curie, Paris, France
| | - Marc Bazot
- Department of Radiology, University Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique 6, Centre Expert En Endométriose, University Pierre et Marie Curie, Paris, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, University Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique 6, Centre Expert En Endométriose, University Pierre et Marie Curie, Paris, France
| | - Emile Darai
- Department of Obstetrics and Gynecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique 6, Centre Expert En Endométriose, University Pierre et Marie Curie, Paris, France; Unité Médicale de Recherche S938, University Pierre et Marie Curie, Paris, France.
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Non-ART pregnancy predictive factors in infertile patients with peritoneal superficial endometriosis. Eur J Obstet Gynecol Reprod Biol 2017; 211:182-187. [DOI: 10.1016/j.ejogrb.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/04/2017] [Indexed: 11/17/2022]
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Dienogest and deep infiltrating endometriosis: The remission of symptoms is not related to endometriosis nodule remission. Eur J Obstet Gynecol Reprod Biol 2017; 211:108-111. [PMID: 28231497 DOI: 10.1016/j.ejogrb.2017.02.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/13/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of dienogest in controlling pain caused by deep infiltrating endometriosis (DIE), its influence on the quality of live (QoL) of women affected by the disease, and the effect of the drug on the volume of endometriotic lesions. STUDY DESIGN A prospective cohort study including 30 women with a sonographic diagnosis of DIE (intestinal and posterior fornix) treated with dienogest 2mg per day for 12 months. We evaluated the pain symptoms and the volume of the intestinal and posterior fornix lesions before and after 12 months of use of dienogest. To perform the statistical analysis, we used the Wilcoxon signed-rank test, and the relationship between the data was tested using the Spearman correlation coefficient. RESULTS Women were on average 36.13±6.24years old. Pain symptoms most commonly reported were dyspareunia (83.3%), dysmenorrhea (73.3%), and pelvic pain (66.7%). After 12 months of treatment with dienogest, there was significant improvement of various symptoms (dyspareunia p=0.0093, dysmenorrhea p<0.0001; pelvic pain p=0.0007; and bowel pain p<0.0001), without a reduction in the volume of endometriotic nodules. There were significant improvements in the parameters that comprise the QoL (physical p<0.0001; p=0.0007 psychological) and the self-assessment of QoL (p=0.0069) and health (p=0.0001). CONCLUSION Dienogest is an effective medication to control symptoms of pain related to DIE, even without reducing the volume of DIE nodules.
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